Weak and recessed lower jaw-health problems.

[Dutcherhatcher]

I'm not thinking in the terms you are asking me to think in. I don't think in terms of 'high profile doctor = best and worth it'. With the high profile docs, I think in PRAGMATIC terms of things they can do that others don't, in particular, significant DOWN GRAFTING and WHEN such looks to be applicable to someone. Recognition of them, by me, is usually based on capacity to do a significant down graft because that's a key factor in setting them apart from the others.

AS to 'skill', I think in terms of TIME needed to produce SAME outcome. The doctor who could produce the same outcome FASTER than the other one would be considered more 'skilled'. But so what.

It depends on whether or not you have money burning a hole in your pocket. People who think in terms of high price = 'the best' can afford to go to a high profile doctor for a straight forward thing other doctors could do whether or not a lesser know doctor could produce same/similar. If that's the case, I don't need to think for them.

I've already thought about this and I think the doctor who advised you (your local one) is on target for your case based on his assessment. I don't need to think about the high profile doctors for your case. If you do, there are plenty of others who think in terms of high profile, high $$$= best to engage.

Okay, got it. I think i am going to stick with my local guy. I wish i did not have to go with this suegery at all. It is such time consuming and anxiety inducing. I hopw my children wont get my jaws

[kavan]

Guys thank you again for taking the time. And huge thanks for Kavan. I had a few more questions.

My surgeon offered me to give some feedback so i had a few questions.

Is there an ideal saggital projections of the jaw/chin?
An ideal vertical and width of the chin?
Or should i just tell him to do what he thinks.

Not a good idea to be a 'back seat driver'.

[Dutcherhatcher]

Ok, this will be my last consultation. Pretty confused now. I knew i should have stopped at 3.

Says i need CCW. My lower jaw needs to come forward by at least 12mm. 8 not enough.
Impossible to create overjet larger than 5 mm with orthodentics, he laughed very hard when i showed him my program. Said i will lose all my teeth. "Good luck".
Agreed with extracting the first molars.
Says the rotation will be minimal, will bring my upper jaw forard by  2 mm

Also found my nose septum to be deviated, said i need a nose surgery, said my breathing is almost at a "critical state"

Sorry Kevan, should have stopped at time 

[kavan]

Ok, this will be my last consultation. Pretty confused now. I knew i should have stopped at 3.

Says i need CCW. My lower jaw needs to come forward by at least 12mm. 8 not enough.
Impossible to create overjet larger than 5 mm with orthodentics, he laughed very hard when i showed him my program. Said i will lose all my teeth. "Good luck".
Agreed with extracting the first molars.
Says the rotation will be minimal, will bring my upper jaw forard by  2 mm

Also found my nose septum to be deviated, said i need a nose surgery, said my breathing is almost at a "critical state"

Sorry Kevan, should have stopped at time 

Sounds like he's looking for employment opportunities in your mouth.

[Dutcherhatcher]

Sounds like he's looking for employment opportunities in your mouth.

I thought someone like prof who is very thought of in this forum will be above looking to make a quick buck.

Edit: He showed me on the ct scan where is the nose deviated. I am going to confirm it with a local doctor as well

[InvisalignOnly]

I thought someone like prof R who is very thought of in this forum will be above looking to make a quick buck.

That's what I used to think, but changed my mind very quickly as soon as I started consulting with some of these 'big name' doctors! Will not say more here, beyond that you should be careful and use common sense and don't believe everything they say, particularly if they start telling you you 'need' more work on your face (nose, cheeks etc.). As Kavan suggested, you can get that stuff done after jaw surgery if you really 'need' it.

[InvisalignOnly]

I think it's common during bimaxs to get septoplasty done at the same time.

Yes it is if someone needs it - it's very questionable though that OP is one of those if he never noticed there was anything wrong with his septum. For example, for me it is very clear that I have a deviated septum, I can feel it and have been aware for some time that I can breath through one nostril much better than the other. I got a scan done recently and the ENT said it's not nearly serious enough for me to get surgery for it, even though I have symptoms, and it seems that OP has no symptoms. In any case, he's getting his lower jaw moved forward which should help with his breathing problems (I am hoping for the same for myself).

My understanding is that even though it's a relatively common practice, not everyone thinks that nose surgery combined with jaw surgery is a good idea, not least because recovery will be even much more difficult than after just jaw surgery on it's own. Also, personally, if I wanted to get septoplasty, and wasn't a millionaire, I would probably not get it from an expensive 'star' plastic surgeon but just someone that specializes in that procedure, preferably with ENT background. 

[kavan]

To the OP:

1rst 'big name' doctor.
Was HONEST with you. Told you to move upper jaw forward aprox 3mm ONLY IF you had severe sleep apnea. BUT was AGAINST it IF NO medical need. There is also NO aesthetic need to advance your upper jaw either. He CONFIRMED what your local doctor said. You did not name him. But I think he deserves credit for being forthright with you.

2ncd 'big name' doctor, which I think might be Alfaro. Also CONFIRMED that 'less is better' for you as far doing any surgery to the maxilla is concerned. Basically CONFIRMED that your local doctor had a good plan and gave you good advice.

3rd 'big name' which I think would be Raffiani.

Said you 'need' CCW but the rotation would be MINIMAL and advancement of 2mm to upper jaw would also be MINIMAL. Yes, 'minimal' indeed. Perhaps 'just enough' to give you 4mm in EXCESS to the lower jaw and 'just enough' to find ANOTHER EMPLOYMENT OPPORTUNITY when he does the maxilla, ie. a RHINOPLASTY. Then you have him telling you that you would 'lose all your teeth' and your breathing was in 'critical state'. That sounds like SCARE TACTICS.

As to his laughing at your local doctor's plan, given that 2 other 'big name' doctors who IMO, were HONEST with you as in were not OPPORTUNISTS who laughed at your local doctor's plans but instead CONFIRMED them, and in this process suggested extra surgery, in a situation where you can avoid the RISK involved with extra surgery, that RESOLVES to what I told you in a prior post, which is that IF YOU HAVE MONEY BURNING A HOLE IN YOUR POCKET, then by all means, disregard everyone else who was HONEST with you as to want to spare you the extra risk of the maxilla surgery and go to R.

That's all I say about him and since he CONFUSED you as to UNDO the info and reasoning given to you prior, not only by me but also the other doctors, you can ask HIM to 'un-confuse' you.

[kavan]

Yes it is if someone needs it - it's very questionable though that OP is one of those if he never noticed there was anything wrong with his septum. For example, for me it is very clear that I have a deviated septum, I can feel it and have been aware for some time that I can breath through one nostril much better than the other. I got a scan done recently and the ENT said it's not nearly serious enough for me to get surgery for it, even though I have symptoms, and it seems that OP has no symptoms. In any case, he's getting his lower jaw moved forward which should help with his breathing problems (I am hoping for the same for myself).

My understanding is that even though it's a relatively common practice, not everyone thinks that nose surgery combined with jaw surgery is a good idea, not least because recovery will be even much more difficult than after just jaw surgery on it's own. Also, personally, if I wanted to get septoplasty, and wasn't a millionaire, I would probably not get it from an expensive 'star' plastic surgeon but just someone that specializes in that procedure, preferably with ENT background.

There's NO DOUBT that a rhino can be done at same time during bimax, ie, when one is ALSO getting the lefort 1.

The DOUBT comes in--in my mind-- as to whether or not the Lefort 1 was suggested was OPPORTUNISTIC 'shoe in' to do a rhino (Dr. finding employment opportunities). Also, this doctor cast DOUBT on all the OTHER suggestions given to the patient who CONFIRMED that his local doctor's plan was a good one. Hence, my doubt about some of the tactics of this #3 'big name' doctor.

I think it's common during bimaxs to get septoplasty done at the same time. But if he wants you to do a cosmetic rhino though, that's a bit different. Seems he does a lot of those https://www.ncbi.nlm.nih.gov/pubmed/29560545

[Dutcherhatcher]

That's what I used to think, but changed my mind very quickly as soon as I started consulting with some of these 'big name' doctors! Will not say more here, beyond that you should be careful and use common sense and don't believe everything they say, particularly if they start telling you you 'need' more work on your face (nose, cheeks etc.). As Kavan suggested, you can get that stuff done after jaw surgery if you really 'need' it.

He didnt say i need another surgery, he said i need a septoplasty which is included in the original Bimax. The main difference is the 14 mm vs the 8-10 everyone else agreed on and the braces.

Why would you lose your teeth?

So you have 3 opinions

Local guy - BSSO only
Dr A - BSSO only / or CCW if can't make enough space
Dr R - CCW

Dr A seems to sit in the middle, so based just on that, he could be a good pick

I think it's common during bimaxs to get septoplasty done at the same time. But if he wants you to do a cosmetic rhino though, that's a bit different. Seems he does a lot of those https://www.ncbi.nlm.nih.gov/pubmed/29560545

He wants me to get a septoplasty, he is afraid of my losing the root of teeth because he said that creating an overjet of 8mm is insane.

Yes it is if someone needs it - it's very questionable though that OP is one of those if he never noticed there was anything wrong with his septum. For example, for me it is very clear that I have a deviated septum, I can feel it and have been aware for some time that I can breath through one nostril much better than the other. I got a scan done recently and the ENT said it's not nearly serious enough for me to get surgery for it, even though I have symptoms, and it seems that OP has no symptoms. In any case, he's getting his lower jaw moved forward which should help with his breathing problems (I am hoping for the same for myself).

My understanding is that even though it's a relatively common practice, not everyone thinks that nose surgery combined with jaw surgery is a good idea, not least because recovery will be even much more difficult than after just jaw surgery on it's own. Also, personally, if I wanted to get septoplasty, and wasn't a millionaire, I would probably not get it from an expensive 'star' plastic surgeon but just someone that specializes in that procedure, preferably with ENT background. 

Never noticed anything about my nose. I have a ct scan on me i am going to take to a local ENT soon to get his opinon.

To the OP:

1rst 'big name' doctor.
Was HONEST with you. Told you to move upper jaw forward aprox 3mm ONLY IF you had severe sleep apnea. BUT was AGAINST it IF NO medical need. There is also NO aesthetic need to advance your upper jaw either. He CONFIRMED what your local doctor said. You did not name him. But I think he deserves credit for being forthright with you.

2ncd 'big name' doctor, which I think might be Alfaro. Also CONFIRMED that 'less is better' for you as far doing any surgery to the maxilla is concerned. Basically CONFIRMED that your local doctor had a good plan and gave you good advice.

3rd 'big name' which I think would be Raffiani.

Said you 'need' CCW but the rotation would be MINIMAL and advancement of 2mm to upper jaw would also be MINIMAL. Yes, 'minimal' indeed. Perhaps 'just enough' to give you 4mm in EXCESS to the lower jaw and 'just enough' to find ANOTHER EMPLOYMENT OPPORTUNITY when he does the maxilla, ie. a RHINOPLASTY. Then you have him telling you that you would 'lose all your teeth' and your breathing was in 'critical state'. That sounds like SCARE TACTICS.

As to his laughing at your local doctor's plan, given that 2 other 'big name' doctors who IMO, were HONEST with you as in were not OPPORTUNISTS who laughed at your local doctor's plans but instead CONFIRMED them, and in this process suggested extra surgery, in a situation where you can avoid the RISK involved with extra surgery, that RESOLVES to what I told you in a prior post, which is that IF YOU HAVE MONEY BURNING A HOLE IN YOUR POCKET, then by all means, disregard everyone else who was HONEST with you as to want to spare you the extra risk of the maxilla surgery and go to R.

That's all I say about him and since he CONFUSED you as to UNDO the info and reasoning given to you prior, not only by me but also the other doctors, you can ask HIM to 'un-confuse' you.

Ok, thank you Kevan. I wont press for more info.

[Dutcherhatcher]

In general what confuses me is that there are 2 medical opinions today which i also noticed in my country.


Creating an overjet of 8-10mm is possible if young

VS

its never possible.

Which is why it is weird how some of those top doctors contradict each other.

They all agreed i dont need any upper jaw movement at all.

However R decided i need 12mm instead of 8mm. How can they be of such different opinions? He also decided braces will never get me to the needed Overjet, and i need CCW because of it. I have no idea what to think now, since he is one of the top "guns" recommended here and is suppose to be the best of the best in the market compared to my local guy. I have a lot to think about and a decision to make, and it is a decision you only make once, so i hope i will get it right.

[InvisalignOnly]

Being confused is normal in this case. I think most of us that were told we 'need' jaw surgery and then started doing some research / getting more opinions from doctors ended up getting confused and got at least a couple of opinions that directly contradicted each other etc., it just seems to be the way this stuff works. I reckon the only people that don't feel confused are the ones that went to one doctor, were told they need 'the' surgery, never asked any questions, never tried to understand what was happening to them and just accepted everything and let the doctor do their 'thing'. I honestly wish I was one of those, I should have just let my local NHS doctors in England 'do their thing' when I was 20 or so. Anyway, whatever you do, I wish you well and hope it works out for you.

[kavan]

The over jet is approx = to mm amount the upper teeth can be angled out + mm amount the lower teeth can be angled in.

Let mm amount upper teeth can be angled out be 'X'.

Let mm amount lower teeth can be angled in be 'Y'.

Let mm total amount= OJ

X + Y = OJ.

The question is CAN [X+Y=OJ=8] be possible or is is really 'impossible' for [X+Y =8]

For example, is it really 'impossible' for X+Y to = 8

I've certainly not come across any info that it's 'impossible' to achieve an 8mm overjet (in preparation for surgery) by a combination of angling the lower teeth backwards and the upper teeth outwards. Have you cross referenced that 'impossibility' with some ORTHOS who prepare the brace work for surgery?

Have you asked around--even on this board-- what is the LIMIT the upper teeth can be angled out and what is the LIMIT the lower teeth can be angled in such that it would be 'impossible' for [x+Y=8]?

We can assume that [X+Y=12] is NOT possible given that the:

a: 'need' for 12 on the part of R was chosen resolved to HIS 'need' to do MORE surgery than you actually needed

b: Other doctors did not determine any 'need' for 12 mm advancement of mandible nor told you 12 mm over jet was possible.

As to being 'highly esteemed' on this board, in the event you think that I, myself gave you that impression, RULE ME OUT. Not saying I hold him in low regard, rather that he's just one of the doctors I recognize as being able to do a LARGE CCW. But most certainly not a doc I would suggest to specifically seek out for someone who I thought didn't need a large CCW yet alone someone who could still come out ahead with NO surgery to the maxilla at all and was candidate for single lower jaw surgery only.

Better check to see if your confusion is coming from your conclusion that [X+Y=8] is 'impossible' 'because' R set the 'need' for it to be 12.

Also keep in mind that if the whole mandible, INCLUDING the CHIN is what would look good as coming forward at 12, the BSSO, itself can be 8 and the genio advance can be 4. This is especially so if the chin ITSELF is ALSO retruded.

[Dutcherhatcher]

The over jet is approx = to mm amount the upper teeth can be angled out + mm amount the lower teeth can be angled in.

Let mm amount upper teeth can be angled out be 'X'.

Let mm amount lower teeth can be angled in be 'Y'.

Let mm total amount= OJ

X + Y = OJ.

The question is CAN [X+Y=OJ=8] be possible or is is really 'impossible' for [X+Y =8]

For example, is it really 'impossible' for X+Y to = 8

I've certainly not come across any info that it's 'impossible' to achieve an 8mm overjet (in preparation for surgery) by a combination of angling the lower teeth backwards and the upper teeth outwards. Have you cross referenced that 'impossibility' with some ORTHOS who prepare the brace work for surgery?

Have you asked around--even on this board-- what is the LIMIT the upper teeth can be angled out and what is the LIMIT the lower teeth can be angled in such that it would be 'impossible' for [x+Y=8]?

We can assume that [X+Y=12] is NOT possible given that the:

a: 'need' for 12 on the part of R was chosen resolved to HIS 'need' to do MORE surgery than you actually needed

b: Other doctors did not determine any 'need' for 12 mm advancement of mandible nor told you 12 mm over jet was possible.

As to being 'highly esteemed' on this board, in the event you think that I, myself gave you that impression, RULE ME OUT. Not saying I hold him in low regard, rather that he's just one of the doctors I recognize as being able to do a LARGE CCW. But most certainly not a doc I would suggest to specifically seek out for someone who I thought didn't need a large CCW yet alone someone who could still come out ahead with NO surgery to the maxilla at all and was candidate for single lower jaw surgery only.

Better check to see if your confusion is coming from your conclusion that [X+Y=8] is 'impossible' 'because' R set the 'need' for it to be 12.

Also keep in mind that if the whole mandible, INCLUDING the CHIN is what would look good as coming forward at 12, the BSSO, itself can be 8 and the genio advance can be 4. This is especially so if the chin ITSELF is ALSO retruded.

When i went to the original ortho as recommended by my surgeon, she refused to treat me and citing the same reasons as, that my roots will "escape".

Now my surgeons said it is more the old traditional thoughts and that the now it is much more believed that you can move such distances. So i heard his verison once before. I am going to check it with more orthos though.

Is there any differnce healthwise 12 vs 8+4
Any difference visualy?

If not, the logical train of thought is to go with the local guy first.

[kavan]

When i went to the original ortho as recommended by my surgeon, she refused to treat me and citing the same reasons as, that my roots will "escape".

Now my surgeons said it is more the old traditional thoughts and that the now it is much more believed that you can move such distances. So i heard his verison once before. I am going to check it with more orthos though.

Is there any differnce healthwise 12 vs 8+4
Any difference visualy?

If not, the logical train of thought is to go with the local guy first.

I'm saying a BSSO of 8 (contingent on X+Y=8; an over jet of 8mm) with a genio of 4, still gives an overall advancement of 12 and resolves to SINGLE jaw surgery. Your chin is also somewhat recessive and chin advancement also helps with apnea. Also, your maxilla is NOT recessive. Your SNA angle is somewhat higher than normal. Hence, I'm NOT finding much to justify R's surgery proposal to do the lefort as to advance SO HE can make the BSSO as 12.