Genioplasty - yes or no?

[InvisalignOnly]

Does everyone benefit from having the airways opened more, or is it only those with severe obstruction such as OSA? It's clear that someone who have such sever problems that they stop breathing have terrible problems. But let's say you have somewhat narrow airways compared to norm, no apnea etc. Do you still benefit in different ways and feel a relief of having less strained breathing and getting more volume in your lungs?

Good questions, I have been thinking about the same and have to do more research on it. I have definitely noticed in recent years that I run out of breath quite quickly while doing sports, feel excessively tired in the morning and so on. I do not know how to explain but I have a feeling like I do not get enough air when I breathe in... The ENT doctor I saw was confident that these symptoms would improve after my jaw surgery and said he has actually treated several patients with issues like mine and they improved after surgery. But this was only one doctor that told me this so who knows...

I am also thinking whether I might have a deviated septum that is getting worse with age. I will try to look into this as well as jaw surgery options.

[april]

Did the ENT check you for enlarged turbinates. I have the same symptoms as you, and I have both hypertrophied turbinates and a deviated septum. I'm tired always and feel out of breathe doing basic physical activity.

[InvisalignOnly]

Did the ENT check you for enlarged turbinates. I have the same symptoms as you, and I have both hypertrophied turbinates and a deviated septum. I'm tired always and feel out of breathe doing basic physical activity.

I'm honestly not sure! He poked around in my nose and now wants to do a sleep study but I have kind of not been bothered enough to arrange that yet. Did they suggest any treatment for you?

[Post bimax]

I've been trying to figurer out. Does everyone benefit from having the airways opened more, or is it only those with severe obstruction such as OSA? It's clear that someone who have such sever problems that they stop breathing have terrible problems. But let's say you have somewhat narrow airways compared to norm, no apnea etc. Do you still benefit in different ways and feel a relief of having less strained breathing and getting more volume in your lungs?

Maybe a bad comparison, but I'm thinking like testosterone. Some people have sever deficiency and will get medical help. But some athletes take it to another level and go on "treatments" and benefit even though their baseline is good. Can it be same with airways so opening up give benefits or performance in general in some aspect?

At a certain point, the amount of air you get to your lungs has virtually no effect on performance because you have reached your VO2 max; or your maximal oxygen uptake in the bloodstream.  Cardio and high intensity interval training can help raise your VO2 max and improve your endurance.  Opening your airway beyond the normal range is unlikely to enhance performance (in my non-professional opinion).

[GJ]

I've been trying to figurer out. Does everyone benefit from having the airways opened more, or is it only those with severe obstruction such as OSA? It's clear that someone who have such sever problems that they stop breathing have terrible problems. But let's say you have somewhat narrow airways compared to norm, no apnea etc. Do you still benefit in different ways and feel a relief of having less strained breathing and getting more volume in your lungs?

Maybe a bad comparison, but I'm thinking like testosterone. Some people have sever deficiency and will get medical help. But some athletes take it to another level and go on "treatments" and benefit even though their baseline is good. Can it be same with airways so opening up give benefits or performance in general in some aspect?

I really don't know and that seems hard to know.
I've seen a few people mention they breathe better (SJ comes to mind), but in general I don't hear that often. It could be people are more focused on their looks or bite relief and don't mention that, or they simply don't notice it, or it doesn't happen despite the enlarged airway. I'm not sure.

[Dogmatix]

At a certain point, the amount of air you get to your lungs has virtually no effect on performance because you have reached your VO2 max; or your maximal oxygen uptake in the bloodstream.  Cardio and high intensity interval training can help raise your VO2 max and improve your endurance.  Opening your airway beyond the normal range is unlikely to enhance performance (in my non-professional opinion).

Yes, I'm sure there's a point where it makes no more difference. Think of it like trying to empty a glass of water with straws of different dimensions, on the limited time you have for a breath. With a very narrow straw, you need to struggle much harder and push the water through with more speed to get same volume, than with a wider straw. But there is also a limit where it makes no difference, your mouth (lungs) fill up any way without effort.

It interests me because I've done a sleep study that didn't show anything (but I slept very bad that night so not sure how much real sleep it actually got recorded). But I still have these classic OSA symptoms like never feeling rested and adhd and concentration issues. I've looked at my cbct scan and meassured my airways and see that they're outside the normal range, but it's rarely discussed anything else than OSA. It makes sense that if you have airways where you have to struggle like you're being lightly suffocated constantly, that it would cause problems as well. But there's not much research on it or people talking about such benefits.

[Post bimax]

Yes, I'm sure there's a point where it makes no more difference. Think of it like trying to empty a glass of water with straws of different dimensions, on the limited time you have for a breath. With a very narrow straw, you need to struggle much harder and push the water through with more speed to get same volume, than with a wider straw. But there is also a limit where it makes no difference, your mouth (lungs) fill up any way without effort.

It interests me because I've done a sleep study that didn't show anything (but I slept very bad that night so not sure how much real sleep it actually got recorded). But I still have these classic OSA symptoms like never feeling rested and adhd and concentration issues. I've looked at my cbct scan and meassured my airways and see that they're outside the normal range, but it's rarely discussed anything else than OSA. It makes sense that if you have airways where you have to struggle like you're being lightly suffocated constantly, that it would cause problems as well. But there's not much research on it or people talking about such benefits.

I wonder if there's a method of measuring the average air volume intake per breath over a period of time.  That could be adjusted for body size/weight and possibly give a clearer idea if something is out of the norm.

That seems like it would be a better way to figure out what you're talking about rather than a sleep study which just looks for serious obstructive episodes.

[kavan]

You are making good points, however - perhaps surprisingly - it did actually happen to me more than once that general dentists told me I 'should' get this surgery, without me asking, and offered to refer me to a surgeon. This might have something to do with the fact that as GJ mentioned,

I should add that this happened in non-Western countries and I can actually imagine that the dentist would get a commission for referring patients for surgery. Even when I went to the ENT doctor, it did not cross my mind that the breathing issues had anything to do with my jaws or bite and he started telling me that he thought it was related to that and it would be a good idea for me to get the surgery.

There was even a young male dentist years ago - I went to see him for a filling - that told me really enthusiastically (without me even mentioning the subject) that if I got this surgery I would be stunning and look like a model or something like that. I got quite angry actually and tried to explain to him that it was really unprofessional and also irresponsible to say something like this to a patient but he did not understand what was wrong (again, this happened in a non-Western setting, in other countries I would probably make a formal complaint).

Regarding how I feel: yes, it bothers me that my teeth 'stick out' / are visible even when not smiling, and this is something I wanted to address. That's why I spoke to orthodontists, and without exception they have told me that braces would not really solve this issue. They also told me lots of other scary things like my teeth will 'fall out' if I do not get the surgery, I will have TMJ pain, headaches, digestive problems and so on. The first time they told me all these was over 20 years ago and so far my teeth did not fall out and I do not have any pain anywhere but I do have the breathing issues now... So I am hoping that if the surgery goes well, it could improve my breathing and my appearance too.

OK, here you say (to GJ) a dentist in 'Non-Western' country told you such. My assumption was a US dentist most likely would not have volunteered that out of the blue. Which 'non Western' country? I'm just asking because the term 'non-western' country can often refer to a country with a very rich historical heritage where the country is 'not Americanized' enough. To me, it sounds like this dentist liked you, saw potential for you and told you why and was motivated by his genuine opinion and was not fettered by same constraints as in US. Sounds like you got a genuinely honest tip from him. However, your resenting being the recipient of it and waiting OVER 20 years to consider acting on it, now puts you in a higher risk category than say people in their 20's. Also, some people become attached to their face and even though the surgery makes them look so much better, breath better, corrects aesthetic problems and gives a 'WOW!' factor, there are types that resent being changed. Like there are situations where despite being made look objectively better, they mourn the loss of their aesthetic defects because in retrospect they associate them with their 'uniqueness'.

What I'm picking up here is AMBIVALENCE which is kind of a mixture or resenting being told long time ago about a surgery that would benefit you but you still seem unresolved but still wanting it in some way. Also, you're asking very elementary questions about this type of surgery when you actually had over 20 years to read up on these types of surgeries?  Although I do think it's laudable not to automatically 'default' to what a doctor says 'because the doctor said it', IMO, that should (have) come with some academic exploration such as going to a medical library and reading up on maxillo facial surgery as to explore further the advice given.

Being in INDECISION for so long is basically a decision not to decide. My advice is to go to a medical library or any library with books about maxfax surgery. Don't you think that would be a good place to help with what doctors/dentists are telling you and/or to help with some indecision?

[PloskoPlus]

IMO there's a real danger that even if the surgery result is objectively perfect (as in, everyone agrees that it is so), *you* yourself may dislike the result.

[Dogmatix]

I wonder if there's a method of measuring the average air volume intake per breath over a period of time.  That could be adjusted for body size/weight and possibly give a clearer idea if something is out of the norm.

That seems like it would be a better way to figure out what you're talking about rather than a sleep study which just looks for serious obstructive episodes.

I think there is, but not sure anyone does it or have studied clearly how to evaluate it. I think it would be interesting just to look at airway volume and cross section area, and study correlations between different diagnosis.
As to practical measurements, I'm thinking about these masks they sometime put on athletes when they run on the treadmill to meassure air volume consumption. Having one of those when you sleep or just relax would meassure the volume, and maybe also the preassure in each breath. If there would be research interest in it, such measurements before and after surgery would give some clue what's going on. If people suddenly start getting higher volume exchange in each breath after surgery, it's probably a good thing. It seems similar to asthma evaluation actually.

[InvisalignOnly]

Also, you're asking very elementary questions about this type of surgery when you actually had over 20 years to read up on these types of surgeries?  Although I do think it's laudable not to automatically 'default' to what a doctor says 'because the doctor said it', IMO, that should (have) come with some academic exploration such as going to a medical library and reading up on maxillo facial surgery as to explore further the advice given.
Being in INDECISION for so long is basically a decision not to decide. My advice is to go to a medical library or any library with books about maxfax surgery. Don't you think that would be a good place to help with what doctors/dentists are telling you and/or to help with some indecision?

Totally right and thank you for your input! After reading your comment, I asked myself the question why did I not do more research on it years ago (indeed I did almost none), and I think the answer is I simply wasn't that bothered and was discouraged by people around me. I figured it was very invasive surgery with a high risk of things going wrong and when I mentioned it to friends and partners, they were always very dismissive saying I did not need it etc. So I did not really look into it and forgot all about it for many years and just got on with my life.

Last year I changed dentists and by chance started attending a surgery where one of the doctors is a maxillofacial surgeon. I went there for general stuff like cleaning and fillings but when he saw me there, he asked if I have ever thought about this surgery and I asked him questions and started doing a bit more research on it. Then I had the breathing issues and met the ENT doctor and he mentioned the surgery again, and I thought I now have the time and money to deal with this (which was not the case 20 years ago). Also, I am more independent now and do not care about the opinion of friends etc. like I used to.

Anyway, I have two consultations set up with surgeons next week and another two scheduled within the next month. I will also do more research on my own and then try to make up my mind. I am so glad I registered on this forum, I got more useful advice here than elsewhere in the last twenty years. Will post updates.

[GJ]

Question, and you don't have to answer this if you don't want to, but when I see "independent, etc" I think "recently broke up with a BF" -- is this surgery a way to stick it to an ex and/or attract new partners?

But either way it seems like you now have your mind set it on it on some level because every reason given you should do it has been met with a reason you should. This to me suggests you've made up your mind and been lured by the great temptress. So it's about going through the process of consultations and finding the right plan. Once you do that post them all here. Get at least three from reputable doctors, and don't tell them what the other doctor said.

[InvisalignOnly]

Question, and you don't have to answer this if you don't want to, but when I see "independent, etc" I think "recently broke up with a BF" -- is this surgery a way to stick it to an ex and/or attract new partners?

Valid question and when I re-read my comment, I can see how it could be interpreted like that but it was just a case of expressing myself badly. I am divorced but on good terms with my ex actually, and in a new relationship that I am very happy with. I meant independent in the sense that I can make up my own mind now and do not rely on other people's opinion so much. Previously, I asked my husband 'do you think I should get this surgery' and when he said no, that was that. Now, I first thought it through whether this is something I want for myself or not, and when I decided I probably do, I told my boyfriend that this is what I am planning to do and explained my reasons, rather than letting him decide for me, if that makes sense. So this is how I meant 'independent'.

Once again, thank you so much for all the advice and I'll definitely post if and when I get any plans from surgeons.

[InvisalignOnly]

SOOO CONFUSED. Just had a video consult with a German surgeon - I will not name him but it's not Dr Z. He is well recognized and experienced, and has his own private clinic in Germany. A lot of the things he told me are totally different from what everyone else has told me before (he looked at my x-rays, several photos and now saw me on video).

Most importantly - until now, everyone agreed I needed double jaw surgery, except for one surgeon saying I could get away with mandibular advancement only. Now this German guy says I really only need Le Fort 1 and everything else is optional. As far as he is concerned, we could leave the chin / lower jaw as it is and just get rid of the gummy smile / visible teeth thing by changing the maxilla.

He said he uses 3D planning software, and about 2 months before the date of the surgery we could sit down together and decide what movements 'we' are planning and what they would look like on my face. Which sounds really tempting, but I was previously told that it is unpredictable how the soft tissues will respond to the bones being moved around, so this kind of software (that shows the soft tissue movements) is unreliable and leads to disappointment. So now I do not know what to believe. Is it really possible to sit at a computer with the surgeon and plan the face I want and get that result?

Finally, regarding orthodontic treatment: according to him no extractions are needed and he does not even need to communicate with the orthodontist until shortly before the surgery. My teeth (especially the lower ones) need to be pushed inward and the arches need to be widened, making sure there is enough space between the upper and lower teeth at the front and that's it.

I do not know what to think. He really impressed me by saying he uses the latest technology and 3D planning that helps him to avoid cutting the nerves, and he said that practically all his patients gain back feeling in their lower jaw (if that is operated on). Any opinions?

[Dogmatix]

SOOO CONFUSED. Just had a video consult with a German surgeon - I will not name him but it's not Dr Z. He is well recognized and experienced, and has his own private clinic in Germany. A lot of the things he told me are totally different from what everyone else has told me before (he looked at my x-rays, several photos and now saw me on video).

Most importantly - until now, everyone agreed I needed double jaw surgery, except for one surgeon saying I could get away with mandibular advancement only. Now this German guy says I really only need Le Fort 1 and everything else is optional. As far as he is concerned, we could leave the chin / lower jaw as it is and just get rid of the gummy smile / visible teeth thing by changing the maxilla.

He said he uses 3D planning software, and about 2 months before the date of the surgery we could sit down together and decide what movements 'we' are planning and what they would look like on my face. Which sounds really tempting, but I was previously told that it is unpredictable how the soft tissues will respond to the bones being moved around, so this kind of software (that shows the soft tissue movements) is unreliable and leads to disappointment. So now I do not know what to believe. Is it really possible to sit at a computer with the surgeon and plan the face I want and get that result?

Finally, regarding orthodontic treatment: according to him no extractions are needed and he does not even need to communicate with the orthodontist until shortly before the surgery. My teeth (especially the lower ones) need to be pushed inward and the arches need to be widened, making sure there is enough space between the upper and lower teeth at the front and that's it.

I do not know what to think. He really impressed me by saying he uses the latest technology and 3D planning that helps him to avoid cutting the nerves, and he said that practically all his patients gain back feeling in their lower jaw (if that is operated on). Any opinions?

I asked one of the surgeons I consulted if I could get away with only lower jaw surgery, and he responded something like this. "Well, if your question is if I can solve your bite with single jaw surgery, then the answear probably is yes. But with the aesthetic concerns you're asking about, no."
And I later asked an orthodontist same question, and got something like below.
"If you're getting yourself into this, go for a double jaw surgery", without more explanation.

If you think about it, if you losen one of the jaws, you can almost always displace it in the anticipated oclussion and get the bite right. If you losen the bottom jaw, it will be the upper jaw that is fixated and directs where the lower jaw needs to be displaced to fit, and vice versa. If you losen both jaws, you gain the degree of freedome that you can put the teeth in the anticipated oclussion, and then displace the entire complex, any way you like.

So the surgeon is probably right, you can get away with a upper jaw surgery, but it might not give you the result you're expecting or solve the issues you want solved. E.g, if you have restricted lower airways and OSA, then you need to advance the mandible for this to open, and a single LeFort surgery won't do anything for this. If your concern is the gummy smile, you might not be able to adress this to full extent if you're restricted to the mandible being fixed (or maybe you will, depends on the case).  I'd say it sounds irresponsible to "promise" on a video consultation that you only need an upper jaw surgery, and that it's something that needs to be decided when you do the actual planning and you can communicate all your expectations and concerns. I would be concerned with a surgeon that have a predefined opinion that he will not do double jaw surgery.

How did you communicate with the surgeon? What records did you send in and what concerns did you communicate you wanted to adress? Did you say that you're concerned about your airways? Did you discuss any aesthetic concerns? Or did you mostly ask what he would do without giving any directions why you're looking into this?