Jaw surgery after previous orthodontics

[stargirl87]

Hi,

I had orthodontic work carried out a few years ago with 2 upper premolar extractions. Before carrying out this treatment I visited a few different orthodontists, 2/3 suggested extractions and 1 recommended jaw surgery.
At the time I was happy with my profile and felt an advancement was too extreme. My lower jaw is slightly set back but I have a good chin so it doesn't look very noticeably recessed. I've been told I'm within the "normal range" for a female.

After my braces were off, I was happy with my smile but felt the teeth tipped inwards a bit to compensate for my lower jaw.

At the moment I'm a lot more aware of my jaw now. In candid photographs if I bend my head downwards even slightly it looks as though my jaw blends into my neck. The chin sticks out and you can hardly see a jawline. Granted I do have some fat here, but not a large amount.

I'm worried about how I'll age, as I know it'll only get worse. As well as that I've been developing minor TMJ symptoms. Jaw clicking on one side when I open my mouth, and some aching by the joints and temples occasionally. Although I know jaw surgery may not fix this issue (in fact it could probably make it worse).

So my first question is - Is there a way to bring the upper teeth forward without reopening the extraction gaps + having implants? Or would that look odd?
Due to the extractions my wisdom teeth have managed to come in, could these be pulled forward perhaps?
Could that provide enough room for some lower jaw advancement without having to have upper jaw surgery as well?

Secondly, would you say this surgery is worth it for a cosmetic change only?

I know I should consult with an oral and maxillofacial surgeon, but because my bite has been corrected I'm not sure if it's worth it, or if they'd even take me seriously. That's why I'm interested to know if anyone else on here has faced a similar situation.

Thanks in advance!

[bex]

From an aesthetic standpoint, I was in the same boat as you: my chin was recessed, but I was always pretty happy with my face from the front. While I didn't love my profile, I didn't hate it enough to get major surgery, and my TMJ pain - which began around age 7 - was also not bad enough to convince me to get surgery.

What finally convinced me to have bimax surgery was discovering that I had severe sleep apnea due to the position of my jaws. If you experience any kind of sleep issue, I would absolutely get a sleep study done - it does seem like many individuals with recessed jaws are at greater risk for OSA. In my opinion, having major surgery to fix that issue is 100% worthwhile.

I can't speak to the extractions and any potential impact they'd have on jaw surgery, but I did have braces around age 14-15 for a little over a year, and now have a perfect bite and very straight teeth. This had absolutely no impact on my need to get double jaw surgery; except for the fact that I didn't have to wait 2 years before + after surgery to see the final result.

[stargirl87]

Thanks for the reply bex.

Actually I don't have any sleeping issues, I've been told that my jaw isn't recessed enough to develop that. Although I'm worried about developing this when I'm older, if it's better to have the surgery to help prevent long term issues as well as improve my profile, I'd rather do it sooner than later.

I'd most likely still need braces on again for a while to prepare for any surgery. Which would mean decompensating my bite. With that comes the possibility of further root resorption as I already had braces on for over 2 years. 

[kavan]

You're asking questions that pertain to the cosmetics how you would LOOK with maxfax surgery and/or if one jaw can be displaced without the other in your specific case. They really can't be answered in the absence of any photos and/or cephs.

As to being worried about the aging process, there are surgeries called; 'face lifts'.

[april]

Stargirl, I can't help with any of your questions, but I just want to let you know I can relate to some of your issues. I have a shapely chin, which masks some of the recession. If I'm not holding it forward or upwards my jaw blends into my neck as well. I also agree that it'll probably get worse with age, as I've already been experiencing that. Have you looked into jawline/submental liposuction or a neck lift? The lipo would be way less invasive than jaw surgery. I am being set up for jaw surgery, but if I could do just lipo I would've done that instead (but I've been told my skin is of too poor quality, which is a contraindication). I now have root resorption too

[stargirl87]

I wasn't really asking how I would look specifically, but whether previous orthodontic camouflage treatment can be adjusted enough for jaw surgery without needing to reopen spaces for implants. I don't have any x-ray's at the moment either.

If you want a picture, here's a side by side comparison of me normally and one where I'm pushing my jaw forward (although this gives me a bit of an underbite):
http://oi65.tinypic.com/2mfj0ig.jpg

Lipo (and possibly a neck lift when I'm older) may be better but I think bringing my jaw forward a bit (putting it where it "should" be) would look best overall.

I'm not certain if I have root resorption but I've heard almost everyone who had braces have some degree of this, so if I were to have braces again I wouldn't want them on for too long.

[kavan]

I wasn't really asking how I would look specifically, but whether previous orthodontic camouflage treatment can be adjusted enough for jaw surgery without needing to reopen spaces for implants. I don't have any x-ray's at the moment either.

If you want a picture, here's a side by side comparison of me normally and one where I'm pushing my jaw forward (although this gives me a bit of an underbite):
http://oi65.tinypic.com/2mfj0ig.jpg

Lipo (and possibly a neck lift when I'm older) may be better but I think bringing my jaw forward a bit (putting it where it "should" be) would look best overall.

I'm not certain if I have root resorption but I've heard almost everyone who had braces have some degree of this, so if I were to have braces again I wouldn't want them on for too long.

Your (individual) questions resolved to asking: [would you say this surgery is worth it for a cosmetic change only?] You are asking questions with reference to a positive cosmetic change where this positive change is CONTINGENT on a number of displacement possibilities/limitations that I'm not in capacity to evaluate via your question alone. OK?  Theoretically, you would look better with the jaw brought more forward as you did in your morph. But I can't answer the technical contingencies inherent with a single jaw surgery other then to tell you that you can't 'bank' on a SINGLE JAW surgery. They might need to move BOTH jaws for the lower to come forward and of course would have to change the direction of the braces you got prior.

In short, you would have to go through a LOT to have your lower jaw where you want it and this 'a LOT' might include having your upper jaw where you don't want it and/or what ever the consequences would be with being in braces again to do it.

My advice would be to get plastic surgery when the time comes if all is OK now and you are worried about aging.

[stargirl87]

I understand no one here can really evaluate my question, I guess I was curious as to whether or not others were in a similar situation. It's hard to find cases from people who decided to revisit jaw surgery after having previously corrected their bite with orthodontics alone.

Most people don't seem to think orthognathic surgery is ever worth it unless the bite is severely bad and can't be fixed without it. Then again I think a big part of this surgery is cosmetic, you can physically live with a bad bite unless it's causing you a lot of discomfort.

I only like my jaw if I stick my head up really: http://oi63.tinypic.com/b62dk6.jpg
Otherwise I'm becoming increasingly aware that it's recessed. The TMJ issues may improve with surgery too.
Upper jaw surgery would be too risky though.
I might consider it if the upper teeth could be moved forward with braces enough. I wonder how many mm an overbite would need to be in order to bring the lower jaw forward.

Thanks for the advice.

[ditterbo]

In a way I think of jaw surgery like getting a hair transplant (which I also need), but I'm talking about only in cases where jaw surgery is cosmetic, with no medical need.  If your jaw bothers YOU enough that it is hampering your relationships and life goals, accomplishments, etc.., then just like a hair transplant, jaw surgery is probably worth pursuing (if you're not diagnosed with a personality disorder by a psychologist). Obviously pursue it with with way more caution than a hair transplant.

If you still want to do something but maybe not spend 40+ grand on bimax, and you roughly know what plastic surgery camaflouge can do vs bimax aesthetically and it appeals to you, then consider that option.

There's a lot of other personal factors to consider, but my bottom line is if you're doing it for cosmetics only, then your current cosmetics better be seriously hampering your life in one or multiple ways. Otherwise it's probably too high a gamble. The current tech is archaic in bimax and puts a lot of your face at risk of permanent damage. I'll vastly increase my risk for cancer or other autoimmune diseases or infections because I have to take immunosuppresants for damaged TMJ's due to bimax surgery? Or get TMJ replacements that need changing every 10 years or so, with probably higher risk each time that op will fail? I'll pass.. pending new information or techniques/technology.

My TMJs click reliably also (recent development). There are other treatments for TMJ besides jaw surgery, IIRC.

[stargirl87]

This surgery doesn’t cost any where near 40k where I’m from, and I know quite a few people that got it for free when younger (I think the bite has to be off by a certain amount though).
From what I’ve heard, TMJ issues are usually improved after orthognathic surgery because the jaws are in the correct position.

If the lower jaw has a skeletal issue that was essentially camouflaged by extractions/tipping teeth in an unnatural position to work with that discrepancy, is it really that much different to anyone else who has this surgery?
As I mentioned earlier, I think orthognathic surgery is mostly cosmetic unless your bite is causing you discomfort. A lot of people have genioplasty at the same time which is a cosmetic procedure.

I know there are a lot of risks though, that was one of the reasons why I avoided this surgery in the first place.

[april]

If you decide on surgery they'd decompensate both arches, untipping those front teeth and un-doing whatever other camo they've done. Where are you from?

Also your bottom wisdom teeth will have to come out if you have a BSSO.

[stargirl87]

I didn't have my lower teeth compensated, so it's just my upper teeth that would need some work. I don't think it's necessary to undo the extractions and insert implants (that's not something I'd want to do anyway).
My bottom wisdom tooth may need to be removed soon regardless. 

Guess I'll just have to see what the professionals say and decide from there.

I'm from the UK.

[ditterbo]

This surgery doesn’t cost any where near 40k where I’m from, and I know quite a few people that got it for free when younger (I think the bite has to be off by a certain amount though).
From what I’ve heard, TMJ issues are usually improved after orthognathic surgery because the jaws are in the correct position.

If the lower jaw has a skeletal issue that was essentially camouflaged by extractions/tipping teeth in an unnatural position to work with that discrepancy, is it really that much different to anyone else who has this surgery?
As I mentioned earlier, I think orthognathic surgery is mostly cosmetic unless your bite is causing you discomfort. A lot of people have genioplasty at the same time which is a cosmetic procedure.

I know there are a lot of risks though, that was one of the reasons why I avoided this surgery in the first place.

I wouldn't close the book on that question just yet. I've read of cases with it worsening too, but it's quite the tricky feet to research the statistical odds of any individual's exact pre-op TMJ situation improving or worsening post bimax.  Especially when bimax doc's have a natural conflict of interest in saving you from complications post-op vs making money, and yet they're the ones to tell you if surgery will help.  Whatever the likelihood, this is a severely high consequence risk of bimax.

[strongjawman]

If you decide on surgery they'd decompensate both arches, untipping those front teeth and un-doing whatever other camo they've done. Where are you from?

Also your bottom wisdom teeth will have to come out if you have a BSSO.

One of my surgeons said it was possible to do BSSO without extractions if there is enough space.