Treatment Approach for Function and Aesthetics

[datem15]

Hi everyone,

I'm a 23 year old male with a number of chronic lifelong health issues to go with aesthetic concerns that I believe jaw surgery may be the fix for; I've just been left unsure of what specific surgical approach should be undertaken following a recent consult with my maxillofacial surgeon.

I don't have a lot of knowledge like many users on this forum so I'm looking to gain insight on what options I should be considering for my situation and what questions I should be asking my surgeon.

BACKGROUND

I've had orthodontics through childhood including extractions for tooth alignment due to overcrowding. This includes most recently the removal of a central incisor on the lower jaw followed by orthodontic braces to pull teeth back to fix my front teeth touching when trying to bite.

Functional symptoms:

- Lifelong sufferer of allergies paired with a deviated septum leading to chronic mouth-breathing from nasal/airway blockage/restriction that persists to this day.
- Chronic fatigue and poor concentration. Recently diagnosed with ADHD so these symptoms can be masked with stimulants.
- Anxiety
- Forward head posture and forward slanting upper body posture.
- Issues swallowing with an upright head posture (very difficult/uncomfortable).
- Can't place my tongue on the roof of my mouth without either restricting or completely blocking my airway.
- Bad snorer
- Wake up with dry mouth
- Experience sleep apnea if I sleep on my back with my head up.
- Adenoid/mouth-breather face
- Vocal projection issues; because I can't push air through my upper airways and nasal passage my voice sounds nasally and it takes a huge effort energy-wise so it's quite draining therefore I often try to avoid speaking whenever possible.

I've been undergoing regular allergy desensitisation treatment over the last 18-24 months which marginally improved my nasal breathing ability initially but I haven't had any further improvement since.

I recently saw a highly experienced maxillofacial surgeon in my city for an initial consult and expressed these symptoms to him. He's told me I require a bilateral osteotomy involving straight advancement of both jaws in combination with a septoplasty. He uses 3D planning technology and I respect his abilities having seen him before in 2017 for a genioplasty.

Images: https://imgur.com/a/u1IDUfA

__________________________


GOING FORWARD


I have aesthetic concerns about this surgery since I don't know what I'm going to look like post-op. These concerns strictly come from the maxilla advancement, as the only issue I have with my appearance is my weak lower jaw.

Looking at my side profile in the attached image(s), my mandible is already set back in relation to my maxilla. I'm concerned I might be at risk of ending up with the infamous 'chimp look' I've seen people mention here that comes with straight advancement, given my lower jaw is already weak in comparison to the upper jaw and that moving both jaws forward equally would put me at risk of this.

If I proceed, do I need to be looking at cheek implants to offset the jaw advancement and maintain facial balance?

Should I be pushing for CCW rotation? I'm not sure my surgeon or anyone in my state (Perth, Western Australia) does CCW rotation, and since travel is not an option these days I don't know if it'd even be possible.

How much am I rolling the dice here when it comes to an aesthetic outcome, be it positive or negative?

What other questions should I be asking my surgeon?

I'm quite nervous over this since it is a big decision and I don't know what I'm going to look like post-op, so please excuse me if any of the questions come across a bit stupid because again my knowledge on this topic isn't as rich as many people here.

Any suggestions or feedback is a massive help so thank you.

[kavan]

Firstly, consider labeling the last profile shot in your IMGUR link as to make clear if that shot is before or after genio.

Any advice I would render here would be based on extracting SALIENT information and not on extraneous ponderings of 'IF' you do this, then should you get that. So, I won't be engaging in all of the ponderings put forth here.

On the basis that you could be a sleep apnea case, FUNCTION is the salient issue, questions about cheek augmentation are extraneous.

As for pushing for CCW, I'll assume you know that it's something that involves a posterior downgraft. The salient here is whether or not surgeons in your area do that. More specifically, you need to know if your doctor does that. Yet, you don't relay whether YOU asked him that YOURSELF. WHY on earth would you expect anyone on here to know what your UN-NAMED doctor does or doesn't do. You don't bother to name your surgeon, so you just ruled out the possibility of anyone on here from Australia having any information as to whether he/she does CCW posterior downgrafting or not.

Your question/s resolves to wanting to have CERTAINTY in a circumstance where you relay  UNCERTAINTY. It's like needing to be CERTAIN ahead of time that one will get double 6s before they roll the dice. (Chances of getting double 6's is 1/6 X 1/6 = 1/36). However, the uncertainty presented here is pretty straight forward:

IF no doctors in your area (including your own) perform the CCW AND you are limited to your area (can't travel to those known to perform CCW), then it becomes a MOOT issue to engage in any discussion about pushing for something you might not have available to you.

The salient question you COULD get feedback for here is the one you didn't ask. So, let us know when you want feedback as to whether or not you're a candidate for what your doctor told you you were a candidate for; linear advancement.

[datem15]

Imgur updated...

I don't consider having aesthetic concerns over surgery that produces aesthetic altercations extraneous.

I mentioned that I wasn't aware if he did CCW rotation or not which would mean that I didn't ask him - because if I asked him I'd know.

I'm obviously not expecting anyone here to know what my surgeons capabilities are nor is that the focus; I posted here to raise aesthetic concerns with functional double jaw advancement and deduce what steps I can be taking to mitigate these concerns.

Yes, if no surgeons in my area offer CCW then there's no point discussing. But if the advice here reflected CCW being the superior approach I'd consider waiting until travel is an option. But linear advancement may be more than optimal - I just don't know. Hence the post.

Of course any advice on my candidacy for linear advancement is welcome.

[kavan]

ask him

[kavan]

OK. Thank you for the counter commentary.

As to cheek work, I'm saying that it's an extraneous pondering for me to opine on because it has nothing to do with the salient reason (ostensibly sleep apnea) for having surgery. 'Extraneous pondering' from my perspective relates to lack of information for me to do so. However, if others want to opine on cheek augmentation in the ABSENCE of appropriate photos to opine on it, they may do so and of course, know and request from you the appropriate photos to do so.

As to my critique about how anybody could possibly know if your un named surgeon performed CCW, it's implicit you didn't ask him because IF you did, you would know whether he performed it or not. But since you didn't ask him, nobody on here is going to know if your un named surgeon in Australia does ccw or not.

My advice has to be limited to linear advancement given all the uncertainties and absence of information needed to opine on what you wanted to engage opinions on (other than linear advancement).

You look like you could have linear advancement. To inquire further about the possible TRADE-OFF with an unfavorable upper lip contour, I would suggest you ask your surgeon if the prominence of your ANTERIOR NASAL SPINE will kick up an unfavorable aesthetic trade-off with the maxillary advancement and also if it's possible for him to trim it down if he thinks it would. THAT is the possibility you are concerned about HERE by asking on the board. But my concern is about YOUR NOT ASKING your surgeon directly about things you are concerned about which is why your presentation is fraught with information HOLES that can't be filled in for you here.