I think that is a important point what you did say. Let me explain why I am here or why I began to think about my aesthetic. When I was 20 years old I decided to fix my open bite (for functional reasons!) and intuitively it was clear that I will need a surgery. In germany many Ortho. don't want to treat such a case, because they don't get enough money by the public insurance (but still the public insurance covers such cases).
On the other case, of course Jawsurgerist want to treat such cases and try to make money out of it. Because they want more money than what the public insurance covers, they have cruel tactics ( I think it is cruel). I went to one Jawsurgery, because I needed a formal letter for my public insurance and I wanted to be informed about the risks of such a surgery. Instead informing me about the risks, he began to say, "My face is flat". I was like, what the hell? Then I went to Dr. Kater, because he is very experienced. Again, my chin is akward, I should fix my chin.
I mean, I never thought about my appearance. I even thought that I am a really good looking guy and just wanted to fix my open bite. But in germany it is the other way around. You go to a Jawsurgerist and he says, what is wrong with you.
I began to look at my side face and noticed it looks really a little bit akward. But I couldn't say why. I went down the whole rabbit hole and began to read in the internet. I even read in this toxic forums like "lookism". Let my hair and beard grow long to camouflage my appearance.
So Jawsurgerist told me to fix that part and not because I think it should be fixed.
Still I am unhappy with my side face and I think that I am unhappy, because the chin is covered by something.
I said it is intuitively my chin should be more forward, yes, but how much forward? I would like to have an explanation why the posterior impaction isn't enough for my chin.
ok, about the length of my bottom jaw I am not really sure. I really can't see why it should be a problem, even after the posterior impaction.
So i visited already many jawsurgerist, but they just say something like that: "It has to be a bimax, it is the only possibility in your case" And I am like, ok posterior maxilla impaction is really clear for me, but why should be my bottom jaw to be shortened and why do I need a palatale expansion. I mean my upper jaw is not bigger than my bottom jaw, but also not smaller. But for such question no Jawsurgerist had time.
I would not say that Dentistry and surgery in Germany (socialized medicine but also with private pay doctors) is an 'unfortunate' situation. But rather one that you don't need to have a FORTUNE to have it. People on this board wanting maxfax surgery for AESTHETICS who gravitate to one of the US surgeons need to pay a fortune to have it, close to 100 grand ($100,000). So, that's a system where someone can be tortured socially for their appearance (someone with significant deformity) and be declined by some surgeons who could make it a lot better because they elect to appeal to treating maxfax 'problems' of people with a LOT of money instead.
So, maybe you would prefer a system like that in the US where doctors who could help patients with significant facial deformities but turn them down instead because they elect to take on SELF PAY patients who have a FORTUNE to pay them privately.
The way I look at it in your situation is that the aesthetics of your face could not be made much better at all with ortho alone and just MAYBE the system in Germany precludes them from EXPLOITING you financially via SELF PAY to undergo ortho only to find out later down that it does little to nothing to improve your aesthetics. Now if you really want proof that ortho alone isn't going to do much for you aesthetically, all you have to do is get treated that way instead of surgery and you'll find that out for yourself.
I would posit that the orthos who told you they would NOT treat you with ortho alone know damned well that ortho alone isn't going to do much at all for your aesthetics. Yet those who would treat you with ortho alone might notice that you don't notice the extent of your facial problems and might not mind at all if the ortho made your bite better in the absence of making much difference with regard to improving aesthetics. In other words, I don't see financial motivation (profit incentive) on their part as playing much of a role in what they told you.
With surgeons, they can look at your face and just SEE that it's a face that would require such things as removing a maxilla segment attributable to the open bite and unfavorable rotation of the lower jaw, expanding the narrow palate to address narrowness, moving the maxilla 'forward' to offset FLATNESS and perhaps needing to cut the maxilla in MULTI SEGMENTS in that process and for the mandible, it would be BSSO for forward advance and a type of genio that reduced chin excess yet also brought forward. All that with a PRELUDE of ortho prep where lower pre-molar extraction as possible contingency. I see those things too.
So, yes, if the system compensated them in accordance with the EXTENT of the surgery they would need to do to improve the aesthetics of ANYONE who had the SAME ceph as yours, the system would allocate more financial compensation for a doctor addressing a patient with the same ceph as yours compared to that of another patient who's ceph showed a need for MUCH LESS surgery. However, IF the system DID NOT compensate them for the extent of surgery needed to be done for a patient with a ceph like yours but INSTEAD compensated them the SAME for a more straight forward case of less complexity, they'd be electing to limit surgery to the 'easy' cases and tell someone who had a ceph just like yours; 'Sorry, we can't fix everything.'
That said, I don't see the (medical insurance) system in Germany an 'unfortunate one' but rather one you're fortunate to have. However, if you happen to have a financial FORTUNE to pay some of the doctors considered as 'aesthetic gurus', it might not involve them 'proving' to you everything you might want proven to you. But probably more technical information would come forth in a SELF PAY consult against a surgery costing a 'fortune' than you would be given when consulting with a state subsidized surgeon. The SELF PAY consultation might include a read out of ALL the many displacements along with a diagram showing the expected contour changes to the facial skeleton/soft tissue profile that would be somewhat of a function of all those displacements. But they wouldn't be providing you with an education as to teaching you about all the many displacements on the chart in the event you needed that to 'prove' to you how each one applied.
Let's see... You can't see by looking in the mirror and at your own ceph how it qualitatively deviates significantly from a good aesthetic and you need quantitative 'proof' of how much in the process of seeking opinions.
That is not too different from the type of poster who gets on here with a significant aesthetic problem wanting to avoid surgery or a type of surgery that would address what they have. Someone seeking opinions but needing 'proof' when one is given that might run counter to what they want to hear or is outside of what they understand having to do with maxfax relationships.
I would agree bi-max surgery would be the only way to address your (multiple) aesthetic issues. A narrow palate is an aesthetic problem, as 'long jaw'. But if you don't see those things even at the most basic level they could be seen, it isn't my task to 'prove' to you they are there, do a ceph tracing by hand measure all the angles and distances and then educate you what they all mean and how they apply to you and why specific surgical displacements would be needed to fix what you have. I'm not getting compensated to do all of that as a $0/hour VOLUNTEER on JSF and to do so 'just because' you're unable to RELATE to what the surgeons told you would be needed or in any contingency you would need to be subsequent to getting an opinion on JSF.
Not only are you looking for opinions but you're also holding CONTINGENT that those who give them to you 'prove' them to you. Doesn't work that way on JSF on the part of a knowledgeable JSF mod not trying to 'sell you' jaw surgery. Probably doesn't work that way in Germany either where doctors would not be compensated to give private tutorials as to 'educate' patients in all the particulars of maxfax surgery so they understand everything.
Your whole outlook is ausgef**ked to contend that surgeons in Germany 'don't care about aesthetics'just because they don't take the TIME to prove to you why their advice is what it is. Need proof? You're 20. Take 3-5 years off which is plenty of time to study all of the surgical displacements done in maxfax as they apply to the aesthetic relationships of the jaws and bite, particularly your own. In that way, you'll be better able to identify with the surgical suggestions you get for aesthetic improvement such that they will be SELF EVIDENT.
