Rec OMS doing agressive CCW + Inverted L-Osteo ?

[XXRyanXXL]

Looking for a list of recommendations for U.S. surgeons who are currently doing CCW rotation and Inverted L-Osteo?
I only have on my list Wolford and Alfini in Texas. Any others?
Went and saw A&G and they told me I need CCW but they won't do it (and said Inverted L would benefit but doesnt do it nor ever did). He just wanted bill me $85k for a revision genio which does nothing for my dental-facial deformity and underlining health issues.
Honestly been calling offices all over U.S. and the OMS is either out of business or I get the runaround, like "I believe my collegeue can help you" which turns out they been out of business for 30+ years.
I actually have cash to afford the procedure, so I don't have to worry about the "in network" or "out of network" BS runaround that always declines you anyways even if its medically necessary (which I have in hand like the sleep study, CPAP patient, and Recs from sleep study and barium swallow tests I failed in spectacular fashion). 
Please any recs?

[kavan]

One way to find leads to doctors who do inverted L osteo is to Google for images of it which will resolve to authors of papers about the procedure.

The upper diagrams I found show cuts with no rotation to the mandible which looks like they can lop off excess length to the ramus of the mandible which they also can do with inverted L cut.


The lower diagram is a very straight forward geometrical observation I've done (via colored lines) on a diagram I found by 2 authors who perform the procedure. The diagram shows an added CCW-r can be done separately to the mandible in addition to what ever CCW-r they do to the maxilla via the inverted L cut. So, it would be the additional CCW-r to the mandible that would account for the technique providing more CCW-r than CCW-r isolated to the maxilla could provide. The relationship to the additional CCW-r to the mandible also provides a longer lower facial third . It t doesn't shorten a long lower third. It lengthens short lower third).

[XXRyanXXL]

Good analysis.
If one was interested in shorting the lower third face due to a high mandibular plane angle and occlusional plane angle, couldn't the person opt to have a genio reduction as in shaving off some of the chin, and doing maxillary impaction (if they have enough upper tooth show when smiling) which would add more CCW rotation and by the forward movement of the maxillary it would show more teeth due to the upper lip, like a cushion, or they could get an upper lip lift to show more upper teeth, right ?

[kavan]

Good analysis.
If one was interested in shorting the lower third face due to a high mandibular plane angle and occlusional plane angle, couldn't the person opt to have a genio reduction as in shaving off some of the chin, and doing maxillary impaction (if they have enough upper tooth show when smiling) which would add more CCW rotation and by the forward movement of the maxillary it would show more teeth due to the upper lip, like a cushion, or they could get an upper lip lift to show more upper teeth, right ?

Well, with reference to my observation of the length changes to the lower 3rd, they could take a cross section out of the chin for a length decrease to the chin as opposed to shaving from the bottom. So, the chin could be shortened independently without effecting the rotations done to the maxilla and mandible.

As to adding an impaction in addition to the CCW-r posterior 'drop' to the maxilla, to shorten further, both the bite and the potential aesthetic consequences to the nose would have to be taken into consideration. Impaction is going to cut off part of the nasal spine and they have to balance the bite. So, I can't tell you if an added impaction can be offered just to shorten the lower third more in the absence of any unfavorable aesthetic sequalae. It would depend on whether one's specific measurements allowed for an extra impaction.

ETA: With reference to the top diagrams I Included, it looks like they might have option to lop off a section from the ramus to shorten the lower 1/3rd (in addition to rotating). So, I guess that option could be explored with a doctor (a doctor who performs it?) who told you that you were candidate for Inverted L osteo.