Journal 1: Intro, Prelim Photos, Consult Inquires

[Penguin88]

Good morning everyone.

To start, I have always hated my side profile. I have no chin. I thought about getting a chin implant but implants don't really appeal to me as I find it to be less natural. Then I had my gummy smile which stopped me from smiling all the way unless a super funny joke was cracked. Of course, that resulted in my embarrassment/insecurity coming out.

I recently switched dentists and she mentioned something about me being a mouth breather. This led me down the rabbit hole of mse but realized this wouldn't really solve my problem. This journey led me to find jaw surgery and realize its potential benefits.

First I will go over my goals and aims for jaw surgery and then my experience thus far.
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I did have braces as a highschooler and when I was finished my TMJ was triggered. This is likely from pushing my front teeth inwards resulting in my jaw dropping slightly. As such, one of my goals for this surgery (which I'll likely be paying out of pocket for) is to prevent any TMJ in the future.

Secondly, I would like to see if I could get away with just a maxillary shortening and automatic ccw rotation. I like my chin as it is and all genioplasty's I've seen all look less then ideal. Mentoplasty's seem better but I'm not sure what the difference is. At any length, I like my chin. It just needs to come up. I read a paper on maxillary impaction and it stated that for every 1mm of jaw impaction taken from the back of the maxilla, 1mm of chin was regained. In the study the impactions ranged from 3 to 8 mm. I would personally like to aim for a minimum of five and an upwards of eight mm of impaction. Aside from that I'm not sure if I should request anything else.

I am hoping that only having a single jaw worked on will help lessen the impact and make my recovery easier. I'm not sure if they (the surgeons) have to cut through the jaw muscle for maxillary surgery or if its just for mandibular surgery.

Here are my photos: https://imgur.com/gallery/LCkJd4o
Please let me know if it dosen't work. Its my first time using imgur.
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Consults:

Last night I reached out to two surgeons. Dr. Raffaini and Dr. Alfarro.

Dr. A has the better website and is taking video calls. However they have not reached out to me via email so far and I can't figure out how to schedule a video call. Currently it is in the request stage.

Dr. R has emailed me back and asked for profile photos (which are the same I gave here) and asked for an in person consultation. Besides the high extra expense (an extra 2K for where I live) and due to Covid restrictions, I have emailed him back asking for a video call and for any necessary scans or impressions to be sent via mail to him. Waiting for his assistants reply.

(He replied right as I was finishing up so here it is): He is not doing remote consultations. I have to fly in. This makes me a little frustrated as I liked his results the most but there is no way with Covid that I can get down there. And I wanted to get my jaw surgery sometimes this summer (if that was possible). I am graduating university in May and will likely be working professionally in a few months.

Any other surgeon suggestions? Ones that focus on aesthetics primarily.

[GJ]

Your Imgur link doesn't work.

[Penguin88]

https://imgur.com/a/LCkJd4o

I think this one will work.

[GJ]

Regarding potential surgeons, where are you located?

Regarding your case, I don't think upper jaw alone with auto-rotation will result in enough mandibular advancement. You're smart to want to minimize risk, but this level of recession needs at least some CCW movement of the mandible, IMO. You say you like your chin, but you really don't have much if any chin. You could ask a surgeon for a mockup showing upper jaw only, auto-rotation, and the chin moving CCW (up/forward). See what that looks like. It should look recessed still, but maybe you will like that. You have a cute, delicate type of face, so I don't think a big movement is appropriate, and maybe you'd like the plan I just outlined. If you want a more technically "correct" movement, it will involve both jaws. Part of the "cute" appearance is the gummy smile, so you have to mentally prepare to lose that.

[Penguin88]

Your right. My face is definitely more delicate and I don't want a huge change. I can see my chin when i look at myself from the side and am smiling. This and what I see on my mothers chin make me think less is more in my case. If my gonial angle was better I'd probably go for something less drastic than jaw surgery. I currently am in the united states. I want a reputable surgeon which is why I didn't mind going abroad. More than ready to loses the gummy smile. Its not cute at all and I generally don't smile that big because of it.

[GJ]

What you need, objectively and to meet "norms", is CCW rotation of both jaws, impaction of the upper jaw, and a genio. If you have specifics that you prefer, but aren't ideal (e.g. the chin comment), then you are going to have to find a surgeon willing to work with you and tailor something to your requests. This can get dicey because there's a lot that can get lost in the communications once the patient starts planning the procedure.

There are plenty of good surgeons in the U.S. I'll PM some.

[GJ]

Also mentally prepare for the reality that losing the gummy smile might age you. This is a well-known effect of impaction, and getting the right level of impaction is difficult. Over-impaction is possible. You made some comments that make me wonder if you're open to drastic changes such as this. If you are, start preparing now, because impaction will likely be involved in any plan you get.

[kavan]

The photos alone pretty much convey what you have. Vertical maxillary excess (gummy smile), corrected by Lefort 1 impaction which will result in some auto-rotation of the mandible. But probably not enough to counter all the recession there. Chin recession looks significant where genioplasty would be also in order. So, in general, your case would most likely resolve to bimax (both jaws operated on) in addition to sliding genio (outward and upward displacement of the chin).

IMO, any doctor with aim towards kicking up a good aesthetic would suggest something along the lines of what I said above. If your  personal preferences preclude surgery to both jaws and chin advancement and/or are skittish about having a dramatic but objectively favorable improvement, (meaning one where an objective observer would deem 'attractive') then you would probably need to look for doctors who are not with aim of kicking up good aesthetics.

[Penguin88]

I'm not against double jaw surgery, it just means I have to wait a bit longer since insurance won't cover it. One thing I've noticed is that it is nearly double in price to get it done inside the U.S. than travel abroad. I was planning on paying cash but I may need to look into financing options ( ). Any suggestions?

[GJ]

I was planning on paying cash but I may need to look into financing options ( ). Any suggestions?

How many kidneys you got?

[Penguin88]

Looks like I’ll be digging a graveyard lol

[CCW]

Any other surgeon suggestions? Ones that focus on aesthetics primarily.

Ramieri (Maxillo Roma) does online consultations.