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General Category => Functional Surgery Questions => Topic started by: biterelapse on October 18, 2019, 12:19:26 PM
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my dentist and my orthodontist both reccomended i get jaw surgery and at the beggining of the whole ordeal I was dead set on getting it because i saw it as the best solution to fix my "functional issues". They both "convinced me " or sold me on the idea of getting it based on airway based improvements. (i have a narrow airway)
However the more i do research and the more i find out about what this surgery really is about, ive been thinking lately, its all a big misnomer and without aesthetics being the driving force for getting the surgery, there really is no reason to get it.
simply put, if "how you look" isnt a concern (not saying it shouldn't be) there are better ways (safer) airway issues, at least the way i see it.
for example, if someone has sleep apnea issues, or breathing issues - this can be improved by simply losing weight, eating better and having better sleep hygiene
if one has bite issues, these can be corrected using a combination of orthodontics, implants, occlusal balancing, etc
I think the big issue is that this maxilofacial surgery is always "sold" to the patient as being required for functional problems, but in reality the only thing that is exclusively and predictably solved by surgery itself are esthetics and how a person looks.
id appreciate if anyone has experience with this surgery and cares to provide opinion
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For issues like sleep apnea and a maxfax surgery that OPTIMIZES aesthetics and FUNCTION, a very good analysis for that is the 'Arnett' analysis. This type of analysis is incorporated into some software coming out of SPAIN (think it's called 'Nemo') and referred to as 'FAB' which stands for something like; 'Face Airway and Bite'.
A lot of building in aesthetics with function such that there is optimal balance of both is often contingent on CCW (counterclockwise rotation) where sometimes this might call for a CCW posterior downgraft, something where there are more doctors who don't do them then those who do them. Although not everyone will be needing that type of downgraft, just be informed, the reason the technique came into existence was with the objective to optimize aesthetics WITH function.
Disclosure: My post to this regard is not an invitation to teach all about CCW posterior downgrafting or entertain IF you need one. Rather just something you may, on your own, research further.
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For issues like sleep apnea and a maxfax surgery that OPTIMIZES aesthetics and FUNCTION, a very good analysis for that is the 'Arnett' analysis. This type of analysis is incorporated into some software coming out of SPAIN (think it's called 'Nemo') and referred to as 'FAB' which stands for something like; 'Face Airway and Bite'.
A lot of building in aesthetics with function such that there is optimal balance of both is often contingent on CCW (counterclockwise rotation) where sometimes this might call for a CCW posterior downgraft, something where there are more doctors who don't do them then those who do them. Although not everyone will be needing that type of downgraft, just be informed, the reason the technique came into existence was with the objective to optimize aesthetics WITH function.
Disclosure: My post to this regard is not an invitation to teach all about CCW posterior downgrafting or entertain IF you need one. Rather just something you may, on your own, research further.
yeah thats exactly what they suggest. what constitutes the arnett analysis ? by that i mean, what separates arnett's technique from other types of analysis ?
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yeah thats exactly what they suggest. what constitutes the arnett analysis ? by that i mean, what separates arnett's technique from other types of analysis ?
Here's a link: https://www.semortho.com/article/S1073-8746(19)30046-5/fulltext
See my disclosure in my prior post: 'Disclosure: My post to this regard is not an invitation to teach all about CCW posterior downgrafting or entertain IF you need one. Rather just something you may, on your own, research further.'
So, no invitation either implied for me to describe Arnett analysis with reference to all other types.
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thanks kind sir
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for example, if someone has sleep apnea issues, or breathing issues - this can be improved by simply losing weight, eating better and having better sleep hygiene
if one has bite issues, these can be corrected using a combination of orthodontics, implants, occlusal balancing, etc
I think the big issue is that this maxilofacial surgery is always "sold" to the patient as being required for functional problems, but in reality the only thing that is exclusively and predictably solved by surgery itself are esthetics and how a person looks.
id appreciate if anyone has experience with this surgery and cares to provide opinion
While there's some truth to what you're suggesting, I think you're making some quite strange assumptions here. Re: breathing issues, I have no idea what you mean by 'better sleep hygiene' - in my case, I am a slim, fit woman with a very healthy diet and I have breathing issues probably related to my recessive jaw, nothing to do with weight or other factors. Also, a lot of bite issues cannot be fixed by orthodontics alone.
You say that aesthetic problems can be 'predictably' solved by jaw surgery - in fact it's anything but predictable, if it was, there wouldn't be hundreds of people on this forum trying to figure out what they might end up looking like after surgery. The fact is, the surgery changes the way the face looks, for the better or for the worse. So if you are fine with the way you look now, it might be a good idea not to have this surgery even if you have functional issues, in case you have complications from the surgery that might be worse than the functional issue, and / or you end up looking worse or just in a way that you don't like. This does not mean, however, that the surgery itself is useless for correcting functional problems for those who have them.
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While there's some truth to what you're suggesting, I think you're making some quite strange assumptions here. Re: breathing issues, I have no idea what you mean by 'better sleep hygiene' - in my case, I am a slim, fit woman with a very healthy diet and I have breathing issues probably related to my recessive jaw, nothing to do with weight or other factors. Also, a lot of bite issues cannot be fixed by orthodontics alone.
You say that aesthetic problems can be 'predictably' solved by jaw surgery - in fact it's anything but predictable, if it was, there wouldn't be hundreds of people on this forum trying to figure out what they might end up looking like after surgery. The fact is, the surgery changes the way the face looks, for the better or for the worse. So if you are fine with the way you look now, it might be a good idea not to have this surgery even if you have functional issues, in case you have complications from the surgery that might be worse than the functional issue, and / or you end up looking worse or just in a way that you don't like. This does not mean, however, that the surgery itself is useless for correcting functional problems for those who have them.
by sleep hygiene i meant turning off the phone/computer/screens at least 2 hours before going to bed, eating smaller meals before bed, not consuming drugs/substances that alert the nervous system too much, turning off all of the lights, etc...its marginal, but can lead to better sleep.
what kind of breathing issues do yu have ? are you short for air/oxygen during the daytime , and/or do you have sleep apnea? and if so how much apnea do you have mild, moderate, severe?
i see your point, the surgery fixing the aesthetics is not "predictable" necessarily, however my point is that the aesthetics are the only "issue" that CAN ONLY be corrected by surgery. there is no other way to alter the facial structure other than cutting/repositioning bone....meanwhile for other issues like breathing/bite/facial pain....there is a way to circumvent the need for surgery and assuage those issues without it -
howver i am generalizing here and there are some people whose jaws are so far back and/or assymetric that they literally NEED airway expansion and/or surgeical bite correction ....my argument would be wrong when referring to that group of people
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You are clearly confusing breathing issues with insomnia / sleep disorders, plus the things you mention have nothing to do with any kind of 'hygiene'. There are quite a few people with bite problems that cannot be solved by orthodontics and in fact, so called camouflage orthodontics can make their functional issues worse.
Obviously jaw surgery is very invasive with a lot of potential risks and downsides, so there are plenty of valid reasons to refuse it, but it's a bit of an exaggaration to say that the functional problems it's designed to solve can easily be solved in other ways. Some of them cannot be, but for many people it's an acceptable option just to live with the functional problems rather than have the surgery. If I was entirely happy with the way I look, I'd not get the surgery and just try to live with the breathing and bite problems I have - that's me, everyone can decide for themselves what's important to them and what risks they're willing to take.
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You are clearly confusing breathing issues with insomnia / sleep disorders, plus the things you mention have nothing to do with any kind of 'hygiene'. There are quite a few people with bite problems that cannot be solved by orthodontics and in fact, so called camouflage orthodontics can make their functional issues worse.
Obviously jaw surgery is very invasive with a lot of potential risks and downsides, so there are plenty of valid reasons to refuse it, but it's a bit of an exaggaration to say that the functional problems it's designed to solve can easily be solved in other ways. Some of them cannot be, but for many people it's an acceptable option just to live with the functional problems rather than have the surgery. If I was entirely happy with the way I look, I'd not get the surgery and just try to live with the breathing and bite problems I have - that's me, everyone can decide for themselves what's important to them and what risks they're willing to take.
got it, i agree with that.
I personally love the idea of this surgery and the benefits it can bring to me, but i just dont think we have enough data to support the stability of it. rigid fixation is pretty barbaric in my opinion (and yeah i realize theres no other alternative) maybe stem cell harvesting ? in addition, if youre a fully developed adult and your muscles, tendons, nerves have already adapted to your current facial structure, there is a chance of relapse even if jaw bones are moved into the "right" place, simply because those same "muscles, tendons, nerves" will "push back" against the new bone position and over time (maybe years) theyre prone to relapse.
have you ever had a sleep study and if so were you diagnosed with sleep apnea ? I ask because many times people with recessive jaws sleep poorly, but that doesnt necesarilly mean that the airway volume is "inadequate". many max-fax surgeons will "convince" patients that having recessive jaws necesarily leads to an "inadequate airway volume" which is not always the case. in fact i know plenty of people with recessive jaws that sleep normally. I ask because even when a sleep test's result indicate "moderate sleep apnea" that doesnt necesarilly mean you have a breathing disorder and your airway may have been compromised for a variety of reasons THAT ONE TIME YOU TOOK THE TEST. --what you ate, how much caffeine or weed you consumed that day, how your stress levels are that day, your sleep position, etc etc. by the way i dont mean to be intrusive or rude, just sharing my thoughts ;)
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Sure, you're making some good points especially regarding the risk of relapse. I'm planning to get jaw surgery primarily for aesthetic reasons, which is probably the case with lots of people, as you point out. I was too lazy to do the sleep study suggested by my ENT doctor so haven't officially been diagnosed with anything yet. I sleep fine but feel excessively tired in the morning and run out of breath really quickly when running or doing exercise, and often find I have to grasp for air even when not exercising and keep blowing my nose for no real reason, like I feel there's something 'stuck' inside. I get sinus infections often.
I also have a deviated septum which is not helping things. I know I could get a septoplasty for that, but my nose looks OK externally and after weighing up the risks vs benefits plus the cost, I decided against it. By the way, apparently quite a few people who had a septoplasty only got temporay relief and then their septum got displaced again, so it's the same potential issue as with jaw surgery (risk of relapse).
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Sure, you're making some good points especially regarding the risk of relapse. I'm planning to get jaw surgery primarily for aesthetic reasons, which is probably the case with lots of people, as you point out. I was too lazy to do the sleep study suggested by my ENT doctor so haven't officially been diagnosed with anything yet. I sleep fine but feel excessively tired in the morning and run out of breath really quickly when running or doing exercise, and often find I have to grasp for air even when not exercising and keep blowing my nose for no real reason, like I feel there's something 'stuck' inside. I get sinus infections often.
I also have a deviated septum which is not helping things. I know I could get a septoplasty for that, but my nose looks OK externally and after weighing up the risks vs benefits plus the cost, I decided against it. By the way, apparently quite a few people who had a septoplasty only got temporay relief and then their septum got displaced again, so it's the same potential issue as with jaw surgery (risk of relapse).
A septoplasty does not alter your nose's external look or structures at all. nose surgery that alters your nose's esthetics and outward structure and appearacne is called rhinoplasty.
a septoplasty, which sound like you need has almost no risk when carried out by a good doctor, its one of the more common procedures and easy to perform by someone who has the necessary expertise. furthermore, a septoplasty is covered by insurance since it has no esthetic implications whatsoever, and even if you have no insurance and have to pay out of pocket, its around $3000 dollars on average which isnt too much money considering youre fixing your most important breathing structure. Finally, i would suggest getting a CT scan of your sinuses (if you havent already ) and having your ENT check if you have turbinate hypertrophy and conchae bullosa (2 VERY common side effects of a deviated septum) .
i can relate to your breathing issues, I sometimes find myself gasping for air when im just moving around or walking, but i have no way of knowing if this is pathologically realted to the position of my jaws.
honestly, there is no reason for you NOT to get a sleep study and i would strongly reccomend you get one. again, its covered by insurance and even if they dont cover, it its only about $2000 dollars which is not an outrageous amount of money relative to the important findings a test like this one can bring to light . AT THE VERY LEAST get a pulse oxymetry test which is used to measure oxygen levels of the blood. this can give you more information on to how your breathing is affecting you at night...if you oxygen levels are fine (above 95% AFAIK) then maybe you dony even need a sleep study.
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I was too lazy to do the sleep study suggested by my ENT doctor so haven't officially been diagnosed with anything yet. I sleep fine but feel excessively tired in the morning and run out of breath really quickly when running or doing exercise, and often find I have to grasp for air even when not exercising and keep blowing my nose for no real reason, like I feel there's something 'stuck' inside. I get sinus infections often.
Have you tried the breathe right nasal strips from the pharmacy? You can't really wear them during the day in front of people w/o looking weird, but they've been helpful during the night for me. They open your nose and the air that comes in feels so refreshing.
They also kinda give you an idea of what you'd look like with wider nostrils after a jaw surgery.
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While there's some truth to what you're suggesting, I think you're making some quite strange assumptions here. Re: breathing issues, I have no idea what you mean by 'better sleep hygiene' - in my case, I am a slim, fit woman with a very healthy diet and I have breathing issues probably related to my recessive jaw, nothing to do with weight or other factors. Also, a lot of bite issues cannot be fixed by orthodontics alone.
You say that aesthetic problems can be 'predictably' solved by jaw surgery - in fact it's anything but predictable, if it was, there wouldn't be hundreds of people on this forum trying to figure out what they might end up looking like after surgery. The fact is, the surgery changes the way the face looks, for the better or for the worse. So if you are fine with the way you look now, it might be a good idea not to have this surgery even if you have functional issues, in case you have complications from the surgery that might be worse than the functional issue, and / or you end up looking worse or just in a way that you don't like. This does not mean, however, that the surgery itself is useless for correcting functional problems for those who have them.
Ruling out untoward events (getting one of the risks/complications) and whether or not the patient likes the result, with GOOD PLANNING and software (by the surgeon), aesthetic improvement IS predictable as are some deviations from it in situations where there are to be some trade-offs. With the high tech planning software, it will also list the deviations from norm IF any are to be 'trade-offs' of the design. Just because the PATIENT can't figure out what they will look like with all the planned displacements does NOT preclude predictability on the part of the surgeon designing the plan.
However, the people who do get the most out of bimax surgery are usually those who are 'bothered' by (as in not 'attached' to them or would not miss them when gone) the SAME aesthetic deviations that the surgery can 'fix' or otherwise improve on.
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A septoplasty does not alter your nose's external look or structures at all. nose surgery that alters your nose's esthetics and outward structure and appearacne is called rhinoplasty.
Yes I know. However, many people get something called a septorhinoplasty - once they cut up your nose anyway, they take the opportunity to also change the way it looks. If I wanted to get a nose job anyway, I'd combine it with the septoplasty, but decided against it, because it is a serious and uncomfortable procedure with possible complications and for me it's not worth it. The ENT doctor I saw also said it wasn't worth it, based on my CT scan. I'm not going to go into any more details about this, I feel like we are wasting each other's time going on and on about this on a jaw surgery forum.
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Have you tried the breathe right nasal strips from the pharmacy? They also kinda give you an idea of what you'd look like with wider nostrils after a jaw surgery.
Thanks for the tip, will see if they're available where I live.
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Ruling out untoward events (getting one of the risks/complications) and whether or not the patient likes the result, with GOOD PLANNING and software (by the surgeon), aesthetic improvement IS predictable as are some deviations from it in situations where there are to be some trade-offs.
I was told by more than one experienced surgeons that results aren't predictable, especially because the soft tissue response is impossible to predict. Worldwide, only a minority of surgeons use planning softwares, for example in the country where I currently live, nobody does (which is why I'm trying to get the surgery elsewhere). I recently spoke to a very reputable and experienced British maxfac surgeon and he told me he only started using 3D planning last year, and only uses it for certain cases. So this type of planning is still far from the norm (maybe it's different in certain countries like the USA), which might contribute to the 'unpredictability' factor.
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I was told by more than one experienced surgeons that results aren't predictable, especially because the soft tissue response is impossible to predict. Worldwide, only a minority of surgeons use planning softwares, for example in the country where I currently live, nobody does (which is why I'm trying to get the surgery elsewhere). I recently spoke to a very reputable and experienced British maxfac surgeon and he told me he only started using 3D planning last year, and only uses it for certain cases. So this type of planning is still far from the norm (maybe it's different in certain countries like the USA), which might contribute to the 'unpredictability' factor.
Yep, the vast majority just eyeball things and make it up as they go along. As long as the occlusal splint fits - job done.
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Yep, the vast majority just eyeball things and make it up as they go along. As long as the occlusal splint fits - job done.
thats so messed up
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I was told by more than one experienced surgeons that results aren't predictable, especially because the soft tissue response is impossible to predict. Worldwide, only a minority of surgeons use planning softwares, for example in the country where I currently live, nobody does (which is why I'm trying to get the surgery elsewhere). I recently spoke to a very reputable and experienced British maxfac surgeon and he told me he only started using 3D planning last year, and only uses it for certain cases. So this type of planning is still far from the norm (maybe it's different in certain countries like the USA), which might contribute to the 'unpredictability' factor.
Well, I attributed predictability to both aesthetic improvement AND high tech 3D planning software. So, the fact that a LOT of surgeons aren't with the program and DON'T use this kind of planning software doesn't negate my statement.
As to soft tissue responses, not being predictable, I've seen situations where they are predictable BUT the doctors WITHHOLD the information. For example the 'chimp lip' look from a lot of linear advancement for SLEEP APNEA cases on the part of doctors who not only lack good planning software but also don't do CCW posterior downgrafts.
We can get into SEMANTICS as to what exactly is predictability and say 'not predictable' because the doctor can't show the patient 'exactly' what they will look like after surgery. Yes that is true. But that doesn't negate a good aesthetic outcome being predictable with the high tech software via a surgeon who has good planning capabilities.
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thats so messed up
Not really, I'm pretty sure most surgeries are conducted like that, if not, then it would be more easy for machines to replace surgeons than it currently is.
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Not really, I'm pretty sure most surgeries are conducted like that, if not, then it would be more easy for machines to replace surgeons than it currently is.
That's right, until recently there were no computers and doctors still performed surgeries, mostly successfully. Of course for jaw surgery they used to draw plans and use dental casts etc. (which are still used). This doesn't mean that softwares aren't extremely useful, but surgery is quite possible without them of course.
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As to soft tissue responses, not being predictable, I've seen situations where they are predictable BUT the doctors WITHHOLD the information. For example the 'chimp lip' look from a lot of linear advancement for SLEEP APNEA cases on the part of doctors who not only lack good planning software but also don't do CCW posterior downgrafts.
We can get into SEMANTICS as to what exactly is predictability and say 'not predictable' because the doctor can't show the patient 'exactly' what they will look like after surgery. Yes that is true. But that doesn't negate a good aesthetic outcome being predictable with the high tech software via a surgeon who has good planning capabilities.
I think you're right re: doctors withholding information. Regarding the planning software issue - of course, ideally, one will have a surgeon who is very experienced, talented and uses high tech software, but so far I find this combination is very rare and of course very expensive (Gunson, Alfaro category). I have spoken to younger doctors with less experience that use the latest software, and older, more experienced doctors, some of whom are high profile and well regarded, that do not really use it. I wonder which one is actually more important, the high tech planning or the experience?
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I think you're right re: doctors withholding information. Regarding the planning software issue - of course, ideally, one will have a surgeon who is very experienced, talented and uses high tech software, but so far I find this combination is very rare and of course very expensive (Gunson, Alfaro category). I have spoken to younger doctors with less experience that use the latest software, and older, more experienced doctors, some of whom are high profile and well regarded, that do not really use it. I wonder which one is actually more important, the high tech planning or the experience?
Some cases are straight forward and/or achievable enough where they can be done without high tech planning software. Doctors with a lot of experience (older ones usually) do the tracings and displacement plan by hand and also the casting models.
The high tech software allows them to 'play with it' many times (on the computer) as to try different combinations of displacements and accommodates more complex cases. There also seems to be somewhat of a relationship between doctors who do the significant posterior CCW downgrafts and the high tech software, particularly the 'NEMO FAB' where the headquarters are in Spain and incorporates the Arnett analysis.
I'd say it is important for young doc who uses high tech software to ALSO know how to do the tracings and displacement proposals by hand too in addition to having experience under belt using the high tech software. The not so young, eg. Gunsun and Alfaro also know how to do by hand too.
No definitive answer as to which more important; high tech planning or experience. In GENERAL, the less complex the case and/or the less significant CCW posterior downgrafts come into play, the more likely the case will resolve to types of doctors other than types like Alfaro and Gunson... as in doctors with a lot of experience but who don't use the high tech software.
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Thanks for this, a lot of food for thought... I think you're right, it ultimately comes down to what you say at the end:
In GENERAL, the less complex the case and/or the less significant CCW posterior downgrafts come into play, the more likely the case will resolve to types of doctors other than types like Alfaro and Gunson...
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Thanks for this, a lot of food for thought... I think you're right, it ultimately comes down to what you say at the end:
:)
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As to soft tissue responses, not being predictable, I've seen situations where they are predictable BUT the doctors WITHHOLD the information. For example the 'chimp lip' look from a lot of linear advancement for SLEEP APNEA cases on the part of doctors who not only lack good planning software but also don't do CCW posterior downgrafts.
There was a post on the facebook group where someone wrote how her surgeon warned her she might look like a 'monkey', and everyone in the group was completely outraged, like how dare this surgeon say she will look like a monkey! He was unapologetically honest though. Obviously he couldn't do CCW to avoid it, lol but at least he warned her.
Do you think a 3d/VSP soft tissue mask would show a chimp lip, if it were going to happen?
I really want to avoid that at all costs. I don't trust 2d plans to show it.
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Some cases are straight forward and/or achievable enough where they can be done without high tech planning software. Doctors with a lot of experience (older ones usually) do the tracings and displacement plan by hand and also the casting models.
The high tech software allows them to 'play with it' many times (on the computer) as to try different combinations of displacements and accommodates more complex cases. There also seems to be somewhat of a relationship between doctors who do the significant posterior CCW downgrafts and the high tech software, particularly the 'NEMO FAB' where the headquarters are in Spain and incorporates the Arnett analysis.
I'd say it is important for young doc who uses high tech software to ALSO know how to do the tracings and displacement proposals by hand too in addition to having experience under belt using the high tech software. The not so young, eg. Gunsun and Alfaro also know how to do by hand too.
No definitive answer as to which more important; high tech planning or experience. In GENERAL, the less complex the case and/or the less significant CCW posterior downgrafts come into play, the more likely the case will resolve to types of doctors other than types like Alfaro and Gunson... as in doctors with a lot of experience but who don't use the high tech software.
What’re your thoughts on the use of custom-made osteosynthesis material by CAD-CAM, where the software is not only used to move bones, but also to design osteotomy guides, brocade and plates? meaning software is not only used to print an occlusal splint to guide the bite, but also to print bone cutting guides, plates and screws and print it in a way specifically customized for the patient’s biologic needs. In addition the use of a map during surgery, that includes the length and thickness used for each screw. I wonder what constitutes a patients "biologic needs" and if this only refers to size (width &length of the materials) or if there are other more important qualities of the materials that can be better fitted, to any given patients particular biology? Also, I wonder if this strategy tends to increase the chances of achieving a more stable outcome, thus reducing the chance of complications or relapse or if it only streamlines the procedure and makes it easier for the surgeon.
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What’re your thoughts on the use of custom-made osteosynthesis material by CAD-CAM, where the software is not only used to move bones, but also to design osteotomy guides, brocade and plates? meaning software is not only used to print an occlusal splint to guide the bite, but also to print bone cutting guides, plates and screws and print it in a way specifically customized for the patient’s biologic needs. In addition the use of a map during surgery, that includes the length and thickness used for each screw. I wonder what constitutes a patients "biologic needs" and if this only refers to size (width &length of the materials) or if there are other more important qualities of the materials that can be better fitted, to any given patients particular biology? Also, I wonder if this strategy tends to increase the chances of achieving a more stable outcome, thus reducing the chance of complications or relapse or if it only streamlines the procedure and makes it easier for the surgeon.
It's in the high tech venue and an extension of the 3-d planning software. First the help with planning and next the help with doing.
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Do you think a 3d/VSP soft tissue mask would show a chimp lip, if it were going to happen?
I really want to avoid that at all costs. I don't trust 2d plans to show it.
At least I don't think a software would be designed to not show 'chimp' lips. Anything else than making the best prediction they can would not make sense, why even do a prediction then. It's a well known consequence of jaw advancement, so I don't see any reason to believe this predicition would be any different in accuracy than any else.
But also, chimps look like chimps and humans look like humans. It kind of resolves to that you should have a big enough issue with current situation that you figure that it's not an option to not proceed. Of course want a doctor who can do it in the best way and if you're a candidate for ccw, that will be the best displacement to minimize this effect. The doctors can't do magic. If you get a plan where ANS is advanced in a way that protrude the upper lip, then the option may be to move it back, but then you start saying you want the chin to stay where it is and you have to chose, or probably the doctor will chose for you.
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There was a post on the facebook group where someone wrote how her surgeon warned her she might look like a 'monkey', and everyone in the group was completely outraged, like how dare this surgeon say she will look like a monkey! He was unapologetically honest though.
That's the thing with the Facebook groups, at least the one I'm in. It's full of these women that seem to have no idea what is the surgeon planning to do to their faces but they are all so convinced jaw surgery will make them look great and keep trying to convince each other of the same. If anybody questions anything or mentions anything that went wrong or could go wrong, they get upset and dismissive. That's my experience with the group anyway.
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There was a post on the facebook group where someone wrote how her surgeon warned her she might look like a 'monkey', and everyone in the group was completely outraged, like how dare this surgeon say she will look like a monkey! He was unapologetically honest though. Obviously he couldn't do CCW to avoid it, lol but at least he warned her.
Do you think a 3d/VSP soft tissue mask would show a chimp lip, if it were going to happen?
I really want to avoid that at all costs. I don't trust 2d plans to show it.
Well, with a significant maxilla advancement, a surgeon CAN predict the chimp lip even without high tech software. Chimp lip is consistent with linear advancement cases where for the mandible to go 'forward' enough or a lot, so does the maxilla, usually cases where mandibular displacements are prioritized either for airway issues or just significant retrusion. Cases where what happens to the maxilla profile component (nose base, upper lip area) would be considered a trade off (negative aesthetic one) in exchange for the wanted/needed mandibular displacement.
With CCW (posterior downgraft), the whole mandible kind of gets a 'free ride' and the 'advancement train' even before they do the BSSO. So, maxilla advancement is minimized and mandible advancement maximized.
Since there does seem to be a correlation between docs who DO CCW (posterior downgraft) and who do so to avoid using linear advancement WHEN it might have negative aesthetic consequences (to avoid chimp lip), I would suggest consulting with those types.
The 2D diagrams, at least ones I've seen out of Gunson's office that show the planned contours of the profile which DO have a focus on the lip contour, seem ok to me. Those are Nemo FAB Arnett analysis type. But other docs use similar and I guess adjust according to their own aesthetic preferences.
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That's the thing with the Facebook groups, at least the one I'm in. It's full of these women that seem to have no idea what is the surgeon planning to do to their faces but they are all so convinced jaw surgery will make them look great and keep trying to convince each other of the same. If anybody questions anything or mentions anything that went wrong or could go wrong, they get upset and dismissive. That's my experience with the group anyway.
And they all say "my surgeon is the best!"
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And they all say "my surgeon is the best!"
So true lol. I posted a question there to enquire about a surgeon that was recommended to me, could not find any information about him online beyond his qualifications. I got a response saying he appeared in a TV show, so he must be a great surgeon :))). True story. I checked and he did indeed take part in a TV show that dealt with plastic surgery, but I kind of fail to see how this makes him a great candidate to operate on my jaws. Anyway, this seems to be typical of the way they think.
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So true lol. I posted a question there to enquire about a surgeon that was recommended to me, could not find any information about him online beyond his qualifications. I got a response saying he appeared in a TV show, so he must be a great surgeon :))). True story. I checked and he did indeed take part in a TV show that dealt with plastic surgery, but I kind of fail to see how this makes him a great candidate to operate on my jaws. Anyway, this seems to be typical of the way they think.
Care to PM me the group? I'm looking for more info on surgeons (albeit it'd be from a biased group) Thanks : )
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Care to PM me the group? I'm looking for more info on surgeons (albeit it'd be from a biased group) Thanks : )
PMd you
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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4990372/
Interesting article that talks about how sometimes, joint disorders and trauma to the max-mand complex (that happens during surgery) can actually cause further opening of the bite as well as mandibular retrusion - which in turn can mess up the condyles and joint even more.
"condylar resorption causes morphologic breakdown of the TMJs and a subsequent decrease in ramus height, which results in progressive mandibular retrusion with anterior open bite. This malocclusion is called “acquired open bite associated with TMJ osteoarthritis”26."
"While the TMJ osteoarthritis can produce relatively minor open bite changes fairly slowly, the “idiopathic condylar resorption”, a condition that preferentially affects women, and is influenced by hormonal changes and external triggers, such as orthognathic surgery or other traumas7, is, in comparison, much more aggressive and can lead to severe open bite in a relatively short time"