Is there anything known about Dr. Gilbert in Upland California? Or would that be considered a risky local surgery? Both my doctor and my orthodontist said he is a good surgeon.
Never heard of him. He could be great. Some say that no surgeon is 100 times better than another and that at the end of the day they all do the same osteotomies and surgeons like Gunson are simply overhyped. I don't know what the truth is. "The best local guy" did my surgery and I copped massive nerve damage and a ho-hum aesthetic result (functionally it's perfect, so he admits no fault).
Ask him how many orthognathic surgeries he does per year i.e. BSSOs, Le Forts, genioplasties. Not dental implants, not pulling wisdom teeth - for most oral surgeons this is the bulk of their business. Ask him what are the chances of relapse of the maxillary down graft. How many mms of down graft? What materials does he use for the graft material? If you do relapse, will he re-operate on you? (I heard that when revising his own work Gunson will drop his fee, but not that of the hospital or anaesthesiologist and his fee is the biggest part of the bill. Other surgeons will revision "at a reduced rate". Other surgeons will simply hide from you). Also ask him if having an upper jaw down graft only puts you at a greater risk of relapse vs two jaw surgery, because AFAIK lower jaw surgery really weakens your bite strength for quite a while.
The problem with lengthening the maxilla is that it may lengthen your face and may make it more convex in profile as the lower jaw swings down. I'm not sure if you're gonna like this. The genioplasty is supposed to counteract this, but your mentolabial fold looks good. Also genioplasties can thin the lower lip...
One option worth considering is a lip lift for tooth show. There is a guy on the forum with full lips who did this (and a vermillion reduction at the same time) and he looks pretty good. But personally I think one side effect that people overlook with lip lifts is that they
may make the nose look longer. This is a general issue with aesthetic surgery. You take away from A, B look bigger. You add to A, B looks smaller. Also, I believe Frankel does them, and doing them at the same time as rhinoplasty is often a good idea, since you can hide the scar in the alar rim, so he would've mentioned this to you...
Arnett & Gunson published a paper some time ago where they downplay the importance of jaws period. If you search for this paper you will find it. They claim skin, hair, eyes, features are more important, unless there is a dentofacial deformity so significant that it takes away from those features. For example, someone with such a recessive chin that you don't notice their great eyes. I don't think anyone needs to tell you that you have great features. Your dentofacialy deformities are so minor that they don't take away from your features. They are not the first things that people notice about you (well, sane people). IMO, you may go through a lot of trouble to end up looking no better than you do now. You have to decide if any of this is worth it for you. That's why I would definitely see someone like Gunson. He has so much business, he will only suggest surgery if it's really worthwhile.
