Author Topic: Which Surgical Procedures Might I Need?  (Read 6370 times)

kjohnt

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Which Surgical Procedures Might I Need?
« on: November 19, 2015, 11:00:43 AM »
Hello,

I'm new to the world of jaw surgery and have been searching various things online, but there is a lot of information and I'm hoping that I can explain my situation and have folks guide me regarding the possible procedures I may need (side note - I wish there were stickies which explained the various different types of jaw surgeries/procedures).

I had braces put on when I was 12 or 13 and wore them for a couple of years.  I wore cervical headgear (nighttime) during a portion of this time to "correct" my overbite.  My bite is now good, but I feel my jaw orientation leaves much to be desired.  I had no teeth removed aside from wisdom teeth.

It has been a depressing discovery process recently as I'm learning that my period of orthodontic work likely left me worse off.  The roof of my mouth is pretty deep.  I have occasional TMD pain on my left side, I believe I probably have sleep apnea but have yet to be tested, and I try to breathe through my nose but I feel as though I can get more air via my mouth and I find myself breathing through my mouth.  I mouth-breathe when sleeping.  Last but certainly not least, I feel I have a long-ish face and slightly recessed chin.  Before braces, I felt I was good-looking and constantly received attention from girls at school.  Since then, some consider me good-looking, but I've always known something was off.  At first I thought my nose was too big.  Then I realized my nose is good but it's actually my under-projecting chin which makes my nose appear larger.  Now I'm realizing it's the entire orientation of my jaws/face.  It's as though a regular face might look like this from the side profile "\" and mine slightly looks like this ")" if that makes any sense. 

To put another way, if I look forward an my teeth are perpendicular to the ground, my upper face slightly sits at this angle "\".  If I position my eyes and upper face so the middle of my line of sight is perpendicular to a wall, my lower face is recessed and sits slightly like this "/".

I'd think the corrective action would be to bring both jaws forward and then to somehow rotate them counter-clockwise (from the profile view of my right side) so they align with my upper face.  I think this would bring my everything into balance, including my chin.  It would also be nice if both jaws were wider.

At this point, it is definitely just an assumption on my part that I'd be a candidate for jaw surgery, but given what I've written here, which particular procedure(s) might I look into further?
« Last Edit: November 19, 2015, 11:57:56 AM by kjohnt »

kjohnt

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Re: Which Surgical Procedures Might I Need?
« Reply #1 on: November 19, 2015, 02:58:30 PM »
I think I was referring to my occlusal plane in my first post after reading some other threads.  Here's a picture of me, along with an edited copy showing to what I'm referring.  Am I on the right track here?

Please note that my head is in a slightly forward position here plus stretched on the right side of my face due to how I'm leaning, and I usually have a more "fleshy neck" appearance in photos and video due to what I believe is recessed jaws along with narrow jaw angles.



« Last Edit: November 20, 2015, 02:31:43 AM by kjohnt »

ForeverDet

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Re: Which Surgical Procedures Might I Need?
« Reply #2 on: November 19, 2015, 04:47:46 PM »
Okay from that pic, your profile looks great. The ")" your describing is not an actual denotofacial deformity. Can you post a relaxed pic of your face head on and your teeth biting down?

The TMJ pain is an issue if it worsens.

With that said, no one would ever look at your pictures and think you had any jaw issues. Because unless the pic is super misleading, everything looks normal and attractive.

Seriously question and not trying to minimize your concerns but is the primary reason your looking into surgery is for more attention from women and just wanting to be even more good looking?

You will find a lot of people with significant self-worth issues have a distorted perception of themselves (not saying you do)and when describing their facial problems, it's very vague and almost imaginary. I'm not saying it's just body dysmorphia or w/e diagnosis but it's a common occurrence on this types of forums. Still just so we can give you better feedback, post those pics and then see a maxillofacial surgereon to asses you.

kjohnt

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Re: Which Surgical Procedures Might I Need?
« Reply #3 on: November 20, 2015, 02:24:59 AM »
I don't think that's an accurate photo from which to assess.  I'm going to remove it after this post. 

I've added some photos to this one:  a) side, b) 3/4 profile, c) goofy photo trying to spread my lips with my jaws together so you can get an idea of my bite, and d) recent beard photo to show how I look with lower, wider jaw angles and chin projection.  My bite actually looks better than I thought it did.  I'd think anybody would agree my side profile looks way better with a beard (regardless of lighting) because it appears my upper and lower jaws are projected outward more than they really are.  Note that I'd left my chin whiskers longer for more vertical projection.

Any time I look down beyond horizontal in pictures or video I get that fleshy neck look about which I wrote in my first post.  I absolutely hate it.  I'm quite lean so it's not extra fat.

Regarding the psychological piece... man... I guess I don't know anymore.  I thought about it for a few hours before replying.  I work out a lot and make staying in good shape and good health a high priority.  I've felt for some time I'm more obsessed with how I/people look than others might be, but I've never actually deeply thought that perhaps my perception of myself is not reality.  That's an extremely difficult thing to think about.

Anyway, I do alright with women and am seeing somebody right now so this isn't necessarily all about that, though it is admittedly vanity for the greater part.  But I am concerned with my possible sleep apnea.  I've had a few people tell me they think I might have it, and I'm always extremely exhausted during the day.  But again, I work out a lot so it might just be that.  The TMD thing is mild and is really not much of a concern so I probably shouldn't have brought it up.  The dentist always asks me if my jaw joints give me trouble because he can feel abnormal movement or something, but I tell him it's okay for the most part and he never seems concerned beyond that.  Only a couple of times ever has my left joint caused more than mild pain/annoyance.

My thoughts which lead to most of my frustration -
I think going into the braces and headgear I was quite good looking, and afterward I looked kind of goofy.  I always assumed this had to do with puberty and genetics from my dad's side of the family, because he and my brother have similar facial structure to me.  But then I got to thinking... they both had braces in their teens too!  My dad has an older brother who is much better-looking with stronger-looking jaws and chin and and not as long of a face.  I need to ask if he ever had braces, because I'll bet he didn't.  Anyway, things got a little bit better for me in my later years as I matured into an adult.  But I still feel like I don't look the way I should have if I'd never had orthodontics and fixed the underbite correctly.  That's the part that really f**ks with me I suppose - that I could have looked better if I or my parents or dentist had known that I shouldn't go to an orthodontist who uses retractive methods to align teeth.

I guess I should be thankful that I didn't have had to deal with a lifelong underbite...

My next step is to find out if I have sleep apnea or not.  Then I'll consult with a maxillofacial surgeon as suggested.  Thanks for taking the time to read through this and provide input.
« Last Edit: December 01, 2015, 11:28:29 PM by kjohnt »

Icy

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Re: Which Surgical Procedures Might I Need?
« Reply #4 on: November 20, 2015, 08:04:38 AM »
I  have to say, without a frontal picture it's a bit difficult to tell whether your face is truly long or not. Interestingly enough your jaw structure looks similar to mine, though your chin is a bit more recessed. I'd check for sleep apnoea pronto, with recessed jaws it is more likely than not, particularly if headgear is involved! You don't look abnormal but I understand your frustrations because I have them too. Best advice anyone can give you is to see a reputable surgeon and go from there, just make sure your ortho is a good one too - I can't tell you what a difference it can make!!

molestrip

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Re: Which Surgical Procedures Might I Need?
« Reply #5 on: November 24, 2015, 09:16:55 AM »
Guys, this is the long face trap that many practitioners fall into. His face isn't leveled for the picture. People with long face syndrome typically tilt their heads up to level the profile, creating the illusion of normalcy. His pictures are still not very revealing but it looks to me like a slight overbite and I'd guess a small vertical discrepancy. His chin projection actually looks surprisingly normal if still recessed, usually it's deficient too. Could tell better from x-rays.

kjohnt

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Re: Which Surgical Procedures Might I Need?
« Reply #6 on: November 24, 2015, 11:24:57 PM »
I  have to say, without a frontal picture it's a bit difficult to tell whether your face is truly long or not. Interestingly enough your jaw structure looks similar to mine, though your chin is a bit more recessed. I'd check for sleep apnoea pronto, with recessed jaws it is more likely than not, particularly if headgear is involved! You don't look abnormal but I understand your frustrations because I have them too. Best advice anyone can give you is to see a reputable surgeon and go from there, just make sure your ortho is a good one too - I can't tell you what a difference it can make!!

Any resources on reputable surgeons by area?  I'd like a consultation at the very least after my sleep test.

I think you look decent. You have the kind of face I would like to have, lean, on the longer side and angular, whereas mine is wide, fat, short, 0 facial definition.

Personally I would never even consider surgery if I looked like you, but thats just me.

I appreciate the kind words, though I think we all notice our own flaws more than others.

Guys, this is the long face trap that many practitioners fall into. His face isn't leveled for the picture. People with long face syndrome typically tilt their heads up to level the profile, creating the illusion of normalcy. His pictures are still not very revealing but it looks to me like a slight overbite and I'd guess a small vertical discrepancy. His chin projection actually looks surprisingly normal if still recessed, usually it's deficient too. Could tell better from x-rays.

I tried to keep my head level.  I have a large forehead plus mildly receding hairline so that might be what you're seeing.  Or maybe I do tilt my head back... IDK. 

I do not have an overbite; you can tell by my picture in which I'm showing my teeth.  The problem is, I had an overbite.  My upper jaw was purposely retracted with cervical headgear as a young teenager as part of my orthodontic treatment.  The maxilla is held back so the mandible has a chance to catch up.  But bone growth must occur anyway, so the maxilla grows downward and backward instead of outward, which causes what you call "long face syndrome."  This is known is known as the "headgear effect" to orthotropic folks, and aside from the obvious aesthetic negatives, it can potentially come with all of the same adverse health effects folks write about on this forum: sleep apnea, TMD, tongue thrust, gummy smiles, bruxism, snoring, etc.

I also am a mouth-breather with bad tongue posture and am working on it.  Given my previous overbite, I believe this was occurring prior to my orthodontics and was undoubtedly exacerbated by them.

My orthodontist should have instead advanced my mandible, and should have expanded my jaws to be wider, both of which would have given me more room for my tongue and a flatter arch to my now narrow and deep palate.  But he didn't, and I need to move forward, because thinking about it pisses me off.

I've come to the conclusion that my aesthetic concerns could now be resolved with a bimaxillary advancement and maxillary impaction.  A sliding genioplasty done at the same time would help my chin projection and length, which in turn would help my labiomental fold to not be so prominent, but I'd be worried about it being overdone when used in conjunction with impaction since the impaction may help balance the chin a bit already once the mandible swings further up (counter-clockwise). 

Is it common or do patients ever get width added to their upper and lower jaws as part of bimax surgery?

Edit: perhaps I meant CCW rotation as opposed to impaction... not sure of the difference
« Last Edit: November 25, 2015, 12:21:14 AM by kjohnt »

ForeverDet

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Re: Which Surgical Procedures Might I Need?
« Reply #7 on: November 25, 2015, 03:31:55 PM »
I've come to the conclusion that my aesthetic concerns could now be resolved with a bimaxillary advancement and maxillary impaction.  A sliding genioplasty done at the same time would help my chin projection and length, which in turn would help my labiomental fold to not be so prominent, but I'd be worried about it being overdone when used in conjunction with impaction since the impaction may help balance the chin a bit already once the mandible swings further up (counter-clockwise).

I don't think you have long face syndrome (long in the lower third due to vertical maxillary excess rotating the lower jaw down/back) or if you do, it's mild. I had it and the usual earmarks for it... lip competence, severe lower jaw recession, gummy smile, etc, poor soft tissue support.

Your new photos clearly show some recession and I always recommend jaw surgery when significant and noticeable aesthetic deviation exists and/or functional impairments. I don't think you fit either category but I could be wrong.

Remember this though and I'm not saying this too scare you off double jaw surgery... if your main concern is improving your looks which is fine... if you have upper jaw surgery there is a strong possibility your nose will change for the worse as in widen. U Even with preventative techniques, it occurs although it's usually minimized. And then let's not forget the litany of other potential side effects (expect minor ones likely permanent partial numbness in small areas which is no big deal and small annoyance) which of course can be mostly eliminated with a competent and experienced surgeon. But just want to mention that.

Edit: perhaps I meant CCW rotation as opposed to impaction... not sure of the difference

CCW involved rotating the entire jaw complex in a counter clockwise fashion which usually involves impaction impaction of the front of the upper jaw and lowering of the back of the jaw which for steep occlusal planes, this would allow flattening to a normal degree and allow large advancement of the mandible in the horizontal plane. There's a good pic that was posted around here recently demonstrating it..

kjohnt

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Re: Which Surgical Procedures Might I Need?
« Reply #8 on: November 27, 2015, 03:08:49 PM »
A couple more questions -

1) I've read that a three-piece Lefort I widens the maxilla as well as forward projection.  What is the difference between the one-, two-, and three-piece Lefort I surgeries?  Specifically, are there any pictures/websites which show where the bone cuts are made for the various versions of the Lefort I?  I've been searching but keep finding pages on the differences between the Lefort I/II/III.

2) In cases in which maxillary expansion is needed, how is the lower jaw or lower teeth adjusted to compensate?  I.e. wouldn't the lower jaw need to be expanded as well so that the teeth would then still fit together?  This is obviously assuming both the upper and lower jaws are too narrow but fit together, as would occur with folks that have had braces as children.


PloskoPlus

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Re: Which Surgical Procedures Might I Need?
« Reply #9 on: November 27, 2015, 09:00:12 PM »
Lower arch may be widened with total subapical osteotomy. Very high rate of total numbness.

kjohnt

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Re: Which Surgical Procedures Might I Need?
« Reply #10 on: November 28, 2015, 12:04:47 AM »
Lower arch may be widened with total subapical osteotomy. Very high rate of total numbness.

Assuming this is not a procedure most would want, are the only candidates for upper palette expansion those who already have ideal lower arches?  Because if not, I'd think after upper palette expansion, the upper teeth would then be too wide for the lower teeth resulting in a bad bite?

PloskoPlus

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Re: Which Surgical Procedures Might I Need?
« Reply #11 on: November 28, 2015, 12:42:23 AM »
Assuming this is not a procedure most would want, are the only candidates for upper palette expansion those who already have ideal lower arches?  Because if not, I'd think after upper palette expansion, the upper teeth would then be too wide for the lower teeth resulting in a bad bite?
The only commonly done arch expansion surgery is the widening of the upper arch via SAPRE or a 3-piece lefort 1.  The upper arch being too narrow for the lower arch is actually quite common.
There is another procedure for widening the lower arch - surgically assisted mandibular expansion.


But like the total sub apical mandibular osteotomy, it is rarely done.

terry947

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Re: Which Surgical Procedures Might I Need?
« Reply #12 on: November 28, 2015, 12:51:27 AM »
^ kjohnt - I'm in the same situation. My lower arch isf narrow but I have a narrow upper arch. I want to expand it for tongue posture and better breathing but I can only expand so wide based on my lower arch. From what I read you can only expand the mandibular arch from slow expansion or distraction osteogenesis but you risk losing your front teeth form the D.O.

Schrödingers Jaw

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Re: Which Surgical Procedures Might I Need?
« Reply #13 on: November 28, 2015, 10:32:34 AM »
The only commonly done arch expansion surgery is the widening of the upper arch via SAPRE or a 3-piece lefort 1.  The upper arch being too narrow for the lower arch is actually quite common.
There is another procedure for widening the lower arch - surgically assisted mandibular expansion.


But like the total sub apical mandibular osteotomy, it is rarely done.

Why is it so uncommon though?

It seems like a shame as this could be very cosmetically beneficial for men. I would love a wider jaw myself but I am adverse to implants.

kjohnt

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Re: Which Surgical Procedures Might I Need?
« Reply #14 on: November 28, 2015, 11:57:41 AM »
Why is it so uncommon though?

It seems like a shame as this could be very cosmetically beneficial for men. I would love a wider jaw myself but I am adverse to implants.

I assumed it was also risky due to nerve damage.  Furthermore, it seems to me that this would have implications at the TMJs.

I think something people don't talk about is how weak mandibular angles (width from frontal facial view) are caused by inward curvature at the angles.  An operation to separate the angles from the mandible by cutting from the middle of the ramus to the middle of the mandibular body and reattaching after outward rotation and securing with hardware would be nice because, like jaw angle implants, it wouldn't affect the joints. BUt is probably not feasible given the masseter muscle and likely need to immobilize the jaw during recovery, so implants are more ideal (though obviously come with all of the complications of placing foreign material in your body). 

Personally, I figure if I can fix everything else I hate about my jaws, I can live with narrow jaw angles.