Author Topic: 10 different surgeons, 10 different opinions! What surgery do I really need?  (Read 4394 times)

kavan

  • Global Moderator
  • Hero Member
  • *****
  • Posts: 4034
  • Karma: 426
Thank you for your kind words and of course again A HUGE thank you for your reply!  :)

Yes, it is true that I know what I don't like about my face (length and chin) and it is also true that I was hoping for the magical answer from one of the surgeons. What I didn't know when starting my research was that my case is different and more complex than the ones from other people who can just get a conventional jaw surgery or even only a genioplasty. But the whole gum/tooth/TMJ situation makes everything more difficult.
At the moment I don't feel like the other options beside the ccw-r with posterior downgraft are just a compromise because it is not my steep mandible that bothers me the most, it is my chin and that would be corrected in every surgery the doctors have suggested for my case. 
I just have to figure out which way to go now.

Furthermore the posterior down graft wouldn't even be an option if my TMJs were healthy because my ramus is so short.
If I didn't already have the TMJ problem at the moment, I would have it later after surgery. So short ramus = no down graft  :-\
When you have a short vertical ramus, you can't do too much of counter clockwise, in every case. If you increase it to move the manibular angle down, you are increasing the pressure and the muscles won't adapt to this lengthening.

Thank you so much for the book recommendation. I just purchased it and will start to read it  :D

At this point, I think your choice boils down to getting the full maxfax monty first OR an isolated genio first. I've seen cases where people who have had prior isolated genios (conservative ones) get DJS later down the line. They are not precluded from doing so and just leaving the chin where it was prior displaced. I would suggest consulting with some of the plastic surgeons who do the isolated genio for an alternative 'take' on isolated chin improvement. It's not as if a request for an isolated chin improvement is asking to compensate for bimax recession and it's not as if having the chin displaced so it looks better in it's own right should patently preclude you from getting DJS later down the line. Might even cut down on the anterior impaction extent of things later down the line when the chin point is already in a better position.

Are any of these doctors, (especially the ones who advocate having the BSSO take the chin point out with NO genio ) telling you that they would DENY you surgery later down the line if you got an isolated genio first or that it could preclude you from getting DJS later down the line? You should grill them on that aspect.

I think it's best to ponder the differences in docs wanting to do the 'full monty' DJS or close to full monty DJS after you RULE OUT isolated genio. So, you really should set up some consults with PSs who do isolated genios because you want an opinion that is ISOLATED from the maxfax field.

ETA:

I've not come across cases/situations where a maxfax surgeon actually PATENTLY REFUSES a DJS to patients who've had prior isolated genios, are satisfied with the chin correction but get the DJS later down the line for more bimax advancement. So, DO establish from the surgeons you consulted with, especially the ones you like better than the others IF they would DENY you surgery later down the line if you got an isolated genio prior.

You could also ask the plastic surgeons similar: 'Do you know of any problems with getting an isolated genio first and then later getting double jaw surgery?'

What you want to establish is whether or not a prior genio precludes you from getting DJS later down the line.

« Last Edit: June 09, 2021, 03:51:42 PM by kavan »
Please. No PMs for private advice. Board issues only.

Luis_McLovin

  • 66mm IPD
  • Newbie
  • *
  • Posts: 21
  • Karma: 1
Hi, May I weigh in and give an opinion? I’ve noticed references being made to photos however they seem to all have been deleted.