What surgery do I need to fix my underdevopled, 4-bimolars-removed face?

[Jk]

Idek where to start. When I was young I had 4 premolars removed to fix crowding. My jaws are so far back. Note: I have an edge to edge bite.

The butcher didn’t even get my midline right, so my jaws point to the right/my left side is more flat. I imagine this is also why my left alar is smaller. If you look at the pictures, like I said, my left side looks wayyyy flatter.

I have signs and symptoms of recessed jaws. I have sclera show, and dark circles (maxilla). And I always have forward head posture.. well.. because it doesnt look pretty standing with proper posture (which is how I took the pictures). Idk maybe this was a fluke, but 1 time I slept on my back, I woke gasping for air; other times I just get sleep paralysis which is signs of sleep apnea. Like I said tho, I dont have this happen when I sleep on my sides. Ive never had a sleep study. Also! My nose has a droopy ness at the nasal bone aka a recessed maxilla/ans(?).

Here’s pictures: https://imgur.com/a/yNnXcuS



Im trying to figure out what I need to get my face to what it’s supposed to look like. If I jut my jaw about 7-9 mm andf I picture my maxilla matching, it wouldnt look right. Also, my lip sticks out which I I have 3 theories for/ a combination after research. It might be because my lower teeth are possibly tipped out / I need ccw / I need more advancement of the lower jaw but once again i dont think my maxilla needs to be moved out that far. When I jut my jaw / chin sorta points down so I think I need ccw rotation. Idk heres more pictures. (The pictures are sorta bad but im not worried, i feel like the first set of pictures are more important.)

https://imgur.com/a/znIYQIy

Yeah so I know I need double jaw surgery, but Im not sure about any rotations and any dental decompensations I need.

Post script: I don’t have a gummy smile btw so ik I read somewhere that that means it changes how you do ccw rotation?

Post script: Wouldnt fixing the edge to edge bite be a factor in the solution to what i need?

Idk what I want out of this post, Im sorta introducing myself lol. How flat does my face look? Also, if you need certain pictures then ask!

Heres what im trying to achieve: https://imgur.com/a/HWbZlU7
Using the end of my forehead/ eyebrow as a guide, it looks about 15mm?

Another important thing I remembered, I am half WHITE, and half asian. So i dont think i just have an asian maxilla lol. Im pretty sure I got more of my white side due to being 6 inches taller than my asian dad.

[kavan]

details of all the movements and measures are not something we can call from here. the maxfax doctor needs to figure all that out from a ceph study. but in general you are a candidate for bimax surgery (double jaw).

as to which rotations, clockwise or counter clockwise (CW vs. CCW), that's something determined by the ceph X ray study they do to evaluate. if you have posterior excess (too much downward growth to the BACK of the maxilla), the rotation is CW to remove the excess. if you don't have posterior excess, then the rotation (if there is to be one) would be CCW (possibly with down graft). The area of the maxilla near the nose which is the Lefort 1 area is definitely recessed. so bimax would bring that forward with good improvement to the the flatness of the face you see right beside the nose. however it doesn't address flatness directly under the eyes which is something that could be addressed later. lower jaw and chin advancement would be part of what would be needed. the chin advancement would support the lower lip. all that has to be balanced with getting the bite right.

definitely a candidate for bimax. start consulting by getting referral from orthodontist to a maxfax surgeon.

[Jk]

Thanks.

Idk if you know but how do I even go about explaining to an orthodontist that I need a referral to a maxfac for bimax surgery? Afterall, an ortho ruined my face. Also, the ortho that ruined my face is the president of orthos in my.. city(?)

Basically I feel like they wouldnt understand. What I mean but how do I go i literally mean what do I say because im only 19 and idek how the adult world works lol.

Also, you keep saying that im a “candidate” for bimax. Well, yeah, I am obviously.. but Is there some sort of diagnosis I can get (like how people get diagnosed with overbites, underbites, etc) in order for insurance to cover it? Someone mentioned to me, “bimaxillaey hypoplasia”? Would that be covered my insuance you think? Like I might possibly have some sort of sleep apnea when I sleep on my back.

Also, I tried explaing to my general doc that my jaws are recessed and that 1 time I woke up gasping, and i tried showing him my neck/face when I stand up with correct posture as opposed to foreward head, and he said, “Youre giving yourself” a double chin. Like he said my jaw (only mentioned lower) is slighty recessed. He said im fine. But then he referred me to an ENT on July 24th, I was planning on just trying to explain to the ENT to refer me to a maxfac. Should I just talk to an ortho before that?

[kavan]

I don't know all the ins and outs of getting insurance to pay except they will pay for the surgery IF you have sleep apnea. However, insurance pays when the apnea is bad. Sleep study, you get referral from your main doctor, PCP or general practioner. Insurance won't pay for anything they deem is just for 'cosmetics'. Bimaxillary hypoplasia is what you SEE on your face. It's just med term for both jaws are RECESSED. But insurance will not pay for the bimax advancement UNLESS sleep APNEA is found in a SLEEP STUDY.

For self pay, there is (sometimes) option to consult with maxfax first. The maxfax works with his/her preferred ortho. The ortho prepares teeth for the surgery.

ENT is NOT going to fix your face. Only a maxfax will move the jaws.


There is not much for you to 'explain'. Prior to a sleep study, you fill out a form which asks you a bunch of questions.

Again, i don't know all the ins and outs of insurance except that it starts with a sleep study (your main doctor refers for that) and the sleep study needs to find a lot of sleep disturbances for insurance to pay for the bimax surgery.