Hello,
I'm really trying to get jaw surgery done as soon as possible, but feel stuck right now.
During the past couple of years I’ve seen 5 jaw surgeons. I’ve seen Dr. Wittenberg, Prof. Alfaro, Prof. Raffaini, Dr. Walline and Dr. Gunson. I've also seen a few orthodontists: Dr. Richard Ting, Dr. Rebecca Bockow, and Dr. Trista Felty.
Everything seemed to be going well at first and I was just going to pick the surgeon I felt most comfortable with. However, after my last couple of consultations, concerning discrepancies started coming up between these doctors’ opinions. Now, I’m unsure of what to do because I don’t want to embark on this journey only to make things worse or fix one problem only to cause a different problem.
I’ve been using this forum for years and it’s been an amazing resource, so I would really appreciate any input you could provide. If you could share any reading material or links, that would be great as well, as I’m eager to expand my knowledge.
My Goals
Functionally, better breathing. Here's a GIF I made which shows the aesthetic change I am aiming for:
https://imgur.com/32eeAzTBy the way, in the morph I deliberately moved my nasal base forward because Dr. Gunson wrote in his report that I was missing 4 mm of nasal support. I also deliberately pushed my lips in very slightly because it seems to look better.
Structurally, I'd love to see similar changes to the ones in this B&A from Dr. Gunson's site, and I think my face looks a lot like her's in the before photos:
https://imgur.com/dtLiV3kSurgeon ConsultationsDr. Wittenberg - He suggested medpor implants and refused to do jaw surgery on me, saying my case was not "severe" enough.
Prof. Raffaini - He initially suggested a CCW rotation with no retraction of my teeth prior to jaw surgery, and then minor orthodontic work afterward. However, as soon as I showed him photos of what I wanted to achieve, he said that 4 premolar extractions (2 upper & 2 lower) and retraction of the anterior incisors were the only way to achieve this, because I wanted my mouth to protrude from my face LESS, and not MORE after surgery. He said he would do CCW rotation, linear advancement and a small genioplasty.
Prof. Alfaro - Essentially the same as Prof. Raffaini: first he suggested the "surgery-first" protocol with no extractions and CCW rotation, but as soon as I showed him what I wanted, he said extractions would be needed before CCW, linear advancement and genioplasty.
Dr. Walline - Again, essentially the same as Prof. Raffaini. He suggested CCW rotation with no extractions, then when I showed him what I wanted, he said extractions would be needed before CCW, linear advancement and genioplasty. What was different is that he noted that my maxilla was a bit on the narrow side, and that it would be beneficial to do MSE in addition to extractions before jaw surgery.
Dr. Gunson: This consult really confused me. Gunson said he really wished I had a steep occlusal plane so that I could have CCW rotation, but that my occlusal plane was too flat already, and that if I was rotated I would end up with a "reverse smile" and a risk of functional issues. He concluded that I wasn't a good candidate for jaw surgery and that I should do genioplasty of maximum 6 mm. He said if, and only if I provided a positive sleep study, it might be an option to do MSE, extract 4 premolars and then do a linear advancement. He said if I extracted 4 premolars without MSE I would end up with a visibly narrow maxilla.
ALL of these surgeons, aside from Dr. Gunson, said that genioplasty alone wouldn't achieve the effect I wanted. I didn't get a chance to show Dr. Gunson photos of what I wanted, though.
Orthodontic ConsultationsDr. Richard Ting - He said I had a narrow upper palate and that MSE was highly recommended. He didn't think that CCW rotation would cause any of the problems that Dr. Gunson mentioned but said that linear advancement would be better for my case.
Dr. Trista Felty - She said my maxilla was almost the ideal width because my "black triangles" were very small, and that I wouldn't benefit much from MSE.
Dr. Rebecca Bockow - She said MSE + SFOT was an option but that I could probably "get by" with just correcting the shape of my dental arches and IPR (sanding down between the teeth) to make a bit of space to retract my anterior teeth with braces, before doing jaw surgery. She thought CCW rotation was an option for me.
Some Points I'm Worried About1. Dr. Gunson said that I wasn't a candidate for CCW rotation, while all the other doctors said I was.
2. Some said I really needed MSE because my maxilla was narrow, and others said it was unnecessary.
3. Dr. Gunson said doing jaw surgery could lead to a "full" appearance around my mouth. I don't know what he meant by this, but I'm wondering if the result in the photos above is achievable with jaw surgery.
4. Since a few doctors expressed concern about extractions exacerbating the width issue, I was thinking I could do MSE + SFOT to widen my maxillary and mandibular dental arches to create the space needed to retract my anterior teeth, instead of doing the premolar extractions. I don't know if this is an option and how I can get a surgeon to go along with this idea.
5. Since Dr. Gunson doesn't seem to want to work with me, it's hard to ask him about this, but he wrote in his report that I had 4mm of nasal support missing. If I'm understanding this correctly, I would need my teeth retracted and then an advancement of my maxilla to bring my anterior nasal spine forward to get the support that's missing. I don't know if this is correct or if I should expect to need to do a separate procedure later to fix this issue.
6. I don't know if the changes in the GIF I made are what I should be aiming for or if something else would look better.
Can anyone please make any suggestions or provide any input on this?
I would be very grateful.
Photos of my face:
https://imgur.com/a/rZAworbCeph and snapshot of CBCT:
https://imgur.com/a/2neyFcx