Very confused on surgeon to select

[beautyislife]

sorry for posting too much. I am just so confused on which surgeon to pick.
I am mostly doing jaw surgery for cosmetic benefit, increased airway is another part that two surgeons mention

I don't want too much advancement, I'd like to have projected jaws + get rid of vertical lip + keep my smile line/gum show same + hopefully mitigate mid face worsening. So far I have consulted with:

Gunson: he would do CCW with HA paste. I believe 9-10mm lower jaw, 6mm upper jaw movements. problem is I don't like HA paste from reading I do and the wait time and cost is high.
.
Zarrinbal: he said bimax with very conservative cow, spina nasals osteotomy and chin wing. problem is he doesn't give any measurements, but cost and timeframe is good.

I am thinking to consult with Raffaini and Alfaro, but I am unsure if it is worth consulting with them. I do not know which surgeon to select. Any advice?

[Ivano95]

sorry for posting too much. I am just so confused on which surgeon to pick.
I am mostly doing jaw surgery for cosmetic benefit, increased airway is another part that two surgeons mention

I don't want too much advancement, I'd like to have projected jaws + get rid of vertical lip + keep my smile line/gum show same + hopefully mitigate mid face worsening. So far I have consulted with:

Gunson: he would do CCW with HA paste. I believe 9-10mm lower jaw, 6mm upper jaw movements. problem is I don't like HA paste from reading I do and the wait time and cost is high.
.
Zarrinbal: he said bimax with very conservative cow, spina nasals osteotomy and chin wing. problem is he doesn't give any measurements, but cost and timeframe is good.

I am thinking to consult with Raffaini and Alfaro, but I am unsure if it is worth consulting with them. I do not know which surgeon to select. Any advice?

Consult raffaini and wolford. not sure about raffaini but wolford will give you planning/measurements.

[kavan]

If Z does not give you any measurements or displacement proposal, there is NO way for people on here to give you help with reference to his 'plans' if he doesn't give any for reference.  I just look at plan proposals. NOT verbal assessments of them given to patients who now jack s**t about things who then relay them back. I've already told you that Gunson's plans looked pretty good. But YOUR issue if if you choose Z who does not actually give you plans.

[april]

If you can afford Gunson or Wolford it's a no brainer.

[beautyislife]

If Z does not give you any measurements or displacement proposal, there is NO way for people on here to give you help with reference to his 'plans' if he doesn't give any for reference.  I just look at plan proposals. NOT verbal assessments of them given to patients who now jack s**t about things who then relay them back. I've already told you that Gunson's plans looked pretty good. But YOUR issue if if you choose Z who does not actually give you plans.

I know I don't know much aside from basic reading. I also know whoever I choose it's my own issue with the results.
I have heard Z is a good surgeon and the timelines is a big thing since I'd like to complete things this year which is why surgery first is a factor

If you can afford Gunson or Wolford it's a no brainer.

why? HA paste from what I have read doesn't seem ideal

[kavan]

I know I don't know much aside from basic reading. I also know whoever I choose it's my own issue with the results.
I have heard Z is a good surgeon and the timelines is a big thing since I'd like to complete things this year which is why surgery first is a factor


why? HA paste from what I have read doesn't seem ideal

What do you mean by 'surgery first', something you would like to do as soon as possible and get it over with OR the method where one gets the maxfax surgery first and the braces later. ?

If it's the former, it's not a good idea to rush into things when you are confused. If it's the latter, the 'surgery first' method is limited to candidates for that. Candidacy is determined by the doctors who do the 'surgery first' method.

[beautyislife]

What do you mean by 'surgery first', something you would like to do as soon as possible and get it over with OR the method where one gets the maxfax surgery first and the braces later. ?

If it's the former, it's not a good idea to rush into things when you are confused. If it's the latter, the 'surgery first' method is limited to candidates for that. Candidacy is determined by the doctors who do the 'surgery first' method.

I would like to do it as soon as possible. When I spoke to Dr.Z he said I would be able to get surgery first and then braces later. So by doing the surgery first method, it seems I would be able to get the surgery quicker, if that makes sense.

[kavan]

I would like to do it as soon as possible. When I spoke to Dr.Z he said I would be able to get surgery first and then braces later. So by doing the surgery first method, it seems I would be able to get the surgery quicker, if that makes sense.

OK. So surgery first is both for you.

[apollo]

why? HA paste from what I have read doesn't seem ideal

You could just not get the HA paste if you are opposed to it. It's a separate procedure from the orthognathic surgery itself (although they can obviously be done simultaneously), and I assume there would be an additional fee for it.

They use HA paste to augment the malar/infraorbital (and sometimes mandibular angle) regions to improve facial balance. If one has a deficient maxilla, the cheeks/infraorbital rims may also be deficient, and bringing the maxilla forward only accentuates these upper midface deficiencies.

Other options for augmenting the upper midface include skeletal implants, fat, filler, and (very rarely) osteotemies.

[beautyislife]

You could just not get the HA paste if you are opposed to it. It's a separate procedure from the orthognathic surgery itself (although they can obviously be done simultaneously), and I assume there would be an additional fee for it.

They use HA paste to augment the malar/infraorbital (and sometimes mandibular angle) regions to improve facial balance. If one has a deficient maxilla, the cheeks/infraorbital rims may also be deficient, and bringing the maxilla forward only accentuates these upper midface deficiencies.

Other options for augmenting the upper midface include skeletal implants, fat, filler, and (very rarely) osteotemies.

Interesting, my understanding was when going with Gunson, HA was required. I would rather do fat / filler.
Maybe it's best to see Alfaro and Raffaini and then decide.

[kavan]

Interesting, my understanding was when going with Gunson, HA was required. I would rather do fat / filler.
Maybe it's best to see Alfaro and Raffaini and then decide.

Doubtful he would 'require' HA (he uses granules and not the paste) as a contingency for the bi-max surgery. It was more likely a suggestion to augment upper midface area. Alfaro and Raffaini are in a similar (high) price bracket.

[PloskoPlus]

Surgery first if you have life threatening sleep apnea. Otherwise you risk a messed up bite. Surgery without orthodontic decompensation can never be accurate enough - the surgeon has to guess where the teeth will end up. In fact he may not even be able to move the jaws as much as would be ideal.

[beautyislife]

Doubtful he would 'require' HA (he uses granules and not the paste) as a contingency for the bi-max surgery. It was more likely a suggestion to augment upper midface area. Alfaro and Raffaini are in a similar (high) price bracket.

I will ask him. Perhaps that would ease some concerns with the granule usage. I have seen some mentions for Alfaro being in a similar cost range, I thought Raffaini was closer to Z.

Surgery first if you have life threatening sleep apnea. Otherwise you risk a messed up bite. Surgery without orthodontic decompensation can never be accurate enough - the surgeon has to guess where the teeth will end up. In fact he may not even be able to move the jaws as much as would be ideal.

I thought surgery first was good for those that have had bite corrected via orthodontics already?

[beautyislife]

also thank you to everyone that continues to help/answer my dumb questions

[april]

I thought surgery first was good for those that have had bite corrected via orthodontics already?

I don't know requirements for surgery-first, or your case, but if you have skeletal disharmony your bite would not have been corrected via past orthodontics, it would have likey been camouflaged.

Did Gunson give you a copy of the post-ortho tracing? Was there much work to be done?