Author Topic: Am I a candidate for jaw surgery (honest opinion welcome)?  (Read 5578 times)

alexismg2

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Am I a candidate for jaw surgery (honest opinion welcome)?
« on: February 01, 2016, 06:45:58 PM »
Hey everyone, I'm a newbie to the forum. Nice to meet you! I came here today to get opinions from strangers because I feel real confused lately.

Long story short: I've always felt that my face was too long (its much longer than anyone's face I've ever come across who don't have underbites)) but I thought it was normal for some reason. Growing up I never once noticed anything, although I was bullied for having an unattractive face, but still didn't see anything wrong. Both my parents don't have the facial structure that I do, instead they have shorter rounder faces that look harmonious. About a year ago, I started noticing more prominent lines around my mouth area. I'm 22. But strangely, I didn't notice my mouth protrusion at all...which had been there for years. You would think I had because of looking in the mirror all my life but I never noticed. I just thought I was aging terribly due to stress and I started freaking out. When I got opinions from doctors on RealSelf's website about fixing the lines around the mouth, was told by three oral surgeons I would be a candidate for jaw surgery. I literally never once thought that my jaw looked out of place... seemed a tad bit long but I was fine with it. Some people have naturally long faces, except their face is balanced and mine doesn't look so balanced in photos.. Now that it's been pointed out, however, my confidence has went down the drain. I look back on photos after I hit puberty, and noticed when I turned 12 is when my face started growing in weird. Before that, it was the structure of my mom's face (short and round) and balanced.

When I visited a dentist last week to get a referral to an Oral surgeon (I live in NYC), I was looked at briefly for a minute by an oral surgeon and informed that Jaw surgery is reserved for people with very severe deformed faces and mouth issues, and that I looked fine/great but that he wouldn't know for sure on my situation without an xray. Then the dentist brought the Oral surgeon's assistant in the room (who wasn't as busy), where he examined me for 5 minutes and told me that he doesn't think I need jaw surgery...and that if he saw me on the street he wouldn't think I needed it. He also said I don't have an overbite and that my mouth protrusion is normal (although I wasn't born that way), and that braces won't fix my mouth protrusion but just straighten my teeth and fix the crowding. I left the dentist feeling very confused because they both acted like they didn't see any issues. I know my face isn't extremely deformed looking, and I don't have life threatening issues associated with my jaws but the fact is that my jaw did not grow properly, and I now hate my mouth area. I don't like going out anymore either. I never dated and I think it has alot to do with my face.   :'(

Never did xray, but have an appointment scheduled for February 17th with another oral surgeon where I plan to get xrays and see what's going on.

I was wondering just by looking at my pictures, do you think I would need jaw surgery or just braces for a few years? I heard something about extracting teeth and wearing braces until the mouth pushes back into the face. But since I don't have an overbite, I'm wondering if that would still work or not. I'm not really set on jaw surgery (yet) either as it seems like an aggressive way to treat the problem. Plus I'm not sure if insurance would even cover it (I have United Healthcare). One oral surgeon told me I have a 'bony problem' and only surgery can fix but I plan to find other options to fix this problem too, and then decide what should go down. Opinions from you guys are greatly appreciated. Thank you for reading!


(my mom's pictures are last 2 on bottom btw.....just to prove her facial structure is different from mine..)

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kjohnt

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Re: Am I a candidate for jaw surgery (honest opinion welcome)?
« Reply #1 on: February 01, 2016, 08:08:43 PM »
Yes. 

At the very least a sliding genioplasty to bring your chin forward.  But you have a steep mandibular plane so even without seeing your teeth I'm almost certain you have a steep occlusal plane.  You'd need counter-clockwise rotation to fix that (rotating entire jaw structure and plane of bite CCW if looking at your right side profile).  That would help bring the chin forward and shorten your midface.  You'd still need a sliding genioplasty though.

How's your bite?  Any overjet?  How much do your upper gums show when you smile?

alexismg2

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Re: Am I a candidate for jaw surgery (honest opinion welcome)?
« Reply #2 on: February 01, 2016, 09:11:25 PM »
Thank you for your response!

I have slightly crooked teeth, and when I smile my gums show normally. When I searched google images of overjets I did find something that looked similar to my mouth. I'll attach a pic. It looks similar except my teeth are crooked and I have crowding, and the dentist told me I'm a tooth grinder.

It doesn't look that severe to me. It's just that my gums protrude out of my face that really bothers me.

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kjohnt

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Re: Am I a candidate for jaw surgery (honest opinion welcome)?
« Reply #3 on: February 01, 2016, 11:58:45 PM »
That picture won't tell anybody anything.  t would have to be a model of your teeth.

If your upper front teeth stick out further than your lowers, you have a dental overjet.  If so, it could just be the teeth are tilted within their arches, but way more likely is your mandible didn't grow outward enough and would need surgical correction.  But I can't tell without pictures of your teeth, because your lower lip matches with your upper.

Also I'm almost certain you have a steep occlusal plane and would require CCW rotation.

alexismg2

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Re: Am I a candidate for jaw surgery (honest opinion welcome)?
« Reply #4 on: February 02, 2016, 07:56:02 AM »
Decided to post pics of teeth. Probably won't help much without an xray, but I plan to update this after the appointment in 2 weeks with xray photo. Just by then I'll see what's going on. I know nothing about steep occlusal plane but I think what you said is quite on point, kjohnt. Unsure if it fits the situation perfectly but sounds about there.

"Steep occlusal plane – this condition usually occurs in both jaws when present. When viewed from the side the occlusal planes of both jaws are steep, and the back teeth of both jaws are superior relative to the anterior teeth. The source of the steep occlusal plane is almost always a lack of jaw joint growth or regressive remodeling of the TMJs. The steep occlusal plane presents with severe chin recession, lack of throat length, and small retroglossal airway. Oft times these patients will develop obstructive sleep apnea (OSA) with aging and weight gain. Correction of facial and airway problems requires flattening of the occlusal plane with bimaxillary counterclockwise (CCW) jaw advancement. Many surgeons feel uncomfortable with CCW advancement stability and therefore avoid this procedure even though both facial and airway results are compromised when CCW is not utilized."


I'm not exactly clear what CCW rotation means, but I plan to look up more information. It sounds aggressive if many don't wanna perform it. I don't think I have sleep apnea, I don't snore, and I can breathe at night (I'm a nose breather).

Thanks again for your opinion, it did help!

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TMKA

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Re: Am I a candidate for jaw surgery (honest opinion welcome)?
« Reply #5 on: February 02, 2016, 10:25:26 AM »
My oral surgeon does ccw (counter-clockwise) orthognathic surgery regularly, but I live in Kentucky. You will have to have ccw in order to fix your jaws. Find a good orthodontist and go get records made. It will cost you some money (mine was $200), but it will give you xrays, graphs, drawings, before and after computer imaging, measurements, etc. It's the first step and well worth it (plus your surgeon will need to submit all this in order to get insurance to pay for the surgery. Unfortunately, they won't pay for the braces ).

You may get sleep apnea when you're older and if you pick up some weight if you don't get this corrected.

alexismg2

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Re: Am I a candidate for jaw surgery (honest opinion welcome)?
« Reply #6 on: February 02, 2016, 06:23:48 PM »
Dang $200?  :o Wish it was free!! Lol. I know oral surgeons do xrays (I think where I'm going there is no charge for an xray) but didn't know you had to pay for the graphs, drawings, computer imaging and measurements, etc. I know you may also have to pay for a sleep apnea test but doubt I have it so won't be getting tested. If paying for these things help get approval from the insurance company then it would be worth it to me, though. I need enough information to know how severe the problem is so I can discuss with surgeon, and see the best way to correct it. Hadn't even thought of this. Thank you for the advice TMKA. Just need to find a good orthodontist, which I'm looking into now. Never been to one of those.




TMKA

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Re: Am I a candidate for jaw surgery (honest opinion welcome)?
« Reply #7 on: February 03, 2016, 05:01:37 AM »
Dang $200?  :o Wish it was free!! Lol. I know oral surgeons do xrays (I think where I'm going there is no charge for an xray) but didn't know you had to pay for the graphs, drawings, computer imaging and measurements, etc. I know you may also have to pay for a sleep apnea test but doubt I have it so won't be getting tested. If paying for these things help get approval from the insurance company then it would be worth it to me, though. I need enough information to know how severe the problem is so I can discuss with surgeon, and see the best way to correct it. Hadn't even thought of this. Thank you for the advice TMKA. Just need to find a good orthodontist, which I'm looking into now. Never been to one of those.

You'll have to pay for your braces also, mine were $7000.

JimmyTheGent

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Re: Am I a candidate for jaw surgery (honest opinion welcome)?
« Reply #8 on: February 07, 2016, 03:08:44 PM »
My oral surgeon does ccw (counter-clockwise) orthognathic surgery regularly, but I live in Kentucky. You will have to have ccw in order to fix your jaws. Find a good orthodontist and go get records made. It will cost you some money (mine was $200), but it will give you xrays, graphs, drawings, before and after computer imaging, measurements, etc. It's the first step and well worth it (plus your surgeon will need to submit all this in order to get insurance to pay for the surgery. Unfortunately, they won't pay for the braces ).

You may get sleep apnea when you're older and if you pick up some weight if you don't get this corrected.


When you get the x-rays and stuff does the surgeon give you copies on a disk or thumb drive for second and third opinions?
The more I learn about the gamble that is jaw surgery the more afraid I become!!!   :-(

Bobbit

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Re: Am I a candidate for jaw surgery (honest opinion welcome)?
« Reply #9 on: February 07, 2016, 03:32:32 PM »

When you get the x-rays and stuff does the surgeon give you copies on a disk or thumb drive for second and third opinions?

Typically yes.   It may take special software (often on the disk) to see the images. 

kjohnt

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Re: Am I a candidate for jaw surgery (honest opinion welcome)?
« Reply #10 on: February 07, 2016, 04:49:36 PM »
I'd think any ortho will give a free consultation with cephalometric x rays, or at least mine did, but it was admittedly a weird circumstance since I was questioning my prior treatment.

alexismg2

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Re: Am I a candidate for jaw surgery (honest opinion welcome)?
« Reply #11 on: February 29, 2016, 11:10:19 AM »
Not that anyone cares, but just thought I'd update as mentioned. So I actually saw an oral surgeon and he told me that I look normal/fine. Was pretty shocked. He asked me if I had any bite problems, I said no. He asked me why I wanted jaw surgery and I told him my concerns. I said that my face is too long, my chin is weak and I have noticeable mouth protrusion. He told me it is all normal and that I don't need surgery, that he honestly couldn't see anything wrong with my face. I mentioned sleep apnea, and he said even if it were possible that I have sleep apnea, that surgery wouldn't address my aesthetic concerns because he would move my jaw forward, not backwards. Because my jaw is not recessed it would look worse as far as appearance goes, since my jaw is pushed out already. So since I didn't have any functional problems, he told me that he didn't want to xray me, and that if I wanted this surgery then I would have to pay out of pocket because insurance won't cover. There's no way IN HELL that I could afford what they charge in the US.

I was really bummed and even had to stop myself from crying in his office (pathetic I know). He dismissed anything about steep occlusal plane, and said there's no correlation between sleep disorders and a long jaw. Truthfully, I have been having breathing problems at night for the past few years, but was told it was just allergies so I take allergy meds, which don't really do much. I sleep on my side, never on my back. My mom IS a mouth breather, snores loud at night (has been for the past few years tho), and sleeps on her back. I have seen her breathing pause while she snores. I started observing her for the last two weeks and noticed this. She is a diabetic, suffers from daytime sleepiness and grinds teeth at night. That seems to match up with sleep apnea kinda, even though I'm not entirely sure yet. She is still very active during the day, though she's just tired and says she needs to get more rest. She did tell me her mother (my grandma) slept with her mouth open also.. My mouth hangs open when I rest at night, but only because my jaws are not lined up properly.

But even if this was a sure thing, that if my mom had sleep apnea and maybe it was being passed down, it still wouldn't help me surgery wise. If we both had it, we'd probably just get the cpap machine I guess.

Everybody seems to think that my face looks fine... except for my mom. At least she thinks it's not all in my head. When I post pictures of my profile online people say it looks not good, but in person people say I look good. I dislike how my face looks though. Nobody has the type of face that I do, my features are ok, just stretched out. And I would look sooooo much better if my mouth protrusion was non-existent. I obsess over it a lot. I'm not trying to become no supermodel....just want to look normal like other people. I want a face like my moms.

Anyway, I decided to look into traveling somewhere else outside of the United States. I already spoke with a South Korean surgeon (with quite good reviews). He reviewed my pictures, said I definitely need double jaw...although I could get ASO and just genioplasty but it wouldn't fix the long bone structure...and said the price for two-jaw surgery + genioplasty would be $11,000. Not bad. I'm not rich by any means but it's not impossible. I read something about jaw surgery in Costa Rica for a cheaper price, and I'm looking into that, plus other options.

I could go to a training center but there's only one that I know of in NYC, and this jaw surgeon has mixed reviews. I don't trust him based on what I read. Apparently he ruined someone's face, refused to fix it and they had to get it corrected by 3 other surgeons paying out of pocket. Yeah...no...not gonna happen to me. I know there may be training centers in other states but that would be a hassle to travel back and forth by train/bus/plane just to get this all done. I want a quick option...something that can be done fast. No back and forth, back and forth. Hopefully it can become reality eventually.

Just wanted to say thanks for your help. If I do somehow end up getting jaw surgery (even if it's a long time from now) I'll come back and post my after pictures.

  :-*

Picollo30

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Re: Am I a candidate for jaw surgery (honest opinion welcome)?
« Reply #12 on: March 29, 2017, 04:35:28 PM »
of course its not in your head. you need a ccw rotation. go see another maxilofacial surgeon and ask him for exams and sleep study.

you will also need a sliding genioplasty