Genioplasty - yes or no?

[InvisalignOnly]

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.

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?

I never told him I only 'wanted' one jaw being moved; I assumed he would definitely suggest double jaw surgery as everyone else did that so far. I just told him something vague like I wanted to improve aesthetics and had no functional problems apart from the breathing. He did not rule out double jaw surgery and when I asked, he said that would be an option along with genioplasty, but he was just saying that Le Fort 1 on it's own could solve the aesthetic issue. Which I find very hard to believe - I imagine I would end up with a flat face and totally recessed profile and a big looking nose. Then again, who knows.

I sent him ceph x-rays, photos from different angles (smiling / at rest etc.) and during the video call he asked to see my teeth and profile from different sides (was the most awkward video call I ever made lol, but I guess there is no other way to do it).

[Dogmatix]

I imagine I would end up with a flat face and totally recessed profile and a big looking nose. Then again, who knows.

So you clearly can't jump into surgery with this surgeon at this moment. Either you continue with one of the other surgeons who you think have made more sense when you talk to them, or you send your questions and ask for clarification on what's worrying you after the description in the call.

[GJ]

I'm pretty sure I said impaction only with the lower jaw rotating very slightly and naturally from that impaction.

Seems like the only way to fix your issue given you have a short face already. And to me that's risky with the aging/nose issues mentioned.
If it's not enough later down the road you could do the chin. I think bimax would be very masculine.

Just my .02. I'd get more opinions and more records.

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?

Everyone should be using the latest technology, so you shouldn't let that effect your decision in any way.
No extractions is a good thing. But you need to ask if the traverse (width) discrepancy, if there is one, can be stably addressed orthodontically. Else you need a multi-segment lefort, and that's not something everyone can do safely.

---
Just double checked what I wrote. I said no surgery, but added if you do want it:

Regarding your case. I now see better why they want to do impaction. Still think it's risky (aging), though, given your short face. Might run into problems with your nose that you're not expecting, too, from the impaction. But technically, yes, that would be the best plan on paper, IMO.

His plan fits my thoughts on it.

[kavan]

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?

For someone who's vague in what they want, the doctor is better off sticking to the minimum of what can be done. That minimum would be addressing the gummy smile (too much gum and tooth show) with Lefort 1 impaction.

When a doctor tells a patient how they can maximize aesthetics (which takes more surgeries), it can back fire on them with only a vague request. Can give appearance of trying to upsell. Some of them are 'tuned in' to the phenomenon of the longer someone has to get used to their face, the less likely they are to appreciate a significant aesthteic improvement because with that comes an significant aesthetic change. So any attempt to tell them that they need something more and more specific than what they are asking for, positions them to 'sell' the patient on that or to be perceived as such by the patient. Hence, it's better to suggest the minimum UNLESS the patient can TARGET and make CLEAR what changes they want.

The reality of this is that sometimes, it actually takes MORE time to show someone a maximum aesthetic improvement and to EXPLAIN to them all the things that would be needed to do that than to actually DO a surgery. So, from a doctor's perspective, it's best to reserve the maximum aesthetic improvement stuff--even if they can do it-- to patients who know what changes they want and why, can be specific about it where said specifics are on target with the type of stuff the the doctor does.

[InvisalignOnly]

I'm pretty sure I said impaction only with the lower jaw rotating very slightly and naturally from that impaction.

Everyone should be using the latest technology, so you shouldn't let that effect your decision in any way.

Ok, I guess I'm so dumb when it comes to this that I did not understand what you meant when you wrote that the first time. It's still not totally clear to me - would this mean that the lower jaw would not be broken and advanced? All the other people (orthodontists and surgeons) I spoke to before said straight away that the lower part should be advanced because it is too far back. So, according to you and this German guy, this might not be a good idea?

Re: technology - the surgeon in the country where I currently live told me he only uses dental casts for planning and no computers / no 3D planning. He even told me this fancy stuff is unreliable and it is not possible to predict how the soft tissue will respond and so on so he can't see the point of the planning software or something like that. Which is one of the many reasons I never seriously contemplated doing the surgery with him and / or here, and am looking for someone in Europe.

[InvisalignOnly]

For someone who's vague in what they want, the doctor is better off sticking to the minimum of what can be done.

The reality of this is that sometimes, it actually takes MORE time to show someone a maximum aesthetic improvement and to EXPLAIN to them all the things that would be needed to do that than to actually DO a surgery. So, from a doctor's perspective, it's best to reserve the maximum aesthetic improvement stuff--even if they can do it-- to patients who know what changes they want and why, can be specific about it where said specifics are on target with the type of stuff the the doctor does.

Oh that would totally explain it, I was certainly very vague on what I really wanted out of this. I guess it can be a cultural thing too - Germans are not famous for trying to 'sell' you stuff you might not want or need and he also mentioned that one jaw (obviously) would be cheaper and would not even require an overnight stay in hospital. I guess I'll continue with consultations and maybe try to be more specific next time about what I want.

[april]

You're not dumb. It's just that this stuff is a lot more complex and complicated than it first appears, and some surgeons don't show or explain the reasonings & geometry behind their suggestions esp not in a 1st consult. So you are kinda forced to attempt to understand it yourself, which isn't easy at all, and never fully a complete understanding either.

I think when the maxilla changes height (in your case re-positioned upwards) it results in an auto-rotation and slight advancement of the lower jaw. I imagine it won't be as much compared to as if they cut and advanced the lower jaw forward though. But I also don't know - the auto rotation might also depend on how the maxilla is impacted (the whole maxilla impacted up VS the front of the maxilla impacted).

Re: technology - the surgeon in the country where I currently live told me he only uses dental casts for planning and no computers / no 3D planning. He even told me this fancy stuff is unreliable and it is not possible to predict how the soft tissue will respond and so on so he can't see the point of the planning software or something like that. Which is one of the many reasons I never seriously contemplated doing the surgery with him and / or here, and am looking for someone in Europe.

Out of curiosity, was he old?

[InvisalignOnly]

I think when the maxilla changes height (in your case re-positioned upwards) it results in an auto-rotation and slight advancement of the lower jaw. I imagine it won't be as much compared to as if they cut and advanced the lower jaw forward though. But I also don't know -  this auto rotation might also depend on how the maxilla is impacted ( the whole maxilla impacted up vs the only the front of the maxilla impacted).

Out of curiosity, was he old?

I think I understand it a lot better after your explanation, thank you!

The 'local' surgeon I mention is about 60. It's tricky because you don't want a surgeon just out of medical school that's great with computers but has no experience. On the other hand, older doctors might be set in the ways they have been doing certain procedures for several years, even if there are better ways.

The same doctor also told me he wanted to extract four premolars before the surgery (even though my wisdom teeth have already been removed), two from the top and two from the bottom. I imagine this must be some kind of an 'old' technique because the very first time I asked about this surgery twenty years ago, they told me the same thing and another doctor I saw in the country where I now live told me the same again (4 extractions, 2 top - 2 bottom). Whereas Western doctors I spoke to recently all said no extractions or maybe only from the bottom to create more space between the two sets of teeth before surgery.

[InvisalignOnly]

I now officially stopped feeling bad about being 'ignorant' and making the 'wrong decisions' about my teeth / jaws previously. Any time I speak to an 'expert', they say something different so it seems there really isn't a consensus on what to do when someone has 'weird' teeth / jaws, everyone wants to try something and it might or might not work. I e-mailed my x-rays and photos to a surgeon in Hungary and he got back to me saying he does not think I need jaw surgery, rather I should get 4 premolars extracted, two from the top and two from the bottom, which would 'improve my profile' and make my upper teeth less visible and that's it. He added that the orthodontic treatment to close the gaps would take 2.5 years (!).

I am a skinny woman with a thin face, so highly doubt that removing those 4 teeth would 'improve my profile' plus I have the upper lip incompetence and gummy smile thing going on which would still be the same even if they removed all my teeth lol. Anyway, I continue my search for the best solution.

[Dogmatix]

I now officially stopped feeling bad about being 'ignorant' and making the 'wrong decisions' about my teeth / jaws previously. Any time I speak to an 'expert', they say something different so it seems there really isn't a consensus on what to do when someone has 'weird' teeth / jaws, everyone wants to try something and it might or might not work.

Correct. It's a profession full of bulls**t and people who "know" exactly what you "need".

[Post bimax]

I would pretty much avoid extractions at all costs in your case.

[InvisalignOnly]

I would pretty much avoid extractions at all costs in your case.

Thanks, that's what I'm planning to do, especially from the upper jaw. Will see what the other surgeons come up with.

[InvisalignOnly]

It's a profession full of bulls**t and people who "know" exactly what you "need".

That's what I've been discovering in the last few weeks... Guess it comes down to the fact that most people like myself don't actually 'need' anything, but are hoping they could look better or breathe better etc. if only somebody did something about their lower face.

[kavan]

I now officially stopped feeling bad about being 'ignorant' and making the 'wrong decisions' about my teeth / jaws previously. Any time I speak to an 'expert', they say something different so it seems there really isn't a consensus on what to do when someone has 'weird' teeth / jaws, everyone wants to try something and it might or might not work. I e-mailed my x-rays and photos to a surgeon in Hungary and he got back to me saying he does not think I need jaw surgery, rather I should get 4 premolars extracted, two from the top and two from the bottom, which would 'improve my profile' and make my upper teeth less visible and that's it. He added that the orthodontic treatment to close the gaps would take 2.5 years (!).

I am a skinny woman with a thin face, so highly doubt that removing those 4 teeth would 'improve my profile' plus I have the upper lip incompetence and gummy smile thing going on which would still be the same even if they removed all my teeth lol. Anyway, I continue my search for the best solution.

Well, you seem to know what you don't want as soon as a suggestion is made. Your approach to consults is one where it's implicit that you are depending on them to tell you what you 'need' in a situation where you don't know what you want and why. That, in turn, goes into a perpetual indecision mill. Try defining your own needs and articulating your own aesthetic goals.

A good starting point would be to identify what you have that is most obvious such as: 'I have a gummy smile. I have too much upper tooth show.' Then find out what it's called (Vertical Maxillary Excess) and Google how that is treated. At least that would allow you to understand a suggestion (such as maxillary impaction CCW) to address it. You should also be able to be clear TO YOURSELF whether or not you LIKE or DISLIKE your VME. Likewise with other parts of your face. You like the recession to the lower jaw or you DON'T like it.

You probably won't get much out of any of these consults other than more indecision unless you have a clarified (aesthetic) goal you can convey.

A ship without course has no favorable wind.

[InvisalignOnly]

Well, you seem to know what you don't want as soon as a suggestion is made. Try defining your own needs and articulating your own aesthetic goals.

Ok, so I sat down with a mirror today and tried to work out what I want. I want to look as close as possible to how I look in the first picture that I'm attaching to this post (obviously, without the ridiculous looking mentalis strain because here I'm forcing my lips to close - this is a selfie without any 'special effects').

So, I want the lower part of my jaw / chin to come a bit forward and upward. At this point I have absolutely no idea if this is surgically possible. The second picture shows my teeth / jaws as they are now.

What I DON'T want is: tooth extraction, flat face, long face, long and sad looking philtrum, 'man-like' lower jaw, protruding chin.

Now I just need to find out if this is at all possible or not, and if so, who would be the best person to do it.