Upper jaw surgery (Lefort 1) for underbite.. HELP

[Kenziie_m]

First of all, HI EVERYONE! 

My name is McKenzie and I am 22 years old and from Canada. I have an underbite and have been concerned about it for as long as I can remember. I saw an orthodontist when I was around the age of 12, but he said there was nothing he could do until I was 18 and stopped growing at which point the treatment plan would be braces, followed by surgery to correct the jaw, and then braces.

So, a few years go by and I turn 18 and again see the orthodontist who refers me to the surgeon. This surgeon was awful, came in late with his shirt inside out. Was rude and when I asked about complications (numbness etc) he said "I think the statistics actually overestimate the risks, I rarely see anyone who has permanent numbness." He recommended double jaw surgery, however due to not liking him and being terrified I chose not to forgo treatment at this time.

Anyways, at 22 I began having other issues with my jaw such as popping and locking so I bite the bullet and meet again with the orthodontist who refers me to a new surgeon. This guy was nice and informative, had great bed side manner and I decided to undergo treatment. I am currently on month 1 of braces.

About a week ago, I met with my surgeon to hear my rough treatment plan (he said the treatment plan will likely change a lot during the course of braces). My first meeting with him he said it looked like I had an underdeveloped upper jaw but after looking at my x-rays he said that my lower jaw is actually overdeveloped and that my upper jaw is actually a little farther out than the average Caucasians.

However, he still wants to move my upper jaw 5 mm's forward and leave the lower jaw as is. He said that moving the lower jaw brings way more complications, and in recent time it has been discovered that people who have lower jaw surgery actually lose space in their airways and often develop sleep apnea. He also said that my jaw is positioned nicely and that studies have shown that people who have upper jaw surgery even with an overdeveloped lower jaw tend to be more attractive.

I have a slight cross bite (about half a tooth) and he said that it is up to me if I decide to fix that. My right jaw goes to the right a little but it is not noticeable and he does not think it is a concern. However, if I decide to he will fix it. I am just waiting to see where my teeth are positioned after braces.

I appreciate that he wants to do the surgery with as little risks as possible and this guy knows his stuff and I have heard nothing but positive things. However, I am a little worried about the upper jaw surgery. Anyone have their jaw advanced only who can put my mind at ease? I want to hear everything!

[PloskoPlus]

My surgeon advanced my upper jaw only and butchered my infraorbital nerve, totally wrecked it.

[notrain]

If you want advice on aesthetics, you're going to have to either post some pictures or a lateral cephalogram of your skull.

Your starting point dictates the treatment plan and as plosko stated, selecting the statistically safe approach doesn't mean that you will end up being fine individually compared to a riskier approach.

[PloskoPlus]

Do a paper consult with gunson.

[thinkingme]

Do a paper consult with gunson.

I think only upper jaw advancement can give best result. Ape face is like the best on women and this upper jaw advancement upturn ur nose a little.

[jusken]

I think you'd have to be crazy to advance the upper jaw.  Advancing the upper jaw will widen your nose and give you a more masculine appearance.  I wouldn't mess with something that looks good already.

Quick photoshop adjustment: without moving the upper jaw at all you look great (simpler is better imo):


I can't stress enough how upset you'd likely be with an only upper advancement procedure. 

[Lazlo]

You're one of those people who is going to have an amazing result. Now listen to me. If you're in Ontario just have your surgery done with Tocchio and it will be covered by OHIP. Don't go to the states or do multiple consults or whatever. You're an open/shut case you'll look GORGEOUS after your surgery as your nose will tip a bit more up, your cheeks will be full and your face proportioned. Seriously, don't worry about it. You'll save thousands just have it done in Toronto with Tochchio he's the best. I researched everyone in Canada.

[Lazlo]

I also concur just moving upper is the way to go. Definitely have this done, you need it and you'll be beautiful afterwards.

[PloskoPlus]

These things are very counterintuitive. Do a gunson paper consult.

[Lazlo]

well you don't lose too much having a consult with gunson, true. 500 bucks and the trip to Santa Barbara, but i mean it'll help your peace of mind i suppose. But I think Tocchio would follow the same plan. Though I'm not sure, if they decide on bi-max for your then gunson will do a CCW which not everyone follows precisely. But on the whole plosko plus is an outlier i think when it comes to nerve damage from a class 3 repair....

[PloskoPlus]

well you don't lose too much having a consult with gunson, true. 500 bucks and the trip to Santa Barbara, but i mean it'll help your peace of mind i suppose. But I think Tocchio would follow the same plan. Though I'm not sure, if they decide on bi-max for your then gunson will do a CCW which not everyone follows precisely. But on the whole plosko plus is an outlier i think when it comes to nerve damage from a class 3 repair....

Lol, that makes me feel so much better.  A gunson paper consult is not that much. They will ask for bite impressions to be sent over however.

[kjohnt]

I think you'd have to be crazy to advance the upper jaw.  Advancing the upper jaw will widen your nose and give you a more masculine appearance.  I wouldn't mess with something that looks good already.

I can't stress enough how upset you'd likely be with an only upper advancement procedure.

Dude you are totally incorrect.  It's obvious that she needs maxillary advancement.  The maxilla is clearly recessive.  A cephalometric tracing would confirm her brow extends horizontally almost as far as  if not father than her upper incisors, I guarantee it.

Nasolabial folds at rest, the nasal tip comes downward... both of these would change for the better with maxillary advancement.  Then add to the fact that mandibular shortening would 1) lead to less definition between the neck and jaws, and 2) bring the base of the tongue closer to the back of the throat thus eliminating airway space, this is a no-brainer.  Maxillary advancement all the way.

Kenziie_m - please do a googlg search of attractive side profiles, models actresses, etc.  Forward-projected faces are always best.  Please don't let anybody shorten your mandible.

[jusken]

Dude you are totally incorrect.  It's obvious that she needs maxillary advancement.  The maxilla is clearly recessive.  A cephalometric tracing would confirm her brow extends horizontally almost as far as  if not father than her upper incisors, I guarantee it.

Nasolabial folds at rest, the nasal tip comes downward... both of these would change for the better with maxillary advancement.  Then add to the fact that mandibular shortening would 1) lead to less definition between the neck and jaws, and 2) bring the base of the tongue closer to the back of the throat thus eliminating airway space, this is a no-brainer.  Maxillary advancement all the way.

Kenziie_m - please do a googlg search of attractive side profiles, models actresses, etc.  Forward-projected faces are always best.  Please don't let anybody shorten your mandible.

I was assuming either maxilla or mandible movement only.  Yes, the maxilla is probably slightly recessed (maybe 2-3mm), but that's crazy in my opinion to get a more complicated procedure for.  Facial balance is almost perfect looking at relationships (all we have is the photos).   

More advancement isn't always good, and in this case, it's clear to me that too much advancement would be bad.  Be careful with this decision Kenziee, I think a lot of people would regret 5mm advancement in your case.   Just want to get that out there, since a lot of people in here love advancement.

[PloskoPlus]

IMO balance is the key.  A single-jaw procedure sounds too good to be true, because, well... it is.  I know, I've been through this.  OP probably needs the maxilla advanced a little and the mandible set back a little.

[Rikenen]

you just need lefort 1 horizontal advancement. Open and shut case.

Best of luck!