I am not sure what to do!

[jmp62575]

I just found this blog, so I am brand new here.  I am a 39 year old male that lives in the Boston area.  I have an underbite, which is pretty severe.  I have been immensely self-conscious about it my whole life.  Today I went to Massachusetts General Hospital (MGH) Oral Surgery Department. http://www.massgeneral.org/omfs/ - I went for a consultation with a Dr. Lahey.  He gave me a short examination, asked some basic health questions, and gave me a high level overview of what was involved.  I really don't know if I want/can go through with it.  Any advice anyone can give me would be great.  Below are my concerns.
1) Braces - I know there is no way around them - but what 39 year old wants to walk around with metal braces for almost 3 years (I really don't know if I can get by the whole braces thing).  Are there alternatives that will work, I.E. ceramic, invisalign, incognito, etc. - I am finding mixed review.
2)I have been told I have borderline sleep apnea.  The Dr. wants me to see a specialist about it and confirm or deny apnea.  It may make a difference in the surgery.
3)They basically said the surgery and leading upto it is probably going to cost me $3000.  Does this sound right?  I have a decent Health insurance and also Delta Dental
4) Does anyone have any idea how much the braces will cost (this is not counting the above $3k)?
I realize every circumstance is different.  If anyone has any guestimates that would be great.
Most of all, SHOULD I DO THIS?  I am 39..am I too old for this considering I will be in my early 40's by the time this is done?  Am I going to feel better about myself?  Is it worth the money....I just don't know.
Thanks - Joe

[geijutsu]

Joe,

I hope that someone on this forum will shed some light on your first 4 questions, as experience is more important to answer those questions than simply reading about them.

But to address the last question, the only person who can really answer it is you. Ask yourself, are you willing to sacrifice a few years of your early forties with braces to fix your under bite problem? do you feel that changing your physical appearance for the better will improve your quality of life, or you self image? or are you content with continuing the rest of your life with an underbite? The answers to those kind of questions tend to come to us very fast before we allow the self doubting chatter creeping up on us.

[Gregor Samsa]

It's not that uncommon for adults to have braces. I was worried about it myself but most people are simply too self-obsessed to even notice and when they do notice they don't care anyway. If anyone asks you then you can just say that you need the braces to prepare for jaw surgery and that will be the end of it.

$3000 for surgery may or may not be a lot if you have insurance, but on the other hand there are people here who have to pay for the whole thing themselves and in those cases the cost can reach 20x of what you're faced with. There are many here who would be really happy to only have to pay $3000 for the surgery. The cost of braces can vary a great deal depending on the circumstances. Check with your insurance company if you're covered since the braces are required for your surgery and thus medically motivated.

[LoveofScotch]

Assuming you want to have this done...no, you're not too old. Are you in good health? Do you take good care of your body?

I say this with compassion, but get over the braces issue (unless you have a career where they will be problematic). Time tends to go quickly, and will pass regardless of what you choose to do.

If you do indeed have sleep apnea, surgery can really help! But like you mentioned it can also change your surgical plan. (The threat of a few years in braces pales in comparison to a lifetime of sporting that CPAP machine.)

Only paying $3000 for surgery is as good as it's gonna get, IMO.

For braces (I live in the U.S.), my quotes were generally between $7000-$10000. Not sure if that's normal or not?

I also have Delta Dental, and they won't touch any of the costs. Plans obviously vary, so you may have more luck with them.

Cheers!

[PloskoPlus]

Joe,

I just had upper jaw surgery for an underbite @ 37.5 a week ago. 

Braces - no-one cares.  Especially with an underbite you probably don't have much tooth show (at least before the operation, and post-op braces should be 6 months tops and you won't really care at that point).  And as they say, the smart won't mention it, the stupid won't notice it.  Get the normal braces, with maybe 6 ceramic ones over the top teeth - they are the ones most noticeable.  Normal braces move your teeth with the greatest speed and accuracy. Lingual braces take longer, are twice the price and are murder on your tongue. You might want to look for an ortho who uses SureSmile - supposedly this computer-assisted (works with any type of bracket) system moves teeth the fastest.  (Mind you the first ortho I consulted was a user, other orthos (and surgeons) told me it's a crutch for his incompetence.)

Surgery - if you can get away with upper jaw surgery alone, it should be much easier to recover from.  The older you are the more chance of persistent lower lip and/or chin numbness following lower jaw surgery.  Although people who have it say that after a while they simply don't notice it.

Good luck.
 

[jmp62575]

Thanks guys. 
@ geijutsu - I hear ya.  Its about me and what I want to do deep down.  To be honest I am hoping to hear....'I did it at your age and it was the best thing I ever did'

@ Gregor - You make good points!  I will see what the insurance company says - nothing ventured nothing gained.

@ Loveofscotch ( I love that name and I am also a scotch lover ...single malt preferably) anyway the answer to your questions is Yes.  The 3k pretty much takes care of the co-pays, little extra's that come with, items I am sure they know will not be covered by insurance.  I did some quick queries and the 7-10k is what I am seeing for braces

@PloskoPlus - You seem to have had a similar situation.  You make a very good point about how much of my teeth are seen - I never gave that much thought.

Some additional thoughts I had.  In seeing the Dr. and then his admin I really got the feeling it was more of a business then a true medical procedure.  But the MGH is a one of the most preeminent hospitals in the world - so they are not quite used car salesmen either.  The Dr. said they do about 1 a month there and have done 112 in about 10 years. 

Another though I have had is the braces are the longest part of the whole process.  Why can't they just perform the surgery without braces - If my teeth are not that crooked how bad can it be.  It almost make me think its a money making machine.  Everywhere I look no matter how good a persons teeth are - they want them to have braces.  Sorry for the whole conspiracy theory rant.
Of the whole process and procedure what was the worst and best part of the process for you all?
Thanks again,
Joe

[Cmonster]

1) Braces - Focus on finding a great orthodontist. This is probably more important than the type of braces you pop on. Is he/she understanding/accommodating. Will they explain what they are doing and work with you to find the best solution. Do they do great work?  This is what you should focus on. Before knowing this and looking at braces I met with maybe 4-5 orthos, no joke to get a feel for their process, how they handle patients, type of braces and so forth. I would also recommend NOT getting in braces if you plan on getting surgery till you have a surgeon you want to work with. You dont want to spend 2-3-4 years conducting the research process while your ortho has no guideline of how to move your teeth, you know?

3)Surgery can cost anything at this point. Till you've decided to work with an ortho and surgeon, its a shot in the dark. Are you looking to stay exclusively in network? Are you looking for experts in your field?
4) Braces can cost anywhere from 4-9k. It will depend on cost of braces in your area, treatment time, expertise of your ortho. Highest cost doesnt mean the best, just keep that in mind.

I say pursue it if you are very patient and willing to take a few, or a lot of bumps along the way. For some people this has been the best decision of their life, for others the absolute worst. There are a lot of risks involved, problems that can come up and so forth, its sugery, no two ways around it. People who have VERY serious breathing, jaw, bite, aesthetic problems in the hands of a competent surgeon stand to gain the most. People with very mild conditions, stand to possibly lose a lot more and hence a more difficult decision making process.

[jmp62575]

Cmonster,

Thanks for the feedback.  I started with an oral surgeon and he asked if I had an ortho (which I don't) he said he would work with any ortho.  He did give me a referral that his group works with.  I had a lot of questions for both him and the ortho after.  I sent them in and I am still waiting for some feedback.  Call it vanity but the ortho is my biggest problem at this stage in my life.  I'm 39 but do have a more significant under-bite than most.  I wish I had done this 20 years ago.  I know ask myself almost at mid-life is it worth it.  I am definitely at war with myself on this. 
Thanks again,
Joe

[PloskoPlus]

A recessed upper jaw is usually the biggest contributor to an underbite.  So typically these days they try to advance the maxilla more than set back the mandible (unless you're Asian, in which case they have to be more careful with upper jaw advancement).

A side benefit of this is basically a free facelift.  Puff up your upper lip, see how much it blows up.  Before my Le Fort 1 I could puff up my upper lip like a balloon.  Now - very little (OK, I'm only 3 weeks post-op, but still).   

[Alue]

Cmonster,

Thanks for the feedback.  I started with an oral surgeon and he asked if I had an ortho (which I don't) he said he would work with any ortho.  He did give me a referral that his group works with.  I had a lot of questions for both him and the ortho after.  I sent them in and I am still waiting for some feedback.  Call it vanity but the ortho is my biggest problem at this stage in my life.  I'm 39 but do have a more significant under-bite than most.  I wish I had done this 20 years ago.  I know ask myself almost at mid-life is it worth it.  I am definitely at war with myself on this. 
Thanks again,
Joe

I'm 29 and feeling the same way, wish I had done it 10 years ago.  How is your health otherwise?  If you are in good heath and can get insurance to cover it or at least part of it, I'd say go for it. 

[Alue]

People who have VERY serious breathing, jaw, bite, aesthetic problems in the hands of a competent surgeon stand to gain the most. People with very mild conditions, stand to possibly lose a lot more and hence a more difficult decision making process.

I agree with this statement. 

[jmp62575]

Thanks guys!  I am really kicking myself for hesitating.  I have some questions for the ortho and surgeon....I am hoping they can answer some of the questions before I make this huge decision.

[jmp62575]

So I went to see an ENT because I have borderline apnea.  The Dr. said I had Macroglossia.  He said that may be the cause of the underbite.  Anyone else here of this?

[molestrip]

I was told that 15 years ago as well. They don't tell me that today anymore. Now they say my jaws are just too small. They wanted to cut a keyhole sized chunk out of my tongue. Glad I didn't do that! OTOH, I might have discovered that I have severe sleep apnea if I'd gotten more opinions

[jmp62575]

Molestrip,
I know - I guess if they keep digging they will find anything they want.  Ya the tongue is going now where - according to my wife