Cosmetic Jaw surgery

[anona_mz]

Are there any surgeons who would preform jaw surgery if you have a regular bite, and dentist and ortho both say you don't need it? I made the mistake of getting braces to help correct a slight crossbite that developed after my teeth shifted from getting a tooth pulled. I did the implant, then about a year later decided to get braces again to straighten my teeth. I contemplated jaw surgery before, but never felt like I really needed it until now. Both jaws seem to have been set back. Not sure if this is due to braces. I have had braces for about 2 1/2 years now. And almost finished with the contract and my bite and face seems to have gotten worse! My ortho straightened my "midline" and thats all he seems to be focused on. I have no lip support. My face feels short. I feel like I have the mouth of a very old lady. I hate my smile, my chubby cheeks, and thin lips. I know I have TMJ problems, lock jaw (which was the begining of all my dental problems), I grind my teeth, and my bite is/seems crooked. Would a surgeon be willing to take the risk since I'm not a Class II or Class III patient? My ortho and dentist are only focused on my teeth which for the most part are Class I in their eyes. But my smile is crooked. Worse then before, and I don't want to get my braces taken off and have all that money I spent go down the drain. I am really depressed because of this. Its almost like surgery, or death. Im sure many of you can relate.

[PloskoPlus]

Pictures: front, profile, serious, smiling. Block out your eyes if you want to.

[PloskoPlus]

For your age your tooth show is poor. Whether it's because you have a long upper lip or short face syndrome, it's hard to tell without a profile photo and lateral ceph. I think you have a maxillary cant too. Surgeons do operate in such cases - advancing both jaws horizontally, possibly downgrafting the upper jaw.

[anona_mz]

Thank you!! I have reasurance that its not just me and I dont have BDD. No one thinks anything is wrong and its frustrating me to the point of tears. I do think I have short face syndrome. I always leave my mouth slightly open to make up for it and push my lips out with my tongue, and I look normal. But when I smile, or clench my teeth together, ugh. I am so envious of people with nice big smiles. Anyways sorry for ranting I just called Arnett and Gunson today for a consult and found out they are booked for the year so Im kind of frustrated. I figure if anyone would operate on me, it would probably be them. Is it hard to find anyone who works on non-functional issues?

[PloskoPlus]

Arnett no longer operates. Only gunson. They can do a paper consult for you -  send them a ceph, quality photos of your face, bite, cast bite impressions and they will send you a surgical plan.

[Icy]

I wouldn't call your problems merely cosmetic at all! We have very similar issues, and my TMJ condition deteriorated quite rapidly over the last year, so it's very important to get that looked at. Short face and a deep bite usually go together from what I've seen, so at least you don't have to deal with that. I'm sure a competent orthodontist will be able to help you, if your current one is dismissing your issues. My first orthodontist was also just teeth focused and screwed me up horribly! Try find someone who is face focused, otherwise you'll be constantly disappointed.

[anona_mz]

Thank you Plasko! I will see about getting the paper consult with Gunson. It seems as if they are really busy. Also, I don't know if I really could afford them and was really hoping for the feed back you have given me as far as my face problems. I am hoping to find a surgeon who is more affordable. I think I would be a pretty simple case.

Thank you Icy for the feedback! Did you get any jaw surgery for your TMJ? If so, what were your procedures and are you happy with the results?
As far as Im concerned asthetically I cant get any worse so its worth the risk. I was thinking of just doing veneer to camoflouge my bite but due to the teeth grinding Id probably have to replace them alot. Also it wont solve my TMJ issues so probably would just be a waste of money and cost just as much as the surgery itself.

I live in a very small community and theres only 1 jaw surgeon within a couple hundred miles. I will have to travel to get it done since its not medically required. I dont want this inexperienced surgeon touching my face. I email Mcgann today since I read some pretty good things about him on this forum. I am also trying to schedule a phone consult with Dr Yafai who I found online while doing a google search. I really would like to have had this done yesterday but from what Ive read and so far knkw, this is going to be a long journey.

[Icy]

Thank you Plasko! I will see about getting the paper consult with Gunson. It seems as if they are really busy. Also, I don't know if I really could afford them and was really hoping for the feed back you have given me as far as my face problems. I am hoping to find a surgeon who is more affordable. I think I would be a pretty simple case.

Thank you Icy for the feedback! Did you get any jaw surgery for your TMJ? If so, what were your procedures and are you happy with the results?
As far as Im concerned asthetically I cant get any worse so its worth the risk. I was thinking of just doing veneer to camoflouge my bite but due to the teeth grinding Id probably have to replace them alot. Also it wont solve my TMJ issues so probably would just be a waste of money and cost just as much as the surgery itself.

I live in a very small community and theres only 1 jaw surgeon within a couple hundred miles. I will have to travel to get it done since its not medically required. I dont want this inexperienced surgeon touching my face. I email Mcgann today since I read some pretty good things about him on this forum. I am also trying to schedule a phone consult with Dr Yafai who I found online while doing a google search. I really would like to have had this done yesterday but from what Ive read and so far knkw, this is going to be a long journey.

I was scheduled to have the TMJ reconstruction and wisdom teeth removal this month, but due to bad pneumonia had to cancel, so we'll likely reschedule for September. For me, the deterioration is bad enough that there's no fixing it without surgery, so I'd get an MRI scan of the discs as soon as possible so they can really see what's going on and if you can avoid arthroplasty. I have uneven midline and asymmetry because my TMJ is so bad, I'm not sure if that applies to you but definitely try and find out if that's happening with you too, as in my case, my teeth are now ready for the corrective jaw surgery, but we can't proceed without fixing the TMJ first.

I greatly sympathise with your being in a small community, I attend university in a small town 10 hours away from my home, so I have to travel back and forth for appointments and consultations. Huge pain in the ass but what can we do? I also grind my teeth horribly by the way, as I understand it grinding is a symptom that can apparently be helped with the surgery, so I'm crossing fingers that it is resolved along with everything else. I really hope you find a good team, as I'm sure you're probably in the same boat of frustration that I've been in for the past few years. The last thing we need is incompetent doctors, on top of the threat of more damage to teeth and jaws!

[notrain]

it doesn't look like short face syndrome to me (no nasolabial folds) but you do have a class 3 jaw relationship and the maxilla seems to be the culprit (narrow, too far back).

You'd probably need widening of the upper jaw bone and a 3-4mm advancement to make things fit. The smile would also improve once the upper jaw becomes wider and is placed in a more forward position.

[PloskoPlus]

The problem with grinding is that it can cause a maxillary down graft to relapse. You may have to be on benzos after surgery

[PloskoPlus]

it doesn't look like short face syndrome to me (no nasolabial folds) but you do have a class 3 jaw relationship and the maxilla seems to be the culprit (narrow, too far back).

You'd probably need widening of the upper jaw bone and a 3-4mm advancement to make things fit. The smile would also improve once the upper jaw becomes wider and is placed in a more forward position.

I think you're right. But camouflaging class III? The orthodontist is some kind of sadist.

[anona_mz]

Icy, sorry your surgery date got pushed back. I could just imagine being so close only to have it postponed. . I have had isues with my jaw as far back as I can remember so I dont really know how bad it is. You bring up some very good points. My midline was off before this second round of braces. Im sure the TMJ has to do with it. My jaw constantly ache, but it has become the norm for me, Ive learned to deal with it. And your right about finding another ortho. My dentist highly regards my current ortho, and I think it will be difficult to find a asthetic minded ortho where I live. I may have to travel for that as well. Do you think I can go straight to surgery after consult (like schedule surgery, not actually the same day lol) since my teeth are basically straight? Or will they have to mess my teeth up again first? I know I screwed up and did everything backwards but I really wanted to try and avoid getting surgery. Now Ive made up my mind that surgery is the only way, and Im set on it.
Notrain I do have some nasolabial folds however I do think I have a normal amount. Its really prominent when I smile, and from certain angles. I took the pic with the vanity light on so its hard to tell without the shadows. If I were to take a pic in the direct sunlight you could see it better. However you may be right, its not that bad, but I do feel my face is maybe just a little on the short side. Ive always feel like it when my teeth are clenched together. Or maybe I just have to lose weight. Idk. And yes I agree with your assessment on the Class III jaw... My teeth have been flared out a little to cover the bottom teeth. Ortho says he doesnt have room in my mouth which to me is an indication that maybe I need to have my jaws widened?? However what he wants to do is shave my bottom teeth to make more room which I am highly against since I already have such a small mouth...
Thank you again Plasko for your insight. The knowledge of everyone on this forum is why I ultimately decided to post my issue and so far Im happy I took the plunge. I have been on this forum for the past couple of weeks at least trying to find similar cases and learn more about the process and if I would be a candidate for it. I am not worried about the cost, or the risks. I dont think my movements would be so great to have to worry too much. I really want to go with the best, but Ive read another post which said if the case isnt really that bad then most surgeons would be able to give good results, and for less $$. I do want the best possible outcome as Im sure everyone else does. Even if its just a small advancement I believe it will make a big difference for me.

[Icy]

Icy, sorry your surgery date got pushed back. I could just imagine being so close only to have it postponed. . I have had isues with my jaw as far back as I can remember so I dont really know how bad it is. You bring up some very good points. My midline was off before this second round of braces. Im sure the TMJ has to do with it. My jaw constantly ache, but it has become the norm for me, Ive learned to deal with it. And your right about finding another ortho. My dentist highly regards my current ortho, and I think it will be difficult to find a asthetic minded ortho where I live. I may have to travel for that as well. Do you think I can go straight to surgery after consult (like schedule surgery, not actually the same day lol) since my teeth are basically straight? Or will they have to mess my teeth up again first? I know I screwed up and did everything backwards but I really wanted to try and avoid getting surgery. Now Ive made up my mind that surgery is the only way, and Im set on it.
Notrain I do have some nasolabial folds however I do think I have a normal amount. Its really prominent when I smile, and from certain angles. I took the pic with the vanity light on so its hard to tell without the shadows. If I were to take a pic in the direct sunlight you could see it better. However you may be right, its not that bad, but I do feel my face is maybe just a little on the short side. Ive always feel like it when my teeth are clenched together. Or maybe I just have to lose weight. Idk. And yes I agree with your assessment on the Class III jaw... My teeth have been flared out a little to cover the bottom teeth. Ortho says he doesnt have room in my mouth which to me is an indication that maybe I need to have my jaws widened?? However what he wants to do is shave my bottom teeth to make more room which I am highly against since I already have such a small mouth...
Thank you again Plasko for your insight. The knowledge of everyone on this forum is why I ultimately decided to post my issue and so far Im happy I took the plunge. I have been on this forum for the past couple of weeks at least trying to find similar cases and learn more about the process and if I would be a candidate for it. I am not worried about the cost, or the risks. I dont think my movements would be so great to have to worry too much. I really want to go with the best, but Ive read another post which said if the case isnt really that bad then most surgeons would be able to give good results, and for less $$. I do want the best possible outcome as Im sure everyone else does. Even if its just a small advancement I believe it will make a big difference for me.

Yeah, it's been disappointing but I'm just taking it as best I can, can't risk my health for the sake of my teeth! I don't think you'll be able to proceed straight to surgery, you'll likely have to decompensate what your current orthodontist has done, so that your teeth will fit together properly after surgery in their new configuration - at least that's what my ortho said to quell my whining! I would definitely get a second opinion (or any expert opinion at all for that matter) on your TMJ, as pain and asymmetry are big red flags! You're essentially in the position I was in last September, all you need now is to find someone who will really listen to you and address your needs, I'm hoping that you don't have to wait too long!

[anona_mz]

Icy I feel you. Did your ortho refer you to your surgeon, or did you have to find one on your own? I just feel it's going to be harder to get all the xrays and molds needed without the cooperation of both my ortho and dentist. Its going to suck being braced for longer... I was hoping Id be able to get it over with already lol. If I just bring up my TMJ issues with the surgeon during consult, would he be able to adress those issues or would I have to see a specialist?
Its a frustrating process and I probably spent around $10k on my teeth already in the past few years trying to fix everything. Im so disappointed at the results so far and refuse to take my braces off until everything is good. My bf keeps telling my I dont need it, although he half-heartedly supports my decision. I know the financial burden as well as me going under the knife is what has him worried. But I wish he would just let me worry about all of that stuff. I really just need support and this is literally the only place Ive found it so far. Thanks all of you guys. Im greatful to have found this site and glad something like this exists. I wouldnt know what to do otherwise.

[Icy]

My ortho referred me to my surgeon, though I had actually consulted another surgeon before. He was pretty blunt and belittling and dismissed my concerns, but he thankfully referred me to my orthodontist. I'm not sure how it works where you live, but no dentist's referral was needed. We planned my treatment knowing that I was very open to surgery, but keeping in mind that it might not be needed, as my teeth had really been messed with in a bad way by orthodontist number 1, to the point that she wasn't sure exactly where I might end up when my teeth were restored to normal angles. When it became clear that braces alone could not fix my problem, the surgeon was called in. He's one of several surgeons she works with, and is really focused on TMJ issues and facial balance, so she really kept my concerns in mind when picking the surgeon, and that's definitely something you want to look for.
I look relatively normal to other people, and my boyfriend and family seem to struggle to support me because I don't look like I have a "deformity" in their minds, but in the end it's about what will make you feel more comfortable and happy! I also appreciate having this board as an outlet, because few people in your everyday life will understand how difficult it can be to go through this, sometimes multiple times! My housemate is fortunately also in the process of braces and surgery for her underbite - I even referred her to my ortho lol, and we often commiserate and b*tch about our troubles when it gets bad, but not many people are going to be able to understand this. Just keep what you need in mind and go for it as best as you can!