General Category > Emotional Support
~1 year post-op - Over-impaction nightmare w/ 2nd surgery
ImpactedMood:
Hi all, I'm looking for guidance, insight, opinions, advice, anything really.
Background
Had my 2nd jaw surgery with same OS (very experienced, renowned) here in Toronto in Feb, 2020, nearly 10 years after 1st jaw surgery with him (2011) - he didn't charge me anything btw, but spent nearly ~7k for braces again. I was never happy with profile from first surgery, but given the large emotional commitment and life events I didn't pull the trigger until last year. The ONLY objective was to move jaws forward. However I also talked to my ortho about tooth-show and the aging process and figured I could use a little MORE tooth-show (to achieve 1-2 mm of gum above front teeth in smile) which would help defend against aging. I brought this up in my consultation with OS. He told me since I was moving my top jaw forward ~6 mm it would increase tooth show, and he might even need to shorten top jaw, which surprised me.
Fast forward to day of surgery. He tells me the final measurements of moving top jaw forward 6mm, bottom jaw 10 mm, and shorten top jaw 3mm - I was shocked. I nervously asked him again - so this is to offset the forward movement? He reiterated that was the case so not to have a gummy smile..
Literally the moment I was able to see my mouth in the hospital I knew something seemed very off - my top teeth were way up high under my top lip, which was noticeably different from Surgery 1. Of course, OS said it's just lots of swelling, everything will be fine.
Longer story short - I have battled this depression and stress from the beginning. The first couple months were very hard, it was all I could think about and consumed me. OS always would say, give it time - he even said if he were to do it again he would use the exact same measurements. I haven't seen him in maybe 4+ months and the last time he was still saying give it time. He also said he had to impact also so I could close my mouth etc (but wouldn't that mean he completely ignored my wishes of 1-2mm gum show and did his own thing without telling me?). It is obvious now he really messed up.
Present
The pictures I'm attaching don't even do the damage justice imo, but I'm too lazy to take updated pictures. Suffice to say you see NO top teeth at rest or at any time (even when talking for the most part) unless I start to smile, and even then you see only half of my front teeth unless I try smiling extra hard.
I'm so unhappy with what's happened, especially because this is a NEW problem I never had before. I enjoyed smiling and now I don't - only closed mouth smiles for pictures. I feel so much anger and can never accept how this OS could have been THAT off - like 4+mm imo and in the wrong direction than what I asked (to reveal more tooth/gum, not much less).
Even worse, I'm very nervous, fearful, and emotionally unprepared to have a third jaw surgery, especially with a supposedly very risky downgraft procedure, which may leave me unhappy again after #3. But to be honest, that is what I wish to do, I don't want to live being unhappy with my smile and black hole in my mouth when it's open. Not to mention this will get worse as I age I would think.
Ugh. Anyway, I'm open to any advice, suggestions, etc. I plan on organizing several consultations with new OS's here in Toronto as soon as covid calms down a bit, to see what they think about the risks of a third surgery, etc. This OS has said he would do it if I wasn't happy again and also said I would not need braces as it's just one movement with top jaw, but I don't know how I could possibly trust him again.
Edit: I cannot stress how much the AFTER smile in this picture doesn't look as bad as how it seems 95% of the time. Maybe because I was smiling harder and teeth were just polished/cleaned, I don't know. Also, my nose is noticeably a lot wider post-op which I obv don't like either, but would not care at all about it if I were happy with my jaw outcome.
Edit #2: I should also note I AM happy about my profile improvement and have relayed that to my OS along the way. This was the reason I got a revision and I'm pretty happy with the profile positioning. It's a shame this other problem out of the blue has really erased much of this joy and any excitement post-op
GJ:
I understand your concern. The bottom right picture is definitely off, and it's not BDD or anything like that. If that picture is accurate, you have way to much lower tooth show (might be okay if you had upper tooth show along with it). 100% valid. But a video of this situation would help even more to see what is going on. Did you have a genio? I think that can pull the lower lip down, so we need to know.
Seems you're correct, and it is due to over-impaction.
Seems you're also correct that fixing it requires another surgery, and likely a downgraft.
My advice would be to pursue all of that, and while doing it work on mental health somehow (meds, therapy, etc). I get the depression, but you appear to be in prime years. Even if you don't want to go out, be productive at home so you don't look back after all this and realize you wasted years. Do something...anything...to stay productive. I'll ask a surgeon to chime in on your case.
ImpactedMood:
--- Quote from: GJ on January 08, 2021, 10:55:55 AM ---I understand your concern. The bottom right picture is definitely off, and it's not BDD or anything like that. If that picture is accurate, you have way to much lower tooth show (might be okay if you had upper tooth show along with it). 100% valid. But a video of this situation would help even more to see what is going on. Did you have a genio? I think that can pull the lower lip down, so we need to know.
Seems you're correct, and it is due to over-impaction.
Seems you're also correct that fixing it requires another surgery, and likely a downgraft.
My advice would be to pursue all of that, and while doing it work on mental health somehow (meds, therapy, etc). I get the depression, but you appear to be in prime years. Even if you don't want to go out, be productive at home so you don't look back after all this and realize you wasted years. Do something...anything...to stay productive. I'll ask a surgeon to chime in on your case.
--- End quote ---
Thanks so much for your feedback GJ, I truly appreciate it a lot. I made a short clip...
https://www.youtube.com/watch?v=Sx2Z4EfvJqo&feature=youtu.be
I did not have any genio, no.
Yeah, I know it's not BDD but I appreciate the confirmation because the only person I'm able to share these feelings with are my GF - my parents were very against me getting a 2nd surgery and I can't imagine their reaction telling them my consideration for a 3rd, but what can you do. My GF also does not want to see me go through the risks and emotional roller-coaster again (she was on the receiving end of a TON of venting over the past year), but this has never been about anyone else and just my own happiness.
I just can't understand how my OS missed by so much? It drives me crazy thinking about it. It seems at LEAST like a 4+ mm miss, if not more. Instead of impacting 3 mm it seems he should have downgrafted 1+ mm. As your signature says, when mm are like miles, how do you mis-calculate to that degree? The worst part is he knew how important this 2nd surgery was in "getting it right" and we talked about that. I distinctly told him I wished 1-2 mm of gum show when I smile - I'm just at a loss, really. And all of that when I was the one who was shocked and questioned him about 3 mm impaction, yet trusted a veteran OS obviously over my own worries.
I honestly don't care about going through the recovery, pain, discomfort, etc. - my biggest fear of a 3rd surgery is a relapse or another poor result. I've been let down twice by supposedly one of my city's best OS'.
I can keep my mental health sanity only by trying to assure myself this is just temporary, but I know that I don't really know whether that's the case, and feel there's a chance he permanently screwed me with this mistake.
Luka2020:
I agree that you show too much lower teeth after 2nd surgery, but honestly overall you look good.
What exactly you didn't like after the 1st surgery? In my opinion your profile was normal even after the 1st surgery.
What aesthetic/ functional problems you had before the 1st surgery?
Lazlo:
--- Quote from: Luka2020 on January 09, 2021, 06:11:38 AM ---I agree that you show too much lower teeth after 2nd surgery, but honestly overall you look good.
What exactly you didn't like after the 1st surgery? In my opinion your profile was normal even after the 1st surgery.
What aesthetic/ functional problems you had before the 1st surgery?
--- End quote ---
yeah exactly, why did you even want a second surgery? your profile was perfect, now it looks unnatural.
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