Double jaw surgery needed? Pictures inside...

[TestNamePleaseIgnore]

Hello I posted here a while ago and asked the same kind of question but I forgot my username and password so I just created a new one. I didn't really get a whole lot of feedback so I figure I will try again. I have been really self conscious about my smile and wanting to fix my gummy smile for a long time now and realized the most appropriate treatment is jaw surgery. I saw a maxillofacial surgeon recently and he told me that I have vertical maxillary excess, mandibular prognathism, lip incompetence, and a flat chin. His proposed treatment plan consisted of impacting the maxilla ~5mm and moving it forward about 2mm, lower jaw setback, and possible genioplasty. Total for the surgery is right under 30k plus the hospital fee. My bite is OK, I had braces when I was younger but according to the maxillofacial surgeon, my orthodontist did what is called "camouflage" and hid my underbite. I currently have a class I maloclussion and I mouth breath exclusively at night even though I had a septoplasty a few years ago, I also have bad neck posture I guess due to mouth breathing. I really want this surgery to fix my gummy smile, shorten my face, and possibly open up my nasal airway. I really wanted to see what the projected outcome would be but he did not have that software. So my question to you guys is do you think it would be wise to spend the money for this type of surgery and do you think the results of the surgery would improve my smile/face? Thank you for the time to see my post. (1st picture is me with my jaws closed but my lips are relaxed, 2nd picture is same but facing forward)

[Bobbit]

To start with - -  you posted up one of the better sets of pictures that anybody has posted up in a long time.

Have you had a sleep study done ?

[TestNamePleaseIgnore]

To start with - -  you posted up one of the better sets of pictures that anybody has posted up in a long time.

Have you had a sleep study done ?

Oh thank you! I haven't had a sleep study done but im pretty sure i don't have sleep apnea but i do wake up with a bitterly dry mouth every morning which is a great way to start the day

[kjohnt]

My opinion -
1) You do not have mandibular prognathism; it is fine, though your occlusal plane is steep-ish.  I would not get mandibular setback.  That will help nothing and make everything worse.
2) Your ortho did not do any camouflage work that I can see.  Your bite looks good or close to good (can't tell if your incisors meet end-to-end or if the uppers properly cover the lowers when mouth is closed).  Probably braces with surgery and following to straighten teeth once again and fine tune bite.

I don't understand how this surgeon thinks he can move your maxilla forward and set back your mandible and have your teeth in a class I position when it appears they are there right now.  That doesn't make sense to me.

SO with that said, I think you should get maxillary impaction and leave your mandible alone if possible.  This would require slight CCW rotation so the swing of your mandible to cover the new space is such that your lower teeth properly align with your uppers (i.e. impact the front of the maxilla slightly more than the back).  This will help your chin projection and may mean you don't need genioplasty - it appears in your ceph lack of chin projection but I think it's due to straining the muscles to close your lips because I don't see the same in your profile pictures. 

Once the vertical maxillary length is addressed by shortening, I honestly think everything else will fall into place nicely.  If any advancement is done, I'd think it needs to be done equally so the occlusion stays class I.

Consult with another surgeon.

[TestNamePleaseIgnore]

My opinion -
1) You do not have mandibular prognathism; it is fine, though your occlusal plane is steep-ish.  I would not get mandibular setback.  That will help nothing and make everything worse.
2) Your ortho did not do any camouflage work that I can see.  Your bite looks good or close to good (can't tell if your incisors meet end-to-end or if the uppers properly cover the lowers when mouth is closed).  Probably braces with surgery and following to straighten teeth once again and fine tune bite.

I don't understand how this surgeon thinks he can move your maxilla forward and set back your mandible and have your teeth in a class I position when it appears they are there right now.  That doesn't make sense to me.

SO with that said, I think you should get maxillary impaction and leave your mandible alone if possible.  This would require slight CCW rotation so the swing of your mandible to cover the new space is such that your lower teeth properly align with your uppers (i.e. impact the front of the maxilla slightly more than the back).  This will help your chin projection and may mean you don't need genioplasty - it appears in your ceph lack of chin projection but I think it's due to straining the muscles to close your lips because I don't see the same in your profile pictures. 

Once the vertical maxillary length is addressed by shortening, I honestly think everything else will fall into place nicely.  If any advancement is done, I'd think it needs to be done equally so the occlusion stays class I.

Consult with another surgeon.

Thanks for the thorough assessment. I too thought I could get away with maxillary impaction but according to the surgeon the arc of rotation of my mandible, after maxillary impaction, would cause me to have the bulldog look so that is why he said I would need lower jaw setback. The way he described it, my ortho pulled my lower teeth inward to give me a false overbite. I actually have an edge to edge bite. Do you think its worth it to go thru with this kind of surgery?

[PloskoPlus]

Yes. Edge to edge bites are terrible.

[kjohnt]

Yes. Edge to edge bites are terrible.

But regarding the edge to edge bite, is the issue to be corrected via surgery or ortho?  Because it appears his molars meet as they should and the upper incisors could be flared outward more...

I feel like surgery would be more for impaction to take care of the gummy smile.

[TestNamePleaseIgnore]

Yes. Edge to edge bites are terrible.

Do you think I will look a lot different? I am hoping for a noticeably shorter face

[Vic]

Impaction will give you a shorter face