Arnett Gunson has created a before and after results page

[Dogmatix]

If people aren't happy with those bites, they shouldn't have jaw surgery.

1mm margin of error from the best surgeons, and those look well within that if not lower. If you expect perfect you will be sorely disappointed.

Yes, they look perfect to me. But on the other hand you only see what they chose to put up and it's undetermined what amount of post operative orthodontic work was done. But at least it's a good sign that they can distinguish what to put up.

[GJ]

Yes, they look perfect to me. But on the other hand you only see what they chose to put up and it's undetermined what amount of post operative orthodontic work was done. But at least it's a good sign that they can distinguish what to put up.

I personally know some A/G patients with bad bites post-op. Every surgeon will have that issue, so at that point what is important is how they handle cases gone wrong. But with regard to this thread, all I'm saying is if those photos don't satisfy you, then you shouldn't have surgery.

[eastcoastian1]

Most of the result are quite awesome, particular from 3/4th and profile views.

That said, they better be when you're paying about 70k out of pocket.

[Movebone]

PM’d you.

Sadly I thought the same thing, that if I wanted CCW-r with downgraft it was Wolford or Gunson or nothing. Nobody here told me there are Italian surgeons who do it and who don’t cost the price of a mortgage, and they’re actually more aggressive in their movements. Get plans from
both and you’ll see for yourself. You may have more input into the final plan with these surgeons as well, AFAIK Gunson does what he wants, end of story.

I’m not telling you to not go with Gunson, I’m just saying consult with other surgeons and compare the plans.

Of course, the HA paste is a nice touch but it has its flaws as well.

Thank you for your pm. I'll definitely seek the input of those two surgeons, the price you mentioned was very appealing and the movement very enterprising. Its sad that the majority of surgeons still refuse to integrate down-grafts into their movements, pushing patients seeking the best results into either financial strain or multiple procedures. Hopefully the CW can provide results, apparently in-office before afters are very impressive.

The more I research the standard BSSO the more I find it lacking. Compared to the attached scan, why aren't these kinda cuts more popular? Are surgeons too set in their ways, like the surgeons who refuse to incorporate rotations into their procedure? Do you think its simply lack of exposure to the technique that keeps it in research papers and out of the surgical room?

This was the authors conclusion to the attached procedure;
'This modified BSSO has the same complications as conventional procedures (nerve damage, condylar resorption). However, it requires less exposure of infra-alveolar nerve length, and limits the risk of bad split due to the lack of cor­ti­cal bone that is left to brake dur­ing the cleav­age.'

[Gadwins]

I have to say that the results page is really good. Not because of the presentation itself, but more of the choose of patients. Nobody looks really special afterwards, but much better than before. So it shows all the "lookism" guys, that there is no "chope", lol. Also it shows, you have really to outweight things, if it is worth to undergo such a major procedure.

[eastcoastian1]

Thank you for your pm. I'll definitely seek the input of those two surgeons, the price you mentioned was very appealing and the movement very enterprising. Its sad that the majority of surgeons still refuse to integrate down-grafts into their movements, pushing patients seeking the best results into either financial strain or multiple procedures. Hopefully the CW can provide results, apparently in-office before afters are very impressive.

The more I research the standard BSSO the more I find it lacking. Compared to the attached scan, why aren't these kinda cuts more popular? Are surgeons too set in their ways, like the surgeons who refuse to incorporate rotations into their procedure? Do you think its simply lack of exposure to the technique that keeps it in research papers and out of the surgical room?

This was the authors conclusion to the attached procedure;
'This modified BSSO has the same complications as conventional procedures (nerve damage, condylar resorption). However, it requires less exposure of infra-alveolar nerve length, and limits the risk of bad split due to the lack of cor­ti­cal bone that is left to brake dur­ing the cleav­age.'

Are those images of the same patient? The shape of the skull looks completely different.

[Confusedguy]

I personally know some A/G patients with bad bites post-op. Every surgeon will have that issue, so at that point what is important is how they handle cases gone wrong. But with regard to this thread, all I'm saying is if those photos don't satisfy you, then you shouldn't have surgery.

I've been reading a couple of poor reviews about gunson as well and of course a surgery of this sort is supposed to have some sort of failure rate but I am worried as most of his patients with -ve reviews have been reporting similar issues with his bone paste and drastic advancements of both the jaws. I wonder if they all were really complex cases or was age a major factor. I seem to be losing hope, my case isn't severe I have a decent bite as a result of orthodontic compensation my main worry is lip incompetence and with such -ve reviews of a top tier surgeon I can't seem to find a light at the end of the tunnel ☹️

[kavan]

I've been reading a couple of poor reviews about gunson as well and of course a surgery of this sort is supposed to have some sort of failure rate but I am worried as most of his patients with -ve reviews have been reporting similar issues with his bone paste and drastic advancements of both the jaws. I wonder if they all were really complex cases or was age a major factor. I seem to be losing hope, my case isn't severe I have a decent bite as a result of orthodontic compensation my main worry is lip incompetence and with such -ve reviews of a top tier surgeon I can't seem to find a light at the end of the tunnel ☹️

Very cool way of abbreviating a word.

[droplyfe]

PM’d you.

Sadly I thought the same thing, that if I wanted CCW-r with downgraft it was Wolford or Gunson or nothing. Nobody here told me there are Italian surgeons who do it and who don’t cost the price of a mortgage, and they’re actually more aggressive in their movements. Get plans from
both and you’ll see for yourself. You may have more input into the final plan with these surgeons as well, AFAIK Gunson does what he wants, end of story.

I’m not telling you to not go with Gunson, I’m just saying consult with other surgeons and compare the plans.

Of course, the HA paste is a nice touch but it has its flaws as well.

ODog, could you also dm me the info too, would be greatly appreciated  . My plan from a noteworthy US name included a  downgraft and some impaction for CCW-r. I was going to consult with a few other names and choose one to eventually go with, given all the prices are quite high yet in a similar range. I am intrigued by the possibility of having a more aggressive plan and would love to find out more on my own case for comparison.

[kavan]

Are those images of the same patient? The shape of the skull looks completely different.

Ya. It does look different. Either a different cross section of the scan or different person. I think the latter due to the root orientation of the maxillary molars.

 It would depend on what the article is trying to CONVEY.

'a' has hardware to the maxilla and a steep OP. 'b' has no hardware to the maxilla and a normal OP.

'a' looks like linear advancement over an inherently steep OP where the bimax surgery will just exaggerate BOTH the overly steep OP and MPA.

'b' looks like it's trying to CONVEY a type of BSSO cut and extended genio that counter rotates mandible and the chin to offset the problem 'a' has with NO genio at all to offset the overly steep MPA left by the linear advancement bimax.

Although we are told (in the post) that the reference is to a type of BSSO cut, what is salient in the after photo is a type of extended genio that is giving good CCW rotation.

[eastcoastian1]

Ya. It does look different. Either a different cross section of the scan or different person. I think the latter due to the root orientation of the maxillary molars.

 It would depend on what the article is trying to CONVEY.

'a' has hardware to the maxilla and a steep OP. 'b' has no hardware to the maxilla and a normal OP.

'a' looks like linear advancement over an inherently steep OP where the bimax surgery will just exaggerate BOTH the overly steep OP and MPA.

'b' looks like it's trying to CONVEY a type of BSSO cut and extended genio that counter rotates mandible and the chin to offset the problem 'a' has with NO genio at all to offset the overly steep MPA left by the linear advancement bimax.

Although we are told (in the post) that the reference is to a type of BSSO cut, what is salient in the after photo is a type of extended genio that is giving good CCW rotation.

There’s also nothing that proves whether ‘b’ didn’t already have a pretty leveled jaw before.

[kavan]

There’s also nothing that proves whether ‘b’ didn’t already have a pretty leveled jaw before.

My assumption/guess is that the article is trying to demonstrate a CCW effect on someone with a high MPA. An assumption made in the ABSENCE of 'proof' or knowing what the article is about.

It's given that there is no proof about what the article is about. Are you trying to tell me it's 'wrong' for me to make an assumption of what it could be about.

[eastcoastian1]

My assumption/guess is that the article is trying to demonstrate a CCW effect on someone with a high MPA. An assumption made in the ABSENCE of 'proof' or knowing what the article is about.

It's given that there is no proof about what the article is about. Are you trying to tell me it's 'wrong' for me to make an assumption of what it could be about.

No I’m actually agreeing with you. I’m just stating it’s hard to tell exactly how much was achieved in b if we don’t know the starting point. How do we know that the patient even had a high angle to begin with? Again this is assuming a and b are different people.

[kavan]

No I’m actually agreeing with you. I’m just stating it’s hard to tell exactly how much was achieved in b if we don’t know the starting point. How do we know that the patient even had a high angle to begin with? Again this is assuming a and b are different people.

Basically, I don't need to see 'a''s before to know that 'a' did NOT get CCW-r. All I need to see is that 'a' has NO APPEARANCE of having had CCW-r. Similarly, I don't need to see 'b's before either to see that 'b' DOES have appearance of CCW-r and of course, from the surgery.  Hence, I don't need to 'know' because I can go through a process to assume it.

It's not too different a process of addressing one of your questions about what the woman in Mohaved surgery had. Like nobody told me what she had (doctor didn't list it). But I can go through of process to figure stuff out in the absence of  some information as to make a good guess.

Here, I'm just trying to think in terms of what they, the writers, could be wanting to convey when they show those photos side by side (assuming the photos are of different people and from the same article). We have a clue that they want to convey something having to do with CCW rotation. We see that 'a' has NO appearance of a CCW-r (because the OP and MPA are steep). But 'b' has the appearance of CCW-r.

So, it is likely they are wanting to convey something DONE to 'b' to give appearance of CCW-r.
'b' has NO plates to the maxilla, so I'm assuming no CCW-r at the maxilla. That leaves only 2 things to give a CCW-r to the mandible a type of BSSO cut and also a type of extended genio that can give a CCW-r to the anterior mandible and the chin.

Therein comes the assumption that 'b' probably started with a high MPA even though before having the surgery.

Do you have another assumption as to what the authors could be wanting to convey by having those photos side by side?

[tie]

I’m probably in the minority here but I think a lot of the patients had such bad starting points (based on their jaws) that any surgeon would have improved them. The HA paste looks good and offers a nice improvement but I mean it’s in no way better than your run of the mill zygomatic osteotomy. I’ve seen more transformative results from other surgeons who are 1/7th the price.

He does seem to have a knack for making the bite absolutely perfect, though. Very impressive.

Which surgeons please ?