jawsurgeryforums.com
General Category => Functional Surgery Questions => Topic started by: Ginger on September 03, 2014, 07:44:03 PM
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Hi, I'm looking for a little wisdom. I plan to have braces put on this month to fix my bite. My bigger issue is that my lower jaw is asymmetric... underbite on one side with a slighter underbite on the other side. Also lovely TMJ on one side. My options are 1) braces with lower extractions or 2) braces with lower jaw surgery. Here are some of the opinions I've heard:
Ortho 1: Braces with lower extractions. She said I was a difficult case and didn't even want to deal with the asymmetry. (Not going with her.)
Ortho 2: His preferred option - jaw surgery and braces. Alternate option - braces with 2 lower extractions (I'm going with this ortho.)
Oral surgeon: Says I'm a candidate for lower jaw surgery, but said my bite can probably be fixed with braces alone.
Dentist: Advised me to stay away from surgery if it can be done with braces only. (However, she also mentioned that she doesn't know anyone who regrets jaw surgery.)
I had pretty decided on jaw surgery before I saw my dentist this week for a cleaning before my braces, and she tried to talk me out of surgery.
I can see only getting braces. However, braces without jaw surgery will only fix my bite, not the facial asymmetry. If I'm embarking on a 2+ year journey, I'd really like things to be functionally and aesthetically pleasing at the end of it. Any thoughts?
A couple of pics below:
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Were you told by all your orthos and surgeon the pros and cons of surgery? such as; chin + lower lip numbness? relapse? chance of asymmetry being amplified?
If you have sleep apnea I would be really careful with mandibular set back since it can be worsened by moving the lower jaw back.
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Braces + surgery are the only option if you want to maximise your looks and are prepared to bear the risks (which only increase as you get older). You don't have much of a chin though, so you might go from underbite to having a weakish profile.
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It may just be the pictures, but it actually looks like you have a small upper jaw cant. If that's the case, it's my understanding that you would require bi-max (double jaw surgery). I assume you'll also need a genioplasty, too.
It's also my understanding that often when the jaws are advanced (if you were to need that) it can actually make asymmetry appear worse (in some cases). I too have some frontal asymmetry and have been told, a few times, that it's incredibly difficult to correct. With that said, I've seen several cases where it was essentially corrected. I just can't yet figure out why sometimes it works, and other times it's made worse.
I was also wondering about sleep apnea based on your profile picture. Those are awkward to take yourself, so it could just be you positioning to make sure your whole face is in the picture.
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It looks like upper jaw might be an option as well.
It may just be the pictures, but it actually looks like you have a small upper jaw cant. If that's the case, it's my understanding that you would require bi-max (double jaw surgery). I assume you'll also need a genioplasty, too.
It's also my understanding that often when the jaws are advanced (if you were to need that) it can actually make asymmetry appear worse (in some cases). I too have some frontal asymmetry and have been told, a few times, that it's incredibly difficult to correct. With that said, I've seen several cases where it was essentially corrected. I just can't yet figure out why sometimes it works, and other times it's made worse.
I was also wondering about sleep apnea based on your profile picture. Those are awkward to take yourself, so it could just be you positioning to make sure your whole face is in the picture.
Was just about to say this.
You could be looking at upper, lower and genio, which is gonna cost a lot. You've then got to worry about numbness, relapse, (seemingly unavoidable) nose changes, bite and speech problems.
You might be able to get away just doing upper, because lower might be resolved with braces, and if you do decide to setback lower, the case for genio becomes pressing.
I'd consult with more surgeons before you make a decision.
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Thanks for all the replies. They're really quite helpful. Let's see if I can answer some questions:
- Risks - The oral surgeon discussed adverse effects with me, except I don't think we talked about relapse. Now to read up on that...
- Profile Yeah, those pics aren't great. Attached are a few more but not sure they're any better. I have some chin and jaw. No sleep apnea and no snoring.
- Cant - You guys may be right about a slight upper cant. I can see how upper jaw surgery may be needed for this and even a little impaction. Still I'm not sure I'm up for having the upper jaw done.
- Asymmetry LoveofScotch - Yeah, it's weird how unpredictable the surgical results are with asymmetry. I've seen some results where they say they are fixed but only look slightly better. It's definitely a risk.
My face is kind of asymmetrical all around. It's like that quote from Clueless about Amber: "From far away, it's OK, but up close, it's a big old mess." lol. Upper midline to the left, while nose, chin, and lower midline are to the right.
Oh well, I'm not looking for perfection or anything... just a better functioning bite and maybe better jaw alignment in the process. Would like to go as minimally invasive as possible to achieve those goals. And I'm almost 40... while my face is kinda wonky... I'm used to it and I'd like to look like me at the end of this : )
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How much movement do you think you need? I don't think you need much of anything done in terms of how you look. If you have an underbite then my main concern would be which jaw to move because it doesn't look like you have a big skeletal underbite.
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You have attractive features and you are well preserved (almost 40!?). Only your bite needs correction, and you can probably get away with very small movements (which hopefully will not radically alter your features - widen, tip up nose, etc..) Your teeth are almost straight, so I don't believe in 2 years. My teeth were much more crooked, and my underbite much bigger and I'm ready for surgery after 12 months*. In orthodontics, closing extraction spaces takes more time than anything. Find a good surgeon first and go with his recommended ortho. Don't bother with invisalign or lingual braces. They are not as accurate as traditional braces, take longer and linguals are hard on your tongue and hard to keep clean. Ceramics only over the top front teeth (but they may be hard to debond later and could strip some enamel!)
*Supposedly my ortho uses SureSmile planning software (says so on his website), which is meant to accelerate treatment time. He never bragged about it to me, but he is a man of few words. In contrast the other orthos I consulted with just wouldn't shut up (one gushed about SureSmile like it's the second coming of Jesus. When I mentioned this to another ortho (another big mouth) he said that "J needs it 'cause he needs all the help he can get" between the lines: the incompetent clod grabs onto every new fad that comes along).
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hi Ginger
i think you look very pretty - you kind of have a Kylie Minogue thing going on. can't believe you're almost 40. this just proves that i've aged terribly - at 32 i could easily pass as your older brother!
do you find the prospect of surgery daunting? is it a total surprise to you that it's an option or did you always have an idea in the back of your mind that it might take such a step to get the bite you want?
It's like that quote from Clueless about Amber: "From far away, it's OK, but up close, it's a big old mess." lol.
lol, i love that film - i think i've seen it about 3 times. oh to be rich in SoCal 8)
... and if you do decide to setback lower, the case for genio becomes pressing.
Sean, can a chin advancement (that's a genio, isn't it) somewhat camouflage a slight underbite? the thing i tend to notice most when someone has an underbite is the prominence of the lower lip area in contrast to the upper one. however, when the person has a full, jutting chin i think that your eye gets drawn away from the imbalanced areas above and the underbite can be less noticeable. George Michael seems to have a slightly prominent lower jaw but it's not that obvious in part, i think, due to the shape and projection of his chin.
If you have sleep apnea I would be really careful with mandibular set back since it can be worsened by moving the lower jaw back.
Is there a risk of getting sleep apnea - even if you don't have it to begin with - if you have a mandibular set back?
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How much movement do you think you need? I don't think you need much of anything done in terms of how you look. If you have an underbite then my main concern would be which jaw to move because it doesn't look like you have a big skeletal underbite.
Thanks! Yeah, it doesn't look like much of an underbite but if I try to line up my midlines, I have a noticeable underbite on one side. Pic below.
I don't think I need much movement at all. The surgery would be to fix the asymmetry, which would also take away the underbite on the weird side. The oral surgeon said he might be able to set back just the left side of my jaw, which would fix the asymmetry. It sounded like this would rotate my lower jaw to get the bite and chin centered.
[attachment deleted by admin]
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hi Ginger
i think you look very pretty - you kind of have a Kylie Minogue thing going on. can't believe you're almost 40. this just proves that i've aged terribly - at 32 i could easily pass as your older brother!
do you find the prospect of surgery daunting? is it a total surprise to you that it's an option or did you always have an idea in the back of your mind that it might take such a step to get the bite you want?
Thanks Mark! Yes, I'm pretty nervous about surgery. While I knew my chin was wonky, I thought braces would improve it along with my bite. So I was rather taken back when the orthodontist suggested surgery. It really surprised me. Oh well, it is what it is, you know? : )
lol, i love that film - i think i've seen it about 3 times. oh to be rich in SoCal 8)
Yes, Clueless is funny and has some great one-liners. As if! lol
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You have attractive features and you are well preserved (almost 40!?). Only your bite needs correction, and you can probably get away with very small movements (which hopefully will not radically alter your features - widen, tip up nose, etc..) Your teeth are almost straight, so I don't believe in 2 years. My teeth were much more crooked, and my underbite much bigger and I'm ready for surgery after 12 months*. In orthodontics, closing extraction spaces takes more time than anything. Find a good surgeon first and go with his recommended ortho. Don't bother with invisalign or lingual braces. They are not as accurate as traditional braces, take longer and linguals are hard on your tongue and hard to keep clean. Ceramics only over the top front teeth (but they may be hard to debond later and could strip some enamel!)
Thanks Plosko. 12 months - that's good to know. For surgery I was quoted 1 year in braces, surgery, then 6-8 more months with braces. 2 years if I went with the option of braces with extractions. It sounds like you're right about extractions... those spaces take awhile.
So you're ready for surgery now? That's pretty exciting : )
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Okay, I went back to the orthodontist today for impressions and paperwork.
We talked about pros and cons of both options. Again, he told me he could go with either option. However, the ortho said while he thinks I'm pretty, my asymmetry is visibly noticeable. Braces won't fix it. He let me know if I do surgery, my bite would be excellent AND I would end up being more attractive.
A sound, honest opinion was what I needed to hear. I'm going with the surgery.
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Wow, you really do have an underbite. It was not that noticeable in the prior set of photos.
I cannot stress enough the need to get multiple opinions from different surgeons. I've had many consults, and I received three grossly different plans. Seriously, you wouldn't think they were made for the same person.
Getting multiple opinions has its downside, though. How far down the rabbit hole are you ready to go?
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Wow, you really do have an underbite. It was not that noticeable in the prior set of photos.
I cannot stress enough the need to get multiple opinions from different surgeons. I've had many consults, and I received three grossly different plans. Seriously, you wouldn't think they were made for the same person.
Getting multiple opinions has its downside, though. How far down the rabbit hole are you ready to go?
Thank you, I can totally understand your point about getting several opinions. I plan to get a least one more. Either way, I'm glad I'm going with the surgery. I wanted to do it, but didn't want to seem too vain since it's somewhat optional. Glad the ortho finally gave a solid opinion.
Hmm, good question on the rabbit hole. I honestly don't really want to go down it much more. It's already been a few months of research. That said, I do research for a living and rabbit holes are my specialty :)
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You don't necessarily have to decide right this moment. Most orthodontists charge you a set price whether you have braces for 6 months or 4 years. My one year of braces pre-op cost the same amount as the teenager sitting next to me who's gonna be in them for years.
Go with an ortho who is supportive of surgery, but start out trying to see where you can get with braces alone. About 6 months in you can evaluate and see if you still want surgery.
One oral surgeon I talked to (I believe it was Dr. Posnick) said that the risk of permanent numbness is closer to about 1% for how old you are. So at 40 you'd have about a 40% chance of at least a small area permanent numbness. He may have been overstating things, but I wouldn't underestimate how risky this surgery is at your age. It's also crazy expensive and not covered by most insurances. Law of diminishing returns says that age 40 this surgery is only worth it if your bite is crazy bad and you are really really depressed about how you look.
You seem pretty well-adjusted and happy with how you look, so I would at least give braces some time before you make a decision.
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FWIW, the ortho managed to bring my midlines into alignment with braces only. Apparently this obviated the need for operating on the lower jaw.
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Thanks Mark! Yes, I'm pretty nervous about surgery. While I knew my chin was wonky, I thought braces would improve it along with my bite. So I was rather taken back when the orthodontist suggested surgery. It really surprised me. Oh well, it is what it is, you know? : )
i find the prospect really daunting but the advice and info here can be reassuring. how supportive are your friends/other half of you doing the surgery thing?
from your last pic it looks like your underbite is bit more pronounced than in the earlier ones. but is that just a result of lining up your mid lines? when your jaws relax back into their usual positions does the underbite decrease?
You don't necessarily have to decide right this moment. Most orthodontists charge you a set price whether you have braces for 6 months or 4 years. My one year of braces pre-op cost the same amount as the teenager sitting next to me who's gonna be in them for years.
Go with an ortho who is supportive of surgery, but start out trying to see where you can get with braces alone. About 6 months in you can evaluate and see if you still want surgery.
that's really interesting. when i last went to get something done about my teeth i was given the option of either orthodontics or surgery, i never realised i could have went for the latter and then changed my mind six months later. that would have been far more flexible. :)
the only thing i don't understand is doesn't the orthodontics sort of go in two different directions depending on whether you're just getting braces or going down the surgical route. doesn't the ortho camouflage a jaw discrepency one way but perhaps make it more apparent if your getting surgery. in my case if you put my lower incisors, canines and first premolars at the correct inclination my class 3 situation would get worse. but wouldn't the ortho be moving these teeth in the other direction (and maybe tipping my upper incisors forward) if i was only having braces? ???
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Yes, orthodontical preparation for jaw surgery is called decompensation.
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is there an initial period during the orthodontic treatment where the teeth are sort of just loosened up a bit (can't think of anything else) where the treatment plan wouldn't vary between a patient going for surgery and one not?
also, is it usual for dental compensation that's already occurred as you grew to go far back into the mouth? i mean, certainly the incisors might be affected but would molars have changed their inclinations due to a jaw misalignment?
just from looking at pics many people who don't appear to have had braces have crowded/crooked lower incisors. I've read this comes from the lower jaw growing a bit longer than the upper with the result being that the lower incisors are left with no space and so are 'uprighted' into a smaller arc.
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The goal of decompensation is to get the teeth in such a position that the jaws can be moved enough to correct the skeletal discrepancy while still giving you a good bite. That's not always possible though like in my case. I am post-surgery and my teeth are now aligned exactly as they're supposed to be, yet I still have a skeletal underbite of around 1 cm. I'm not really sure how that can happen.
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You are a most special snowflake ;)
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Go with an ortho who is supportive of surgery, but start out trying to see where you can get with braces alone. About 6 months in you can evaluate and see if you still want surgery.
Thanks. This would be the route I would go if I could. The need for lower extractions with the 'braces only' option is the one thing stopping it. Extractions would need to be done now.
And thanks for the nerve damage info. I didn't realize the risk went up so much with age. It's a risk for some serious consideration.
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Thanks. This would be the route I would go I could. The need for lower extractions with the 'braces only' option is the one thing stopping it. Extractions would need to be done now.
And thanks for the nerve damage info. I didn't realize the risk went up so much with age. It's a risk for some serious consideration.
Don't pay the ortho upfront if possible. Extra motivation for them. I've been told people don't notice the numbness after a while.
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I'm your age Ginger and I didn't have any numbness at all, everything else went wrong but not that ;D
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i find the prospect really daunting but the advice and info here can be reassuring. how supportive are your friends/other half of you doing the surgery thing?
from your last pic it looks like your underbite is bit more pronounced than in the earlier ones. but is that just a result of lining up your mid lines? when your jaws relax back into their usual positions does the underbite decrease?
Mark, good questions. Yes, the more noticeable underbite is from lining up my midlines, which brings my chin center. It shows how much asymmetry is really going on. When my jaws are in normal position, it's more of an edge to edge bite/ very slight underbite.
As for support, I haven't told many people yet. My sister is very supportive. She used this orthodontist and loves him. Her teeth were much more crooked than mine and they're beautiful now. She was pretty symmetric to begin with though.
My husband... he thinks I look fine and that my crookedness is part of my charm. lol. Mostly I think he's nervous about surgery because of possible complications, and would rather have me skip it. However, he also aware that my bite has caused serious issues like worsening TMJ and even nerve damage. If I do have surgery, he'll be supportive.
I haven't told hardly any friends about surgery... when I mention even braces, they act surprised. Most told me they think my teeth are pretty straight. My closest friend guessed I had braces when I was younger. It kind of goes to show you how much people really notice... probably less than we think.
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It looks like upper jaw might be an option as well.
I think you're right. Looking through some of my other pics, I probably need at least an at least an impaction to go along with lower jaw surgery. My normal smile isn't gummy, probably because of lip size, but things can get gummy if I smile big or laugh.
Wow, you really do have an underbite. It was not that noticeable in the prior set of photos.
I cannot stress enough the need to get multiple opinions from different surgeons. I've had many consults, and I received three grossly different plans. Seriously, you wouldn't think they were made for the same person.
Getting multiple opinions has its downside, though. How far down the rabbit hole are you ready to go?
It really is a rabbit hole, isn't it?
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Well, my profile pics above are pretty crappy. Bad angles and I have a some weight masking my lower jaw. New profile pics below, along with angled views. These better show how long my lower jaw is, especially on the left side. (Can you tell I'm not a big fan of my left side?) Right side is bit shorter than the left but still has a bit of an underbite.
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I'm your age Ginger and I didn't have any numbness at all, everything else went wrong but not that ;D
That's good news about the numbness, but damn, I'm sorry to hear things didn't go well.
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Ginger, I think you look really good as well - you have very good skin. I suppose if you go for surgery and end up with something close to a perfect smile/jaw shape you really will have a very attractive face. but then your in the happy place of being attractive to begin with. :)
it's good to hear that your sister and husband are supportive. as surgery must be an intensely emotional ordeal having your nearest and dearest fully behind you is probably really important, don't you think?
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Hey Ginger,
Just out of curiosity, what side do you have TMJ/TMD issues on?
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Hey Ginger,
Just out of curiosity, what side do you have TMJ/TMD issues on?
Hi LoveofScotch, TMJ is on the right side. Right side of my jaw is forced more to the right due to the longer jaw length on the left. It puts the right joint in a weird position.
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Impaction is aging. It's only necessary if you have lip incompetence or severe gum show even with a faint smile. Don't do it.
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is it aging because the soft tissue isn't as 'stretched' vertically over the underlying bone structure? you know, given more slack which in turn leads to future wrinkles.
also, how many milimetres of gum show when smiling would put you in the severe bracket?
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Previously I thought 1 mm when smiling hard is considered normal. ( I have none, BTW) I just saw my surgeon, and he said "it depends". Gum thickness, tooth crown length.. But the point is, as you get older, soft tissue descends. So you will notice on older people less upper tooth show, more lower tooth show. Conversely people with slightly gummy smiles look younger than they are.
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I'd say that anything more than 2mm could be considered too much.
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IMO, while upper jaw surgery is easier to recover from, and a retruded upper jaw is the main cause of underbites in caucasians (hence a Le Fort I advancement being the major movement and often the only one in whites) , I would be very hesitant to touch it in your case. No operation has as big of an impact on a person's appearance as a Le Fort I (for better or worse). And your mid face looks just about perfect.
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the thing is, in my case, i think that my anterior teeth have longish crowns (does this feature go with a skeletal anterior open bite pattern?) so in my case i'd worry that if my maxilla was dropped down at the front enough to fully expose my upper anterior teeth i could end up looking a bit toothy when i smile, if you know what i mean.
do surgeons ever take this into consideration, leaving some of the upper teeth concealed when dropping the maxilla so as to avoid 'toothiness'? :-\
...a retruded upper jaw is the main cause of underbites in caucasians (hence a Le Fort I advancement being the major movement and often the only one in whites)...
that's very interesting. is there some connection between this and the varying frequency of cleft palates found amongst east asians, caucasians and black people? i wonder does this increase the likelyhood - i'm caucasian (sounds odd to say) - that it's my maxilla that's the sole cause of my underbitish alignment? ???
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Impaction is aging. It's only necessary if you have lip incompetence or severe gum show even with a faint smile. Don't do it.
Plosko, thanks for the info about impaction being aging. After looking at some before/after pics of people who had impaction, I can see what you mean. One woman in her 30's I looked at had a just a bit of gumminess. After impaction she looked at least 5 years older. The slight gumminess must have helped her look at bit younger.
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Ginger - wow you're gorgeous! (and I'm not going to say "for 40" because I loathe the assumption that women over 25 are unattractive by default). Anyway, I personally don't think lower alone is the most ideal plan for your because your lower jaw doesn't look significantly too big for your face. I'd advise to go for advancement of the upper, plus maybe a small genio if you want a smaller chin. Or bimax if the asymmetry is top and bottom
Yes, impaction is aging because faces become shorter with age as the teeth wear down and the lip droops too, meaning less tooth show
Go with an ortho who is supportive of surgery, but start out trying to see where you can get with braces alone. About 6 months in you can evaluate and see if you still want surgery.
Hmm, I'm not sure about this. If you start to close your underbite with orthodontics and then decide you want surgery then you will have to open it again!!
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you look really good to me.
Thanks! Your surgery is soon, right? Good luck!
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How big is your underbite? I'm concerned that moving your jaws will make you look worse because your profile looks good right now. Is it just one side?
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Ginger, I think you look really good as well - you have very good skin. I suppose if you go for surgery and end up with something close to a perfect smile/jaw shape you really will have a very attractive face. but then your in the happy place of being attractive to begin with. :)
it's good to hear that your sister and husband are supportive. as surgery must be an intensely emotional ordeal having your nearest and dearest fully behind you is probably really important, don't you think?
Thanks Mark - that's very nice of you to say.
I think my jaw was supposed to look like my little sister's jaw. If that's how I end up kind of looking after surgery, she'll be happy because we'll look more like we're related.
Do you have friends and family who will be supportive if you decide to have surgery?
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How big is your underbite? I'm concerned that moving your jaws will make you look worse because your profile looks good right now. Is it just one side?
Hi Gregor -- the underbite is on both sides, but more on one left. I don't have the exact measurements but I remember the ortho pointing out to me on the xrays how the underbite on the right side was about width of 1/2 the upper back molar. On the right, about 3/4 to almost the full upper back molar.
My braces go on today -- I'll see if I can get my xrays from the ortho to put up here.
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Ginger - wow you're gorgeous! (and I'm not going to say "for 40" because I loathe the assumption that women over 25 are unattractive by default). Anyway, I personally don't think lower alone is the most ideal plan for your because your lower jaw doesn't look significantly too big for your face. I'd advise to go for advancement of the upper, plus maybe a small genio if you want a smaller chin. Or bimax if the asymmetry is top and bottom
Tiny, thanks for the lovely compliment and your thoughts on this.
Hmm, I'm not sure about this. If you start to close your underbite with orthodontics and then decide you want surgery then you will have to open it again!!
I think you're right... I have a bit of wiggle room to change my plan but not much. My braces went on yesterday. I probably need to decide for sure by my next appointment in 8 weeks.
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Okay, I spaced getting copies of my xrays at my appointment. (However, they gave me a t-shirt emblazened with the ortho's name and a coupon for free ice cream. lol) Will try next week...
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How big is your underbite? I'm concerned that moving your jaws will make you look worse because your profile looks good right now. Is it just one side?
Yeah, looking worse is valid concern, and one I'm really thinking about now. The oral surgeon said my underbite is minor enough to be fixed with braces and my asymmetry is within standard deviation. And after looking at before/after pic of asymmetry surgeries, I'm not impressed. Not sure if surgery is actually worth the risk.
My sister and I have similar lower jaws (it's our grandma's jaw), but mine just grew longer and wonky. A couple of pics of my sister and me below to compare (she's the one with darker hair). The pics show what my jaw might kind of look like if it was moved into better position.
*Edited to remove sister's pics.
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You are more attractive than your sis, wonky jaw and all. I'd be tempted to leave well alone and just go with orthodontics.
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Oh, Ginger, I don't know what I would do. One of the reasons I've been dragging my feet with surgery is I'm afraid I'll look worse after, too. I'm afraid to have surgery because I don't want to mess up my face, lol. If you can legitimately fix your bite w/o surgery, it may be something to consider.
I don't know...
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Since you mainly want to fix your bite and not change the way you look, you'll probably need very small movements of both jaws.
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You are more attractive than your sis, wonky jaw and all. I'd be tempted to leave well alone and just go with orthodontics.
Thanks. I'm tempted to go with just the braces as well.
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Oh, Ginger, I don't know what I would do. One of the reasons I've been dragging my feet with surgery is I'm afraid I'll look worse after, too. I'm afraid to have surgery because I don't want to mess up my face, lol. If you can legitimately fix your bite w/o surgery, it may be something to consider.
I don't know...
I'm glad I'm not the only one of the fence about having surgery. It's a big decision with no guarantees.
Now I'm leaning towards braces only and calling it good enough.
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I'm glad I'm not the only one of the fence about having surgery. It's a big decision with no guarantees.
Now I'm leaning towards braces only and calling it good enough.
From what I've seen, most of the people who end up unhappy after surgery are those who liked how their faces looked pre-op. I think you should contact more surgeons and orthos though and explore if it's possible to fix your bite without having any extractions because that can potentially change your face.
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Yea, I completely agree with GS. If you need extractions to fix your bite without surgery, that could/would be a game changer (in my opinion).
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Yeah, if I go for braces only, I would need 1 or 2 lower teeth extracted. No upper extractions.
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Yeah, if I go for braces only, I would need 1 or 2 lower teeth extracted. No upper extractions.
If possible, try to consult with other surgeons and orthodontists first and see if you can have it done without extractions.
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Honey... You need no extractions and you need upper and lower jaw surgery.
http://m.youtube.com/watch?v=bIivMIcwGhQ&list=PLjC4hIwmyQfjQWNkTyvRUV1iqKdaIAgjD
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Ginger honestly you are very attractive nothing wrong with your jaw at all. align your teeth a bit. don't touch your upper jaw the risk is that you will loose your nice Forward projected face.
Thanks phantomoftheopera. That's nice of you to say.
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From what I've seen, most of the people who end up unhappy after surgery are those who liked how their faces looked pre-op. I think you should contact more surgeons and orthos though and explore if it's possible to fix your bite without having any extractions because that can potentially change your face.
Since you mainly want to fix your bite and not change the way you look, you'll probably need very small movements of both jaws.
Hmmm, I wouldn't say I totally love the way I look. More like I've gotten used it? My lower jaw does bother me. The asymmetry is the bigger issue, but my jaw also makes my face long. I tend not to smile with my mouth closed because it emphasizes how long my jaw and chin are.
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Still deciding. This is exhausting :-\ It's been 2 months in braces so far. My orthodontist has been very patient with my indecision about surgery. There's about a month before the orthodontist needs an answer from me. I've talked with one surgeon. Next week I go in for new wires, and I'll ask the ortho for a second surgeon referral.
I'm going back to the first surgeon this month. My health insurance doesn't cover this surgery >:( He quoted around $15,000 for surgery and hospital fees.
I would definitely go the surgery route if my insurance paid for this, which it won't. If I pay for it myself, I'll need to save as much as I can and charge a credit card for the rest, mortgage my house, or find a different insurance that covers this (not successful so far in my area). Ugh.
Are other folks in this situation of having to pay for surgery? It's such a crappy situation when the cost can influence the decision on whether or not have surgery.
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Oh, Ginger, I'm sorry.
I think many of us are in the position of having to pay for a lot (if not all) of this surgery out-of-pocket. I would put "lol" after that to lighten the mood, but IT'S NOT FUNNY. I'm lucky to have really, really good insurance (which is going up another f**king 20% starting January 1, 2015), but many surgeons are out-of-network. Even if I work with someone in-network, I will still have additional cash costs.
You're welcome to send me a PM if you want more specifics.
Take care, Ginger :)
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Just an update...
I've been in braces for about 5 months. I talked with the surgeon again today since I'm still deciding on surgery. I feel like I got quite a bit more information this time around.
Lower jaw - The asymmetry of the lower jaw is obviously my main issue. From what I understand, he would move the long side back about 7 mm which would rotate my chin to center. Other side would be moved back more like 2-3 mm.
Upper jaw - I asked about the upper jaw since I have a cant, and also some downward growth/gumminess. The surgeon agreed on both counts, but said both issues are so small that it is not absolutely necessary to do upper jaw surgery. He said my cant is less than 2 mm. If we did the upper jaw, he would correct the cant and impact 1-2 mm for the gumminess.
Interesting news about the gumminess. He said I have a hyperactive upper lip. (Aha!) It makes me show a lot of gum, over 4 mm when I smile really big. If I don't do upper jaw surgery, I could calm down the hyperactive lip with botox. (I may do the lip botox soon and see what I think.)
A couple of pics below from the front to show the asymmetry. Last two pics show the gummy smile, and the last one also shows the hyperactive upper lip in action.
I'm leaning towards surgery, at least for the lower jaw. Upper jaw... I'll need to think on that one. Might as well fix all of it?
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A somewhat gummy smile on women is fine, as long as it's not this
http://drrichardjoseph.com/photos/121.php
Impaction can be aging. As others have told you here you have a great face. I would only do very conservative movements to fix things at the occlusion level, but nothing that would drastically change the way you look. Make sure your surgeon communicates exactly what he will do and what the expectations should be.
BTW, does your bite really bother you that much?
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This is such a random question but do you have scoliosis or any postural issues?
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A somewhat gummy smile on women is fine, as long as it's not this
http://drrichardjoseph.com/photos/121.php
Impaction can be aging. As others have told you here you have a great face. I would only do very conservative movements to fix things at the occlusion level, but nothing that would drastically change the way you look. Make sure your surgeon communicates exactly what he will do and what the expectations should be.
BTW, does your bite really bother you that much?
Plosko, thanks for your, as always, valuable input. I definitely agree with you on conservative movements.
My bite does bother me quite a bit. Weird angled pic below, but it shows my bite wonkiness. Some front teeth are edge to edge and the rest are in full underbite mode. The asymmetry of my jaw causes the midline to be pushed over to the left, and the left molars are going into a crossbite. The asymmetry also causes a lot of pain in the left TMJ joint.
P.S. That Dr. Joseph patient looks fantastic afterwards. I love his aesthetic.
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This is such a random question but do you have scoliosis or any postural issues?
Not really. I have some neck issues, which sucks, but seems to pretty common for people jaw issues.
I think you mentioned in another thread that you have some neck issues?
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Not really. I have some neck issues, which sucks, but seems to pretty common for people jaw issues.
I think you mentioned in another thread that you have some neck issues?
ya I believe that theres a connection with jaws and postural issues.
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ya I believe that theres a connection with jaws and postural issues.
I think you're on to something there. If someone's has forward head posture because of breathing issues, jaw pain, asymmetry, etc, their neck muscles have to work differently than normal, which can cause neck pain and strain on other back muscles. A lot of chain of events going on there.
This is from some TMJ clinic but they do a nice job of explaining how the jaw effects overall posture:
http://www.portlandtmjclinic.com/tmj-disorders/the-role-of-body-posture
P.S. Now that I think about it, my head is probably more forward than it should be...
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Thanks Phantom. I didn't even think about impaction causing nose changes! That's really something to consider. My nose already tilts up a bit... it would probably look weird tilted up more.
Thanks for the compliment on the pic. Maybe my cheeks add a bit of sweetness to my face.
And yes, I also have some Irish like you :)
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Botox for gummy smile -- I was looking into it as an option for my upper lip. From most pics I've seen so far, it looks kinda weird and makes the philtrum look longer. I don't need mine to look any longer.
Pic below from a New York Times article....
[attachment deleted by admin]
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Your upper lip will only lengthen with age. So I'd be super conservative with any impaction.
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Your upper lip will only lengthen with age. So I'd be super conservative with any impaction.
True. I've read the upper lip lengthens about a millimeter a decade starting around age 40.
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Just an update. I'm still a few months away from lower jaw surgery. I've decided not to mess with the upper jaw impaction. I don't think the small amount will warrant going through upper jaw surgery (2-2.5mm). Also, I don't want to mess with any nose changes. If my gumminess still bothers me later, I can get some botox or lip lowering surgery.
If anyone's interested, here's a youtube video that shows a patient before and after lip lowering surgery. It also shows her stitches so you can see where the lip is positioned:
https://www.youtube.com/watch?v=y7IYyfffgOs