Author Topic: Best surgical plan for functional/aesthetic improvement  (Read 1261 times)

Blindead

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Best surgical plan for functional/aesthetic improvement
« on: April 16, 2021, 08:00:22 PM »
Hello folks,

I was just wondering if anyone could point me in the right directions of procedures to research and high quality surgeons to possibly consult with?

TLDR:
My teeth are worn down from bruxism, I want to restore them, cannot due to crossbite - I am getting MARPE done for palatal expansion and hopefully nasal expansion as I sleep poorly and am developing sleep apnea. I also have some midface recession and was told Lefort 1 or extractions - due to my poor sleep/breathing as well just general goal of aesthetic enhancement. I'm fairly attractive but I definitely have a flatter midface just from mouth breathing my whole life and am interested in addressing that cosmetically through the same procedure. I have already had a turbinate reduction, septoplasty, and a bilateral nasal valve repair which improved my breathing so much, so the nasal aspect of my ceph's is pre-surgery.

Pertinent info:
I have a career that allows me to take 2-3 months off for recovery with no issue
I have the money to pay 50k+ for surgery if I think it's worth it
I know no cosmetic procedure is going to transform me into Christian Hemsworth and my expectations are pretty grounded

https://i.imgur.com/xCJMjjS.jpg
https://i.imgur.com/0J3NMJA.jpg
https://i.imgur.com/niW1bfL.jpg
https://i.imgur.com/Um3Yoz5.jpg
https://i.imgur.com/aP1ISt2.jpg

Thank you, I appreciate any time and insight

kavan

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Re: Best surgical plan for functional/aesthetic improvement
« Reply #1 on: April 17, 2021, 05:35:21 PM »
DECLINED:

Photos not all on same link. Photos of cephs aren't ceph files themselves. 'Pertinent info' to be looked at would have nothing to do with one's career, finances or Christian Helmsworth.

All that can be determined from this presentation is relative midface recession.

Please. No PMs for private advice. Board issues only.

GJ

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Re: Best surgical plan for functional/aesthetic improvement
« Reply #2 on: April 18, 2021, 08:32:37 AM »
Quote
I also have some midface recession and was told Lefort 1 or extractions

Well extractions would make that midface recession worse. I'm not sure why they told you that's a good plan.

It looks like you have a pretty straight forward case if you decide on surgery. Your underbite looks mild, and like it could be fixed completely by just moving the upper jaw forward. You have a curve to your teeth that will likely need a year or so in ortho before a surgery, though. I'm not sure about MARPE, but in general, I don't believe in expansion of the jaws once you're done growing. Unless they split the jaw for that procedure, I don't think it can do much besides flare teeth.
Millimeters are miles on the face.

Blindead

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Re: Best surgical plan for functional/aesthetic improvement
« Reply #3 on: April 18, 2021, 10:31:27 AM »
DECLINED:

Photos not all on same link. Photos of cephs aren't ceph files themselves. 'Pertinent info' to be looked at would have nothing to do with one's career, finances or Christian Helmsworth.

All that can be determined from this presentation is relative midface recession.

I'm not sure how to upload the actual ceph - it's an i-CAT vision disk. Is there a guide/sticky thread posted anywhere on the forum for how to structure these posts?

Well extractions would make that midface recession worse. I'm not sure why they told you that's a good plan.

It looks like you have a pretty straight forward case if you decide on surgery. Your underbite looks mild, and like it could be fixed completely by just moving the upper jaw forward. You have a curve to your teeth that will likely need a year or so in ortho before a surgery, though. I'm not sure about MARPE, but in general, I don't believe in expansion of the jaws once you're done growing. Unless they split the jaw for that procedure, I don't think it can do much besides flare teeth.

Yes, I'm not interested in extraction orthodontics at all. Unfortunately I live in a small city and it's relatively limited as far as how developed the field is here. The head of the oral surgery department at the local university only recently did his first couple MARPE cases after I spent months hounding him about it because I refuse to do a SARPE.

As far as MARPE, I have seen people talk about using cortical puncturing to ensure a split of the suture - I did watch a presentation on its use in nasal obstruction in OSA and it seemed promising but I'm now watching a video from the forum about its limitations. I'm just not really sure how to proceed - I would like to just find a very esteemed jaw surgeon in the field and let them tell me how to proceed. I just want to be able to breathe better and any aesthetic improvements are icing on the cake.

kavan

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Re: Best surgical plan for functional/aesthetic improvement
« Reply #4 on: April 18, 2021, 08:27:09 PM »
I'm not sure how to upload the actual ceph - it's an i-CAT vision disk. Is there a guide/sticky thread posted anywhere on the forum for how to structure these posts?

Yes, I'm not interested in extraction orthodontics at all. Unfortunately I live in a small city and it's relatively limited as far as how developed the field is here. The head of the oral surgery department at the local university only recently did his first couple MARPE cases after I spent months hounding him about it because I refuse to do a SARPE.

As far as MARPE, I have seen people talk about using cortical puncturing to ensure a split of the suture - I did watch a presentation on its use in nasal obstruction in OSA and it seemed promising but I'm now watching a video from the forum about its limitations. I'm just not really sure how to proceed - I would like to just find a very esteemed jaw surgeon in the field and let them tell me how to proceed. I just want to be able to breathe better and any aesthetic improvements are icing on the cake.

No, there's no sticky as to how to reformat a ceph from a medical document into a jpg or jpeg image. I'm not sure how others manage to do it or if they get the surgeons to send the files so they can be used without having to take photos of them. Just saying, photos of cephs will have distortions and I personally decline giving advice when that is so. Also, I don't keep X different tabs open, each with a different photo/file when all could be put on the same IMGUR link.

If you are looking for highly esteemed doctors, well, they have their names tossed around on this board a lot. But as a mod here, I don't want to be the one to name them because I  want to avoid appearing like I'm giving a personal recommendation or a promotion.

As to expansion of a narrow palate, there are TONS of different devices. I gave a link to those on the string where you probably found the video about limitations of one of the MSE devices. However, since you want to avoid SARPE which involves a bone born device (involving surgical installation) that doesn't tip the teeth and is KNOWN to expand the palate, you could be avoiding a solution. So, I'm hard pressed to help people who are avoiding a possible solution if one of the problems is narrow palate.

As to a 'plan', the way I look at it, a PLAN is something I can SEE like a document from the doctor with a displacement proposal on it (contour diagram of before overlayed with a contour diagram of the after) in addition to a read out of all the planned displacements. 'Have a Lefort or extractions' doesn't translate to me as a 'PLAN'.
Please. No PMs for private advice. Board issues only.

Blindead

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Re: Best surgical plan for functional/aesthetic improvement
« Reply #5 on: May 06, 2021, 01:21:31 PM »
I apologize for the delay in responding, work got crazy - I totally understand what you mean about the picture of the ceph, didn't even cross my mind at the time. I've attached screenshots from the cephs compiled into one image.

And to just clarify my intentions - I have some midface recession, shallow cheeks, etc. which is what drew me to MARPE as it's my understanding that splitting the suture non-surgically can result in a general expansion of the midface, including the cheekbones, which is an aesthetic goal of mine, as well as my desire to get nasal expansion for improved sleep and athletic performance. It's my understanding that due to the 2 cuts that aren't along the palatine suture, there is pretty minimal expansion of the midface outside of the palate with SARPE. I did watch the video you posted about EASE and it was super interesting and something I am exploring further as well, appreciate you posting that.

https://i.imgur.com/xHTQEEn.png

Thank you