Talked to max fac surgeon today. I'm freaking out :(

[Picollo30]

Hi guys

Talked to my surgeon today and came home full of doubts in my head, he scared me a bit to be honest, but i really want to go forward with this, fyi i'm 40, male, had a camouflage treatment for a class II retrognathia, i've been using braces for 5 years. I have retruded chin, and mandibular micrognathia also an obvious facial assymetry where my face is fuller on the left side and the right side is totally different.

Those are the aesthetic problems, then through a sleep study i found out i have severe OSAS and through ceph an airway of only 4 mm, the obvious reason for my sleep apnea problems, i'm not even fat, think its a family thing, my brother who looks like me has it too.
I have asthma, high blood pressure and now OSA which i think is the main cause of all my problems.

Started using C-PAP August last year because i was like a walking zombie through the whole day, i would sleep everywhere, watching a movie, reading a book, at work or even while driving.

C-PAP use has been terrible for me, adapting to it and the health problems it's giving me GERD (Gastroesophageal reflux disease), with symptoms like hearturn, regurgitation, pain in my chest and a burning sensation in my right lung, vomiting, respiratory problems,etc.

I decided i need to change something so i went to see this maxfac who gave me a MMA treatment plan consisting of BSSRO + Lefort I with impaction + CCW mandibular rotation. He made me take a ceph which i will attach in this post. This was last year

Today this how the conversation went

Surgeon: Are you sure you want to go trough this? What do you want to achieve, an aesthetic improvement or a cure for OSA_?

Me: Both if possible, cure of OSA and get the best aesthetic results possible with the surgery

Surgeon: I will be honest with you from the get go, there's a slight chance that your nose tip will become upturned and some forward projection that you might not like.

Me: How's that?

Surgeon: OSA treatment envolves bigger jaw movements, its technically more difficult for the surgeon, and has more risks and a more difficult recovery for patients. So it can happen, but it depends from person to person and the amount of impaction and also the amount of jaw advancement, although we will try to have a consensus decision-making and obviously minimize that outcome.

Me: Is the upturned nose caused by the amount of maxilla impaction?

Surgeon: Yes, its one of the risk associated with the treament for OSA.

Me: Are you going to perform a CCW or CW mandibular rotation?

Surgeon: For your case having OSA and having a steep oclusal plane and for best aesthetic results, CCW is recommended. With clockwise rotation you just would look "strange".

Me: How much will the jaws be surgically advanced in mm?

Surgeon: I need to see  a new ceph and orthopantomography and i need you to get a new dental mould before the surgery.


Guys is it normal for a doctor to ask these questions to a patient: if we are sure we want to go through it, talking about the upturned nose, unwanted prognathic appearance and other stuff that might happen.

I dont want to look like miss piggy, or worse having a chimp lip. will i look even worse than i look now? What are the odds of that happening and can blindness occur because of lefort?





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[molestrip]

No, it is not normal. My first surgeon pulled the same crap on me and it's caused a lot of problems. The surgeon is bringing up these doubts to protect his ass so that when you don't like the results you won't blame him. But he should also know that you're anxious and this is a serious health problem. He can communicate the tradeoffs in many lights without sending you into a spiral of worries. You should join our Facebook group for sleep apnea surgery. Search for "SSSS". I met a girl this week who has heart failure at 37 from OSA, yes most of your health problems stem from this and it likely will kill you by mid-age with a painful life unless you address it aggressively, better sooner than later.

[Picollo30]

do you know someone or is someone here who got an upturned nose after mma surgery? can it be fixed by the surgeon later on? Is it common?

@molestrip thing is i cant afford a top surgeon right now and this surgery is completely free throuh public health service. He is the director of the maxilo facial hospital department and he trained in the US.

What do you recommend me to do?

[Vic]

The surgeon doesn't sound confident in his ability to provide you with the outcome you want, so I wouldn't go with him at all. I've been advised about the upturn nose before but that's only with rotation of the maxilla, not a straight up impaction. Who's the surgeon and where's he based?

[Picollo30]

The surgeon doesn't sound confident in his ability to provide you with the outcome you want, so I wouldn't go with him at all. I've been advised about the upturn nose before but that's only with rotation of the maxilla, not a straight up impaction. Who's the surgeon and where's he based?

Dr. Rui Balhau Mendes he's based in Portugal. I asked him what would be better CCW or CW, and he said based on my steep profile, that CW would give me a bad aesthetic look. From what i understood he could give me a better look but wouldnt treat OSA or cure OSA with giving me the best aesthetic results possible .

Why would he accept doing the surgery then? he could have refused by saying he doesnt do CCW for example.

[Vic]

CW rotation of the mandible would make you more steeper and give you a longer face. If it was me I'd avoid him. Do you live in Portugal?

[Picollo30]

yes, i also contacted Alfaro in Spain but he doesnt do CCW rotation, maybe he is one of those old fashioned doctors that think ccw is too unstable to perform and dont evolve.