My first consultation with Alfaro

[thedude]

You might be tongue tied. Can you touch the roof of your mouth with your tongue and get behind your top back teeth with your tongue? You should be able to do both. A lot of times when the bottom front teeth are flared forward it's because your tongue is tethered to the bottom of your mouth and then you push your tongue forward when you sleep and move those teeth. It seems like a sagging chin is very often actually caused by a tongue tie because the whole tongue muscle is languishing at the bottom of your mouth instead of nicely stretched along the upper palate. I had a chin that sags more than yours and I completely corrected it by just having my tongue tie cut. I've noticed almost every person that has a sagging chin seems to have bad tongue posture. It might do more for that problem than jaw surgery. If you do have it at least in the US you can have a dentist remove it with a laser for like $500. You don't even need anesthesia. Such a simple thing that can dramatically improve your quality of life.

There is some controversy about whether tongue tie surgery is necessary and how to do it. I suspect a lot of the controversy arises in part because some doctors do it wrong. Some cut the tie with a scalpel and then stitch it back together. This is a huge mistake. I know because I made it. I had the surgery done and then went home and was dumbfounded that I couldn't even stick my tongue out as far as I could before the surgery. I immediately removed the stitches and there was an instant feeling of relief as I could stick my tongue out again and I ended up with a nice long tongue that rests naturally on the top of my mouth. I went back and looked at pictures and every person that does the surgery with suture and stitches ends up with a strange looking sausage like appendage and everyone that does a laser without sutures ends up with a nice beautiful long tongue. The tongue is a remarkable organ that remodels itself after being cut so if you stitch it in place you can't stretch it and remodel it the way it should be. So be careful if you do it. There is a lot of talk of needing "myofunctional therapy" to retrain your tongue after surgery too which is nonsense. You just need to cut the tie without suturing it and then stretch your tongue like crazy while it's healing.

I noticed too you mentioned having your chin shortened. Be very very careful with that. Your tongue is literally attached to your chin and pretty far down. I don't see how you can shave down the chin without compromising that attachment. You could end up with very bad sleep apnea by doing that. Or you might just notice you don't sleep as well as you used to and never quite feel like yourself again. Sleep apnea can completely ruin your life. I don't think shortening the chin is even worth it except in maybe the most extreme cases and then I would still say if you understood the anatomical benefit of the deformity you would choose to keep it. If you did it you would want to at least do a very large advancement of the lower jaw to compensate.

In regards thinking you have prognathism, you might just be noticing your lower lip is ahead of your upper lip. I think that is because your lower teeth are flared forward and the lower lip is resting on those teeth. I don't think it looks bad but if you wanted to correct it you might be able to do that with just braces on the lower teeth.

[InvisalignOnly]

OP, you look fine and normal, you have no functional issues, do you really want to have jaw surgery? This is major, risky surgery where bones are cut etc., lots of potential complications, and anybody that tells you the chance of nerve damage is zero is lying. You can get very lucky but the chances of no nerve damage / no lasting numbness at all are very low. I personally think people should only have jaw surgery if they feel that the potential benefits are worth the risk of nerve damage / numbness.

[eglantine]

@thedude I reply very late so I'm not sure you will read my answer but I wanted to thank you very much. I had never heard of tongue tie and it seems relevant to my case. If you can advise me with a good doctor who can do it, I'm very interested!

 I'd be very careful of the functional consequences (like sleep apnea) of my intervention (i I decide to do it). (I don't plan to shorten my chin but maybe to change the angle of my lower jaw (I'm not sure if I'm very clear  )

Thanks a lot for all your advice and the information you gave on the jawsurgery itself also !!

[eglantine]

@InvisalignOnly Thanks for your reply and warnings. Actually I'm still hesitating... Do you have any idea of the probability to get damage and complications (when you chose a very good surgeon) ?

[Lazlo]

@InvisalignOnly Thanks for your reply and warnings. Actually I'm still hesitating... Do you have any idea of the probability to get damage and complications (when you chose a very good surgeon) ?

Noone can give you probabilities really.  I mean I would say of all the surgeons, alfaro's is the least traumatizing, but that doesn't guarantee anything. What I will say is that those of us who do have a dot or small area of the lip or chin which is a bit numb or has a different feeling --it's not a dealbreaker. I have a couple numb stops and I'd go through the surgery again. It's not a terrible tradeoff. Usually the numbness happens around the chin or lower jaw. I have no experience with upper jaw numbness but it's far rarer. Again, Alfaro is prob your safest bet.

[eglantine]

@Lazslo Thank you for your reply and sharing your experience !
I guess your surgeon was Alfaro ?

[Lazlo]

@Lazslo Thank you for your reply and sharing your experience !
I guess your surgeon was Alfaro ?

No i Had surgery in the states. I like Alfaro's approach, but I don't know if his results are any good.

[InvisalignOnly]

@InvisalignOnly Thanks for your reply and warnings. Actually I'm still hesitating... Do you have any idea of the probability to get damage and complications (when you chose a very good surgeon) ?

There’s no point trying to quantify probabilities, especially because ‘damage and complications’ is so vague. This is major surgery that involves cutting bones and nerves etc. Of course there’s a possibility of different kinds of damage and complications, no matter how ‘good’ the surgeon is. Everyone has to decide individually if the risk is worth it for them.

[Lazlo]

There’s no point trying to quantify probabilities, especially because ‘damage and complications’ is so vague. This is major surgery that involves cutting bones and nerves etc. Of course there’s a possibility of different kinds of damage and complications, no matter how ‘good’ the surgeon is. Everyone has to decide individually if the risk is worth it for them.

Go into the surgery assuming you will end up with some peripheral nerve changes. Would you feel okay if you had some numb spots on your lip and chin?

[InvisalignOnly]

Go into the surgery assuming you will end up with some peripheral nerve changes. Would you feel okay if you had some numb spots on your lip and chin?

People with some numb spots are lucky. There are people like me that don’t have any numbness but altered sensation, it’s a permanent feeling that’s hard to describe. For me that’s okay because it’s not painful, very mild and overall I’m very happy with my surgery results, but I can well imagine that for many people this would not be worth it. Not to mention much bigger risks (not being able to eat or speak properly etc.).

[eglantine]

Thanks all of you for your replies !
Actually I don't really îcture what permanent dumbness would be like and what practical consequences it could have in everydaylife, so it's hard for me to know if I would be ok with it...

@Lazlo Can I ask who was your surgeon ?

[eglantine]

Hi,
I find it extremely difficult to communicate with dr Alfaro. I've sent an email more than 2 weeks ago and I still don't have any reply despite me reaching out several times (because I need a reply before my appointment with orthodonctist that is on Tuesday). I had already had the same problem earlier (very long times to get a reply).
I understand that his secretrary must be overbusy but that is really not reassuring. Why not employing more secretaries ? What would happen if once operated I need to ask something concerning my health... Has anyone had problems reaching Alfaro after being operated ?
Thanks