Different Surgical Plans

[midwest_sl8]

Hey all, I have consulted with a couple local surgeons and one of the big names on the forum for my jaw surgery. I am unsure what to do at this point. The local surgeons both just said they would do a BSSO to fix my overbite and a genioplasty "If I want". On the other hand, the big name recommended a 9mm multi-segment lefort I, a 14-15mm BSSO, and a genioplasty. If expense and logistics were not an issue I would choose the big name but he is far more expensive than the local surgeons who could cost close to zero with insurance.

My goals:
Fix overbite
Aesthetics/stronger jawline
Maximize airway volume with aesthetics in mind

Questions:
Are the large movements with the big surgeon worth the risk in my case?
Is my case an obvious DJS or could a BSSO be sufficient?
Why are the surgeons opinions so different? (9 mm multi segment lefort 1 vs none)

Edit: Might be easier to see images here:

https://imgur.com/a/XzEZgYj

[kavan]

The ceph displacement proposal plan from the 'top' doc shows an excellent outcome. In addition to multi segment Lefort, it includes a significant CCW posterior down graft. It's something of a specialty that not all maxfax doctors do.The significant CCW posterior downgraft maximizes the amount the lower jaw can be brought forward and is usually in the venue of the 'expensive' doctors rather than the free insurance ones. But that alone doesn't disqualify an insurance doctor from having similar capabilities. That's something you would need to find out by taking your plan along with you and ask if they can do similar. WITH the PLAN and the displacement read out with it, that leaves you with something IN HAND to show other doctors if you seek to consult with others who may be able to do similar for less cost.

I won't opine on things other doctors 'told you' because that doesn't substitute for a displacement proposal that can be seen for comparison. Risks are relative to the skill of a doctor and what ever risk factors you present with. That sort of thing is a discussion with the doctor, not me.

[GJ]

I agree with Kavan. Bring Gunson's plan to your local surgeons, and see what they say. Don't tell them anything Gunson said about the plan. Just get their response to it. You don't want to bias them by saying "he said xyz etc"...

I think that plan looks aggressive but also very good and logical. Make sure you need the multi-segment. That procedure adds a lot of risk (blood flow can get cut off, causing the maxilla to die. This is rare, but why take it if not absolutely needed?). See both an ortho and another surgeon to confirm that is needed, too. An ortho will know if the teeth can't be moved stably to be wide enough, and at that point you probably do need to do it surgically. Is your bite bad? If your arches aren't widen enough right now then it should be manifesting in some way with your bite. Have you seen an ortho? What did they say? Etc.

More info would be useful. Do you have apnea, bite problems, etc.

Based on that x-ray, it looks to me like flattening the curve of spee, and then advancing the lower jaw + genio could be an option that gives a good result with a lot less risk. The overjet looks enough to do that. But I'm not positive. I'd tread slowly and get more info.

[midwest_sl8]

Thanks Kavan and GJ, I will bring the surgical plan to my next appointment with a local surgeon. To answer some of your questions GJ:

I do not have apnea yet (still young) but have a family history.
Only bite "problem" I could notice is more pressure on my right side when chewing or smiling. Other than that just an overbite.

I think you're right that I need to slow down. I got G's surgical plan and wanted to just stop searching and trust his opinion. It's just hard to tell whether the local surgeons are acting conservative and sacrificing result or G has an aggressive plan, that may be great, but is not totally necessary in my case. Especially when some of the plans involve no lefort and the other involves a massive upper jaw movement and expansion.

[thedude]

That’s an ambitious plan from the well known surgeon. You’re going to look like a different person. I saw another one of his patients recently and it was similarly transformative. The cheek augmentation is a big part of that package as well. Nobody else does that and it makes a huge difference in terms of how you look.

If he thinks you need 9mm of upper jaw movement I don’t think you’re going to be happy with zero. Like others suggested you might want to show the local surgeons his plan and see if you can at least get a little closer to it if you go that route.

Though BSSO only usually does look good, and very natural, it will be a subtle change compared to the other plan. And I agree with the other poster that the multi-segmental leforts are a little sketchy, so you are taking on some risk there. People do it though. At least you’re young.

[midwest_sl8]

Could anyone elaborate on the complications or potential risks that come with a multi-segment left ? While I'm not well versed enough in the medical field to completely understand some of the literature, I have only seen it can be prone to relapse. If anybody have any literature, posts from the forum with bad experiences, or just basic explanation of why it can pose a risk that goes beyond the standard risk of jaw surgery I'd appreciate it.

[kavan]

This is the simple way to look at it:

Another cut adds another risk element but the other cut, eg, segmental lefort could also add another 'pay off' (favorable) aesthetic or functional element.

As to the multi-segment lefort, risks are lower when an experienced doctor who does that a lot than one who is not so experienced.

Risks are combination of your personal risk factors and the doctors skill to mitigate risks and/or to be braced to address possible complications.

The short of it is risks that could specifically apply to you vs. the skill of the doctor to mitigate them should be a conversation with your doctor.
-----------------------------------------------------------------

If you want to read something that has all the scary risks and complications that have been documented as being associated with maxfax surgery, here is an article:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5342970/
--------------------------------------------------

Here's the savvy way to look at it:

If you want to know the risks that your doctor wants you to accept in order to have the surgery, ask him for the LEGAL document he wants you to sign which lists all the risks. Ask BEFORE making your decision, take it home and read it and refer to it when having a conversation with your doctor.
-----------------------------

In closing, you want to know YOUR risks with YOUR selected doctor and the best way to be informed about that is WITH which ever doctor you choose.