What surgeries do I need? [pics and xrays]

[ettubrute]

I personally think I need:
maxillary mandibular advancement, to correct recessed lower and upper jaw.
impaction - to correct open bite, gum show, and incompetent lips. also to reduce long face and create a larger airway
genioplasty - maybe, I'm not sure

My surgeon said I need:
lower jaw surgery
maybe upper jaw surgery (he said he's 20% sure)
initially thought I needed SARPE, but decided against it

I think my surgeon is mainly concerned with functionality. he's a local surgeon, so it's understandable. I'm concerned with functionality too, but aesthetics is very important also. I haven't been officially diagnosed (I have an appointment with a sleep doctor in two months), but I am very sure that I have sleep apnea. I told him I probably have sleep apnea, but it didn't concern him much. I think he's only concerned with fixing the alignment of my jaw.

Help would be very much appreciated. I'll be getting 8 teeth removed soon (4 wisdom teeth), so I will need to be certain of what I want before I follow through with the procedure.

also if you have any advice for other surgeries for after my jaw surgery, that would be welcome. I plan on getting a rhinoplasty to fix my dorsal hump.

The xrays are from 3 years ago, so maybe not totally accurate. In two of my pics, I am jutting my jaw forward and in the other two, my jaw is relaxed.

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[ettubrute]

here is another xray

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[PloskoPlus]

You need CCW rotation.

[ettubrute]

You need CCW rotation.

isnt that another phrase for "maxillary impaction"?

[PloskoPlus]

isnt that another phrase for "maxillary impaction"?

CCW rotation can be achieved by anterior impaction (if yo have a gummy smile), posterior down graft or a combination thereof. Wolford, Gunson get their spectacular results because they can do massive CCW rotations.

[CCW]

You have a steep occlusal plane and are 100% a bimax case if you choose to have surgery. You need a pretty big rotation, so you should get a second and third opinion from someone like Gunson, Posnick or Wolford. Most surgeons are only concerned with achieving a Class I bite with the smallest possible movements and easiest way possible. Your airway looks ok to me.

You don't need a rhino. Your nasal tip is a little downturned due to clockwise rotation of your jaws, which accentuates the hump. It'll be less noticeable after surgery.

[ettubrute]

You have a steep occlusal plane and are 100% a bimax case if you choose to have surgery. You need a pretty big rotation, so you should get a second and third opinion from someone like Gunson, Posnick or Wolford. Most surgeons are only concerned with achieving a Class I bite with the smallest possible movements and easiest way possible. Your airway looks ok to me.

You don't need a rhino. Your nasal tip is a little downturned due to clockwise rotation of your jaws, which accentuates the hump. It'll be less noticeable after surgery.

thanks for the reply. unfortunately i cant afford top surgeons. my country covers 90% of the costs for jaw surgery, so i have to stay local. can you give me a quantitative example of a big rotation so that I can convince my surgeon to rotate as close as possible?