The final decision time, with my CT scan pics

[PhoenixHiker]

It's been almost a year since I started looking for some revisions from my first unsatisfied jaw surgery. I've consulted quite a few professionals and they all have totally different opinions. Here I attached my 3D CT scan (which is more accurate than just plain pics) and I'm asking all friends here if you can give me any suggestions. I'll keep checking this post everyday and plan to make decision near the end of the year.
Basically I heard about 1) Double jaw revision (of course require braces again)    2) Simple genioplasty    3) Wing osteotomy   4) Live with it   5) Condyle issue and requires surgery on the condyle as well

All people are welcome to make comments. Please feel free to let me know if you need more xrays or CTs. Thank you all.

[kavan]

It's been almost a year since I started looking for some revisions from my first unsatisfied jaw surgery. I've consulted quite a few professionals and they all have totally different opinions. Here I attached my 3D CT scan (which is more accurate than just plain pics) and I'm asking all friends here if you can give me any suggestions. I'll keep checking this post everyday and plan to make decision near the end of the year.
Basically I heard about 1) Double jaw revision (of course require braces again)    2) Simple genioplasty    3) Wing osteotomy   4) Live with it   5) Condyle issue and requires surgery on the condyle as well

All people are welcome to make comments. Please feel free to let me know if you need more xrays or CTs. Thank you all.

Your scans reveal symmetry and evenness to where you can expect to be even and level after the surgery. Your orbits are even/level (first 2 white lines) which shows your natural symmetry. The next 3 white lines show the surgery was even/level with your natural symmetry.

I'm not clear on what you were expecting from the surgery. It's  not aimed at making one side of the maxilla longer than the other and the bite uneven to match the natural asymmetry to where you have it to the chin area.

Do you think it's 'botched' because it didn't do what it's not aimed at doing?

Other than asking you directly as to your complaint that I'm not quite clear about, based on your CT scans, IMO,

1: double jaw revision looks useless if you expect it to make your chin area symmetrical. Like I don't see a way to make that area even without making other areas uneven.

2: 'Simple' genioplasty. Maybe IF the doc really thinks it's that 'simple'. It might not be.

3: 'Wing osteo'. Maybe IF you want the shorter side to be longer to match the longer side.

4: 'Live with it'. The bone asymmetry will show via your soft tissue contour. So, it's possible to live with the bone asymmetry and MASK it via FILLERS for the longer side to match with the shorter side.

5: Condyle issue. No comment on something not seen on the frontal CT and that would be beyond my capacity to evaluate.

[PhoenixHiker]

Here's a better look from the front.  The chin asymmetry is so obvious, but not sure if I still need to fix the cant or not? By fixing the cant through a double jaw surgery it seems it could make the whole lower jaw more symmetrical.  I'm not sure how much only wing osteotomy might help my case.

[kavan]

Here's a better look from the front.  The chin asymmetry is so obvious, but not sure if I still need to fix the cant or not? By fixing the cant through a double jaw surgery it seems it could make the whole lower jaw more symmetrical.  I'm not sure how much only wing osteotomy might help my case.

The cant is insignificant compared to the inherent asymmetry to the chin. I've given you my take.

[PhoenixHiker]

Thanks kavan and thank you all who pm me. I've made my decision. Have a good holiday!

[kavan]

so, what was your decision?

[thinkingme]

i didnt get jaw surgery but only for little asymmetry, it wont worth it , surgery is such a discomfortable journey. if there is no pain and bite problems only for aesthetics dont go for it.

[secondtimearound]

The cant is insignificant compared to the inherent asymmetry to the chin. I've given you my take.

I see OP already made his decision. But I just want to say I agree completely. If there isn't something majorly wrong with the bite or alignment there is no justification for revision.

My current cephs are a mess and look like many preops. That's why I'm considering revision.

OP's bite and alignment looks enviable to me.

At most op I would get a genio if you want to straighten your chin a bit.

[kavan]

I see OP already made his decision. But I just want to say I agree completely. If there isn't something majorly wrong with the bite or alignment there is no justification for revision.

My current cephs are a mess and look like many preops. That's why I'm considering revision.

OP's bite and alignment looks enviable to me.

At most op I would get a genio if you want to straighten your chin a bit.

Some of these people.....go out of my way to explain stuff, draw up illustrations to do so and they don't even follow up with what decision they made.

[Lazlo]

It's been almost a year since I started looking for some revisions from my first unsatisfied jaw surgery. I've consulted quite a few professionals and they all have totally different opinions. Here I attached my 3D CT scan (which is more accurate than just plain pics) and I'm asking all friends here if you can give me any suggestions. I'll keep checking this post everyday and plan to make decision near the end of the year.
Basically I heard about 1) Double jaw revision (of course require braces again)    2) Simple genioplasty    3) Wing osteotomy   4) Live with it   5) Condyle issue and requires surgery on the condyle as well

All people are welcome to make comments. Please feel free to let me know if you need more xrays or CTs. Thank you all.

I'd suggest you work on gaining some weight first. You look like a bloody skeleton!

[PhoenixHiker]

Hi All, sorry for the delay and here's what I got recently. I finally decide to go with a prestigious LA surgeon to re-do the double jaw surgery.
I had a 2h+ appointment with him. At first by just looking at my pic he thought I'm a candidate for a simple chin surgery. However after the CT scan he changed his plan. He told me he focused more on the jaw as a whole and not just the teeth. My occlusion as well as jaws are slanted, which would in return negatively impact my TMJ/condyle. My mandible has a more lopsided angle (see the second pic). My teeth look aligned but it's the result of an improper decompensation before the first surgery. Plus he compared it with my pre-surgery CTs and believed although my first surgeon fixed the Class III, since he didn't carefully measure the movement I ended up with an asymmetric result. He actually does NOT recommend a camouflaged chin surgery because, after careful measurement, there's no asymmetry at the chin! He told me foramens positions (holes in the lower jaw) does NOT matter at all. We rotate the mandible a little bit and the chin looks very symmetric. Therefore it's the lower jaw rotation issue rather than chin asymmetry. He was mentioned a couple of times by other patients in this forum as a conservative. However this time he recommends a re-do.

[PhoenixHiker]

so, what was your decision?

Sorry for the delay kavan. I posted the updates above

[PhoenixHiker]

I see OP already made his decision. But I just want to say I agree completely. If there isn't something majorly wrong with the bite or alignment there is no justification for revision.

My current cephs are a mess and look like many preops. That's why I'm considering revision.

OP's bite and alignment looks enviable to me.

At most op I would get a genio if you want to straighten your chin a bit.

Hi secondtimearound thanks for the reply.
This is the pic (after rotation) my second surgeon showed my that the asymmetry doesn't happen on the chin. Instead it's caused by lower jaw rotation. He told me foramen (in my case it might not be aligned) doesn't play any role in terms of measuring symmetry.

[secondtimearound]

Hi secondtimearound thanks for the reply.
This is the pic (after rotation) my second surgeon showed my that the asymmetry doesn't happen on the chin. Instead it's caused by lower jaw rotation. He told me foramen (in my case it might not be aligned) doesn't play any role in terms of measuring symmetry.

Wow. I'm surprised the surgeon would offer a total redo for that degree of asymmetry. It's quite mild. Would you mind PMing me the name of the surgeon? I'd like to see them myself.

Sounds like this surgeon is a perfectionist which is both a good and bad thing though mostly good. Caminiti told me if my only problem was my asymmetry which is worse than yours he wouldn't offer me any revision at all. The only reason he offered it is that I need sarpe as well and even then he was trying to avoid fixing my asymmetry and instead just doing the sarpe.

Keep in mind you're going through all the same risks and recovery all over for that asymmetry so you have to decide if that's worth it to you.

We do live in a superficial world so I can't tell you it doesn't matter. I don't know if I would do it if my jaws were that good though. Jaw surgery is no fun.

[CCW]

Is your new surgeon Dr. Relle?