Gunson Consult

[kavan]

The posterior downgraft is so small relative to other movements it will probably make little difference.

He got the plan with the objective of getting the Gunson DIFFERENCE relative to what another doc might do (or not do). So the downgraft would be considered that difference. Although the difference might be subtle, it's done with objective of optimizing aesthetics with breathing function. Can't say all sleep apnea plans have the same objective to optimize aesthetics.

[Austinou88]

Man, I would rather achieve better asthetic results (if possible), and just use a CPAP long term for my sleep apnea. So maybe I should get another consult (Wolford?) with the approach of asthetics only, and see if there is a difference in the plans?

I just sent an email over to Gunsons office in regards to this question. Maybe a bold move, doesn't hurt to ask right?

[Post bimax]

Man, I would rather achieve better asthetic results (if possible), and just use a CPAP long term for my sleep apnea. So maybe I should get another consult (Wolford?) with the approach of asthetics only, and see if there is a difference in the plans?

I just sent an email over to Gunsons office in regards to this question. Maybe a bold move, doesn't hurt to ask right?

Reserving judgement on this decision, that could hurt your application for insurance coverage because they are covering your operation for the functional issue.  So yes it could hurt your wallet to ask this question in writing. 

[Austinou88]

Well I'm planning to have surgery with the Military MaxFacs anyway, so it wouldn't really affect anything. Also, the insurance reimbursement for Gunson is barely anything at all.

[Post bimax]

Well I'm planning to have surgery with the Military MaxFacs anyway, so it wouldn't really affect anything. Also, the insurance reimbursement for Gunson is barely anything at all.

The insurance reimbursement on SURGICAL fees is barely anything.  What about hospital costs?

[Dogmatix]

Man, I would rather achieve better asthetic results (if possible), and just use a CPAP long term for my sleep apnea. So maybe I should get another consult (Wolford?) with the approach of asthetics only, and see if there is a difference in the plans?

I just sent an email over to Gunsons office in regards to this question. Maybe a bold move, doesn't hurt to ask right?

It's basically malpractice to do a surgery with the anticipation to have you use CPAP for the rest of your life. I would stay away from any surgeon offering you that. Hopefully you will agree to this some time as well.

But it is also that aesthetic and function is very well connected. What is considered aesthetic is often a healthy look. Aestetically retruded jaws and narrow airways are connected and advancement solves both.

[Austinou88]

The insurance reimbursement on SURGICAL fees is barely anything.  What about hospital costs?

Well its 66k in surgical fees. So with insurance, that's 1,250 out of 66k. Not sure on Hospital costs, I didn't see it listed.

[Austinou88]

It's basically malpractice to do a surgery with the anticipation to have you use CPAP for the rest of your life. I would stay away from any surgeon offering you that. Hopefully you will agree to this some time as well.

But it is also that aesthetic and function is very well connected. What is considered aesthetic is often a healthy look. Aestetically retruded jaws and narrow airways are connected and advancement solves both.

Yeah I agree, I understand what you mean.

What I meant is, if you were approaching treatment toward asthetics only. Because surely something already recessed, wouldn't be recessed further for better asthetics?

Here's what Gunsons Treatment Coordinator said though.

"The treatment “plan” itself should not change. Your treatment plan is based on your individual face and function.

Do you have a copy of the sleep study?  It would be nice to have on file at our office, although unlikely, it “could” influence the treatment “movements” slightly."

[Post bimax]

Well its 66k in surgical fees. So with insurance, that's 1,250 out of 66k. Not sure on Hospital costs, I didn't see it listed.

My hospital fees were upwards of 50k and that's what insurance covered.  I don't know what Gunson's hospital costs, but insurance is a big deal for most JS patients.

[PloskoPlus]

From what I have seen American hospital fees are a bit of an insurance scam. Fees for self-funded patients are often significantly less.

[Austinou88]

Yeah that's pretty good coverage. I think when I was a civilian and had private insurance, my hospital costs were about the same, for my UPPP Surgery. Insurance covered 100% of it.

With the Military it's a strict HMO plan (MTF's only). Very frustrating, but I am wanting to take Gunsons plan (if it's really the best plan for asthetics) and have my Military Surgeon do it.

[PloskoPlus]

He got the plan with the objective of getting the Gunson DIFFERENCE relative to what another doc might do (or not do). So the downgraft would be considered that difference. Although the difference might be subtle, it's done with objective of optimizing aesthetics with breathing function. Can't say all sleep apnea plans have the same objective to optimize aesthetics.

I just think it's good that the "most aesthetically minded surgeon" recommended a largely linear plan. Most competent surgeons should be able to carry out. I do think they may not downgraft at the back thinking 2mm won't make much difference, the patient is unlikely to notice and it's more stable.

[Austinou88]

Is the large linear movements just to open up the airways, or is that also contribute some to the asthetics? What's the down grafting in the plan for?

[Austinou88]

The angle of your head in your profile shot is being partially obscured by your jacket, but looks like you have forward head posture.  I did a quick morph assuming what your head angle would be possibly looking straight ahead.  One issue you'd have with these movements is that the angle of your nose currently matches your current facial development and has a  low angle.  If you went ahead with these movements, assuming you didn't do something about your nose angle, it would be heavily compressed by the forward movement and you'd have the wide flat nose look.  I changed this in the morph too.. so I guess it works if you factor all that in?

Thanks for doing the Morph. So, I guess I'll be needing a revision afterward. But still, it's got to be worth the trade off.

Are you able to make a prediction on what the changes would look like on the frontal possibly?

[kavan]

I just think it's good that the "most aesthetically minded surgeon" recommended a largely linear plan. Most competent surgeons should be able to carry out. I do think they may not downgraft at the back thinking 2mm won't make much difference, the patient is unlikely to notice and it's more stable.

Looks to me that the 2mm posterior down graft COULD be with aim to preclude or cut down on unfavorable lip changes with 7.4mm horizontal ANS advancement. CCW via downgraft is usually with aim of cutting down on such a possibility. Without it the ANS will have to be advanced more via 'linear' advancement than it would be with the CCW of 2mm downgraft offered. That is to say, advancement over a DIAGONAL where no CCW is planned (linear advancement) would also have a VERTICAL element to it which is what Gunson is wanting to avoid.

So, PERHAPS if he wanted a straighter contour to the lip and had no issue with the possibility of it looking on the 'conVEX' side (even if remote) or just didn't like the (imo) pleasing nose to lip angle in the contour diagram, he could disregard Gunson's plan.

Personally, I won't opine on a 'who knows what' plan that another doctor might have for which I CAN'T SEE. The one I CAN see--Gunson's--looks very good to me.