If Caminiti’s PLAN is good, and it makes perfect sense for your unique case and face, I have no reason to believe his surgical skills or competency won’t give you the result you’re looking for. Although I may be biased because I got a good result from a Canadian surgeon, I think ruling out Canadian surgeons should mostly be based on whether the plan is good or bad, not necessarily the surgical skills. I could be wrong.
At this stage you need to focus on what will simply be the best plan for you. Focus on surgeons later.
These are your options:
Linear advancement:
1.Conservative linear bi-max to get a slightly stronger upper and lower jaw without risking chimp lip.
2. Aggressive linear bi-max to get a much stronger lower jaw but risking chimp lip (Caminiti’s plan).
CCW-r
3. CCW-r plus bsso to create enough overjet to get a moderate advancement of the lower jaw while leaving the upper jaw where it is, negating any potential adverse aesthetic outcome of the upper jaw (Plosko’s recommendation).
4. CCW-r plus bi-max to get the STRONGEST lower jaw advancement possible, but also a strong upper jaw advancement which, again, puts you at risk for chimp lip.
You need to figure out a few things:
-What’s the position of your upper jaw? Like SNA angle? Is your upper lip contour enough or can it be improved? What’s the limit you can advance the upper without getting a convex lip?
-What’s the position of your lower jaw? How much advancement do you need for a satisfactory result, how much do you need for an ideal result?
Then weigh all these facts in with what you desire to get out of surgery, whether that be a conservative or strong result, to go with a more cost effective surgeon or not, etc.
Start ruling out each option one by one until you arrive at the best plan. For example, it seems like Caminiti is offering you option 2. So get him (and other surgeons of course) to explain to you very clearly his rationale for why he thinks an extra 9 mm lefort on an already advanced upper jaw by 6 mm will not result in chimp lip. If he’s vague or brushes off the concern, it’s a bad sign.
If he says something like well your upper lip is still pretty flat and could use some more projection, then you can consider it. It sounds crazy with his offering 9 mm, but it’s a possibility. I was warned by many on this forum that I was at great risk for chimp lip but my surgeon did not think so at all and it turns out he was right. Bring pictures of chimp lip cases to Caminiti so he fully understands what you mean. If he gives you a strong rationale for why you won’t get a chimp lip, option 4 may also be on the table for you. I will say, however, I agree with the others that his plan seems too extreme.
If he concedes that a chimp lip is an unfortunate possibility, and this is unacceptable to you, you only have option 1 or 3 left, etc.
