Would you recommend surgery for me?

[Anna5]

Hello!
I am Anna and I am almost 40 years old and I have an open bite, unilateral crossbite, a bit of a misaligned jaw and many misaligned teeth (at least at the beginning of my treatment). The ortho recommended jaw surgery (SARPE and/or upper jaw surgery) for me, but I have declined this at first (too scared). Therefore we started with braces and the plan was to just see along the road whether surgery is still necessary or not.
I have been in braces for 18 months now. My ortho thinks I made great progress (better than he expected) and he doesn't think surgery is worth the risk anymore. My upper jaw is narrow, but not so narrow that he thinks it is worth doing SARPE (which he did recommend initially).I also consulted a surgeon and he thinks the same.
However, I am still feeling self conscious about my smile and I wonder whether I should I push more for surgery? I would love to hear your honest opinion about my smile....Do you think my smile looks fine from a cosmetic point of view or do you think it is definitely a surgery case? How obvious is my narrow jaw? How obvious is my off midline and the cant in my smile?  If I won't get surgery, I will get off my braces soon. Thank you very much for your input!

Greetings from Anna

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[Modigliani]

Oh wow, that's a really good result, surprisingly so!

Forget surgery and move on with your life would be my advice 

[treevernal]

You have made great progress with ortho alone it seems.  The upper jaw does not appear narrow at all but I do not know what the rest of your bite looks like.  If you were able to avoid surgery consider yourself lucky!

[Anna5]

Hello! Thanks for your kind replies. Maybe I should indeed call myself lucky! I just wish I weren't so self conscious about my teeth/ jaw....

Anyone else who wants to give his/her honest opinion? I appreciate this very much!

[notrain]

it looks like a class 1 malocclusion, meaning your face is mostly balanced.

aesthetically speaking, double jaw surgery would fix your midline (which is slightly off) and the yaw of your upper jaw. i doubt that it would significantly improve the way you look, so if that's what you are after i wouldn't do it.

[Anna5]

Thanks for your reply, notrain.
I think my ortho said I have a class II malloclusion (5 mm overjet),  but he didn't think it was severe.
You are right about the double jaw surgery. I consulted a surgeon and he said to correct my midline I would need double jaw surgery. But the surgeon doesn't want to do this, the risks far outweigh the benefits in his opinion, because he thinks my midline shift/ jaw deformity is too minor to warrant surgery.

However, I do have lip incompetence. Therefore, the surgeon suggested doing a genio, if myofacial exercises don't work. He wants to do the genio after my braces are off (if necessary).

[Optimistic]

Thanks for your reply, notrain.
I think my ortho said I have a class II malloclusion (5 mm overjet),  but he didn't think it was severe.
You are right about the double jaw surgery. I consulted a surgeon and he said to correct my midline I would need double jaw surgery. But the surgeon doesn't want to do this, the risks far outweigh the benefits in his opinion, because he thinks my midline shift/ jaw deformity is too minor to warrant surgery.

However, I do have lip incompetence. Therefore, the surgeon suggested doing a genio, if myofacial exercises don't work. He wants to do the genio after my braces are off (if necessary).

I don't agree with this.

In the right hands surgery has a very predictable outcome. If you're serious about improving aesthetics, smile, and occlusion then surgery is clearly your only option. Anything else is a compromise.

I wouldn't listen to either of them and simply ask yourself how important these are to you.

Note too that there are other factors outside of aforementioned: Stronger bone structure is better for ageing and recovery is truly not that long in the scheme of things.

[Alue]

it looks like a class 1 malocclusion, meaning your face is mostly balanced.

aesthetically speaking, double jaw surgery would fix your midline (which is slightly off) and the yaw of your upper jaw. i doubt that it would significantly improve the way you look, so if that's what you are after i wouldn't do it.

Jaw surgery won't always fix midline,  mine is off because the condiles are different lengths, but the surgeon said he wouldn't change that with surgery, the risks outweigh the rewards, and it would likely have a negative effect on functionality.  Orthodontically they can fix it by shaving the teeth and moving them one direction, but I honestly don't think it would be worth it.  Midline is no big deal if the jaws seats properly.   In my opinion it has little effect on appearance. 

To Anna5:  I don't think it seems necessary.  That being said, it doesn't hurt to get second opinions or to talk with a surgeon (not just an orthodontist).

[Anna5]

Thanks for your replies. I think I will go to another surgeon for a second opinion, that is surely a good idea!

[nrelax11]

Is your midline off or is it your nose? I mean for myself it looks like my midline is off, but my nose is actually just a little bit crooked making it look like my midline is off.

[Anna5]

Thanks for your reply. My ortho once said to me that my nose is indeed a bit crooked, but I cannot notice this myself. Maybe he just said that to justify that my midline is off. I definitely think my midline is off. To me it is very noticable, but maybe not too much for others?

[Anna5]

Any one else who wants to give his/her opinion? I appreciate this very much!

[Ginger]

You've had a fantastic result with braces alone. If it was me, I'd get the braces off and forget surgery 

[OrthodontistExpert]

Wow! Great orthodontics!
But your bite is not level...
You still need upper and lower jaw surgery

Maybe this video can help explain more about LeFort 1 and BSSO surgery. I use it to explain jaw surgery to my own orthodontic patients.

Surgery today is very benign in the hands of modern trained orthognathic surgeons. You should compliment your orthodontist on an excellent result, which means all you need is excellent surgery.
http://m.youtube.com/watch?v=bIivMIcwGhQ&list=PLjC4hIwmyQfjQWNkTyvRUV1iqKdaIAgjD

[Anna5]

Thank you for your very kind message, Ginger. Maybe you are right that I should forget surgery altogether. My ortho thinks the same!

Also thanks for your comments, orthodontistexpert. Although i can see what you mean and you are probably right, I am sorry to say that I find it hard to trust your advise that 'I need upper and lower jaw surgery' without even having seen my x-rays, profile, facial proportions etc. I saw you did the same with others here on this forum, just saying they need double jaw surgery, without having asked for the necessary information. I wonder whether real experts do this......

Anyway, I have decided to trust the 'real' experts : my ortho and surgeon, and maybe ask for a second opinion. They have all necessary information and can surely make the best judgement in my case.

But I definitely want to thank everybody for their input!