jawsurgeryforums.com
General Category => Functional Surgery Questions => Topic started by: SGseeker on March 02, 2015, 08:56:19 PM
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Hi! Thanks for reading! I am considering having a sliding genioplasty as I have a weak chin and I do not like the idea of having an implant (infection/sliding out of place etc). I have FINALLY been able to do a morph that I like! I have tried over 30 different photos/times. I am also posting other photos of myself from different angles.
Please let me know if a) this result is possible via Sliding Genioplasty and b) if you think it is worth it.
Any other thoughts are also welcome. Please also recommend any surgeons you think I should consult with.
THANK YOU SO MUCH! I REALLY APPRECIATE YOUR KNOWLEDGE AND EXPERTISE!!!
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Yes I think you're a good candidate for SG because your lip competence is not that bad and you have no mentolabial fold to speak of.
However in the after morp that you made, your lower lip would not be advanced like that with a sliding genio, so that part isn't realistic.
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Thank you so much for your response. I actually have some lip incompetence. I have to close my lips together. Naturally they are apart and I have to think about keeping them closed. Do you think SG could resolve that? I am a mouth breather and sleep with my mouth open :(
Here is a photo with my smile - the only time that my mentolabial fold "tries" to appear haha
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Well then the best option would be a standard BSSO advancing the lower jaw, but since this is a much more invasive treatment it would depend on more than just aesthetics. Do you have a constricted airway and general difficulty breathing through your nose, and also sleep apnea/snoring? Also how is your bite?
Btw, I think you would still need a sliding genioplasty even with a bsso because your chin bone has not developed forward growth. There are surgeons who can do both in one surgery.
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Ok! I just had a septorhinoplasty to fix my deviated septum. I am now able to breathe through my nose properly without feeling like i'm suffocating. I still go back to mouth breathing though. When I walk to work - i breathe through my mouth .
I do not snore and I don't think I have sleep apnea - but who knows?!? I asked my boyfriend and he says i don't stop breathing at night. I had braces as a child. My bite is good (im guessing) - my teeth touch and my dentist never brought up having braces again.
I have a consult via skype with Dr. Jamali from NYC tomorrow and I'll see what he says. I was not even thinking about a BSSO. Do you recommend any other surgeons for BSSO ? It seems very scary!
Thanks so much for your help. I am posting some front photos as well so you can get a better idea. Thanks again!
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^Right, well in that case I think you are going in the right direction with a SG. General jaw surgery does not seem like it would be worth it for you from the sounds of it, especially since your bite is ok(btw when you had braces did you get teeth extracted? If so, I don't know if any bsso would be possible at this point).
It would be good to see other posters chime on this to see more views.
Like I said you appear to be a perfect candidate for a sliding genioplasty, you are already good looking but this would do wonders for your profile. You'd look as good from all angles like you do from the front. Good luck, really.
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Ok! Good to know :) I will bring the BSSO question to Dr. Jamali tomorrow. Yes I had 4 teeth extracted when I was younger. How does that impact a potential BSSO ?
I would love to have other members chime in with opinions PLEASE!!!
Thank you so much for the complement !! I am 1 month post rhinoplasty so I still have a lot of healing to do still but it's nice to know it's looking good :) !!
Have you had a SG ? When were you fully functioning again (eating normal/speaking/work etc)?
THANKS!
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Yea I think a sliding genioplasty would be the right direction. God, you got some nice ass lips girl!! ;) lol. Very beautiful already
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Thank you so much :D Sliding genioplasty does feel like it is also as invasive as I am willing to go. I'll update today once I speak with Dr. Jamali. Do you mind recommending other surgeons who perform a lot of Sliding Genioplasties with an aesthetic eye?
Thanks!
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Hi Everyone! I had my first consult today with Dr. Majid Jamali. He is a "newer" max fac doctor but has had some great reviews. Just want to share the information for other people. He quoted me $7.5k in total. $4.5k for him to do the sliding genioplasty. $2k in hospital fees. $1k for the anesthesiologist. He was very friendly and answered all of my questions. I am going to post the reviews and before and afters I have found on him. I would love to hear the thoughts of other members.
I asked who he would consider the best doctors to perform this procedure (besides him obviously). He told me Arnett, Wolford, Wittenberg, and Posnick. I will be looking into them now as well to see what the price difference is.
What do you guys think? He is relatively "new" but has had some great results etc. He performs about 50 SG a year and 100+ oral surgeries a year (jaw specifically).
Before & After:
http://www.omsofny.com/photo-gallery/photogallery-chin-augmentation.html
Reviews:
CRAZY: http://www.realself.com/review/new-york-ny-orthognathic-surgery-24-years-chew
Also on Make Me Heal: http://www.realself.com/review/new-york-new-york-chin-surgery-chin-implant-removal-and-sliding-genioplasty
http://www.realself.com/review/nyc-chin-surgery-chin-implant-removal-sliding-genioplasty
http://messageboards.makemeheal.com/chin-jaw-implants/sliding-genioplasty-journey-t161181.html#p1268615&sid=b03db5d1b8bbc57409db4617918b0e0c
http://www.realself.com/review/new-york-ny-chin-surgery-sliding-genioplasty-recessed-chin-27-year-male-happy
http://messageboards.makemeheal.com/chin-jaw-implants/chin-implant-removal-and-sliding-genioplasty-day-t165818.html#p1271447&sid=996b8cf8663199ccf2607942c99c01f8
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^I must say you are going about this the right way. I have no doubt that you'll pick the right surgeon.
Thanks for posting some of those results and testimonies too. I've thought about having SG in the future as well and reading this type of stuff is always good.
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Did Jamali say you need jaw surgery for an optimal result?
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No - he hasn't seen my x-rays. He says that the SG should be sufficient but we will still need to do x-rays to make sure that I do not require lower jaw surgery. Based on our webcam consult - he thinks my upper jaw is fine and the SG should get me the change I want. Especially since my bite is fine and i had 4 extractions when I was younger. BSSO would still be possible just more complicated. I personally don't want to go for a BSSO as this is purely cosmetic for me. The SG would be the farthest im willing to go in terms of "invasiveness".
Are you considering Jamali ? Not many people have heard of him he was actually wondering how I heard of SG at all as many people get a chin implant and then come to him for help afterwards.
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Are you considering Jamali ? Not many people have heard of him he was actually wondering how I heard of SG at all as many people get a chin implant and then come to him for help afterwards.
No, I just want to get a feel for how frank doctors are in general... Anyway, we have a forum member who had surgery done by him.
http://jawsurgeryforums.com/index.php/topic,3673.msg23671.html#msg23671
He was honest and told him that his jaws were recessed as well, not just the chin.
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It seems that he was happy with his results. I tried messaging him a few times but I haven't heard back. From my search I don't think he ever posted Before and Afters - please share a link if you know otherwise.
I'll let you know what Jamali says when I have my X-Rays.
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I think a SG is enough tbh, your jaw, if it is recessed, is most likely very very minor.
also just to make sure, when he recommend, Arnett, Wolford, Wittenberg, and Posnick, was this recommendation for SG only or regular jaw surgery as well?
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^ Thank you!!
My question was "who do you think are the best surgeons in your field? like who are considered "THE BEST"/most respected?" I added - who else should I consult with based on their work/experience.
He said that Arnett and Wolford are highly respected world wide and are at the top. He has seen good photos of Wittenberg's work. Posnick is also highly respected and known.
Separately Reyneke from South Africa is his mentor and is also highly respected in the orthognathic field and has published a lot. He spent time in SA with Reyneke from my understanding.
Overall our conversation was about SG - but I was asking who were the best in his field which is orthognathic surgery which would encompass both SG and Jaw surgery I believe.
Have you consulted or had surgery with any of these surgeons ?? Thanks!!
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thanks and no Im still trying to decide between surgeons/orthodontists/ do some consultations with surgeons in the states (im from toronto)
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No way!! I'm also from Toronto!!! Have you consulted with anyone in the city? I am pretty sure i'll go in the states. You should look into the surgeons he told me about for sure. Anyways !! Best of luck :) Let me know how your consults go !! I'd love to compare notes :)
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No way!! I'm also from Toronto!!! Have you consulted with anyone in the city? I am pretty sure i'll go in the states. You should look into the surgeons he told me about for sure. Anyways !! Best of luck :) Let me know how your consults go !! I'd love to compare notes :)
no not yet. I've seen a s**t load of orthodontists but no surgeons yet. Cresent Oral Surgery is supposedly the best in t.o, from what I've heard. Im getting upper/lower jaw surgery though, I'm trying to find the best people out there so Im taking my time. I'll keep everyone here posted once things start picking up.
My problem is I dont feel like surgerons in toronto are as good as others in the states/europe. Its covered under OHIP so i feel like surgeons wont care as much since youre not paying out of pocket. if that makes sense.
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no not yet. I've seen a s**t load of orthodontists but no surgeons yet. Cresent Oral Surgery is supposedly the best in t.o, from what I've heard. Im getting upper/lower jaw surgery though, I'm trying to find the best people out there so Im taking my time. I'll keep everyone here posted once things start picking up.
My problem is I dont feel like surgerons in toronto are as good as others in the states/europe. Its covered under OHIP so i feel like surgeons wont care as much since youre not paying out of pocket. if that makes sense.
I saw a few NHS UK results on the jawsurgeryblog that looked good.
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Dr. Wittenberg does great work it seems. Although he has some lawsuits against him and bad reviews :s. I am still leaning towards Dr. Jamali at this point. He has good reviews, its not too far from Toronto, I have family in NYC to recover at.
This is a summary of where I am at. Let me know your thoughts!!
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Dr. Majid Jamali
Located in NYC
Very nice and approachable
Requirements
Pictures
CEPH X-RAYS
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Dr. Larry Wolford
Requirements
Pictures
Dental Models
CEPH X-RAYS
I am not sure about him as I can't find many real patient reviews on SG. His website work looks good though.
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Dr. Arnett or Dr. Gunson
Arnett recommended that I speak with Gunson. Waiting to hear if he can do SG alone.
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Dr. Wittenberg
No because of all of the lawsuits and bad reviews. Although- his online portfolio looks amazing. His portfolio has multiple surgeries so it is hard to see SG alone.
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Dr. Posnick
Haven't really looked into him yet.
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Not a good idea to publish prices in the open like this. This stuff encourages doctors to lift their prices.
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Ok! I will edit my post :) Thanks!!
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A further comment on sleep apnea. You may have it now or not, you don't know. You could develop it as you age. In that case, you might want jaw surgery to fix it later. Doing the SG now could mean having to redo it later. Better to get it all done at the same time if possible. Get a ceph and compare the numbers from it to those shown here (http://www.arnettgunson.com/fab-treatment-planning/airway/sleep-apnea-diagnosis/cephalometric-airway-measurement). If they fall within the norms, then just get SG to fix the aesthetic problem. Otherwise, get a sleep study and consider double jaw surgery instead as the risks/recovery is better while younger. Most of us have a pretty good idea what the answer is going to be already based on the pictures alone but the exercise is just to convince yourself first ;) Some people are fine with CPAP, others pretty miserable.
Regarding your comments, Dr Wolford is an excellent surgeon. I found one patient online and he was very happy with his sleep apnea jaw surgery. He's a good choice for joint work too if you need it but get a 2nd (and even 3rd) opinion before going down that route first.
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Thanks Molestrip!!! I am trying to get a Ceph done here in Toronto. Not sure how much it will cost out of pocket. Do you know the average price? Also how much does a sleep study cost roughly? and how do i go about getting one ?
Honestly - I dont think i have the courage to go through jaw surgery (even if it is only lower). It seems so hard!! I think all of the members on here who are considering/planning/recovering from it are super brave!! Maybe ill feel different if I need it. We will see :) Do you have any recommendations for surgeons performing sliding genioplasty?
Dr. Jamali recommened Dr. Wolford. It's just that I am trying to find real patients with photos that I can actually see to base my decision off of. I am only finding 1 or 2 for Wolford. Which isn't bad but it isn't compelling.
Thanks so much!
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Honestly - I dont think i have the courage to go through jaw surgery (even if it is only lower). It seems so hard!! I think all of the members on here who are considering/planning/recovering from it are super brave!!
Same here. I've also been looking at Sliding Genio as the most invasive I'm willing to get and just get 'camouflage' treatments that will improve the looks. Although I'm lucky that I don't actually need it since my breathing/sleeping etc. is fine. But full blown jaw surgery just has too many risks imo.
If you get a ceph it will be an eye opener though. Xrays almost tell the whole story.
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Sleep apnea is no joke. It'll kill you faster than smoking. I know two prominent doctors who contemplated suicide before getting jaw surgery to fix it. My father in law - a skinny guy who runs 2mi every day - had a heart attack in his 40s. My aunt lost significant lung function by her 50s (despite sliding genio while younger). It's caused me hell. I'll repeat what one surgeon said: "at your age, we don't really worry about risks". The risks from jaw surgery are very minor, especially relative to a sliding genio. It is invasive and time consuming with a tough recovery but from meeting many people I can tell not as bad as the internet protrays it to be. Less painful than tonsil removal, according to Dr Li. This is a routine procedure at this point in the right hands and I'm very conservative. Read Sleep, Interrupted by Dr Park to understand the disorder better before casually dismissing it.
That being said, if you don't have sleep apnea and aren't at risk for it, then certainly don't do it! But your profile suggests that's not the case. Most of us will get sleep apnea at some point in our lives anyway (due to weight gain and muscle sagging), few will be diagnosed and treated. The only way for us to know is to see the ceph. The cost isn't much, a few hundred if not covered by insurance. An in lab sleep study is about $8k in the US but you can do an at home study for ~$400 from easybreathe.com (they had a $100 special a few weeks ago). It won't tell you if you're at risk, just if you're already there.
Dr Wolford is very highly respected. He's aggressive with joint surgeries and that's irked some people. I met him and he's a very nice guy who clearly knows his stuff. There's pictures on his website, they're not so great IMO. The trouble with pictures is that it's very hard for a lay person without detailed records to judge their work. He's done thousands of cases over decades. He doesn't keep getting referrals because he's a bad surgeon. He doesn't need to market his services to get repeat business. He'll do it right but you don't need to go to him for a simple sliding genioplasty. He trains lots of students, call the office and ask for a referral to someone near you.
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The reason why jaw surgery has such a bad rep on the internet is because of the type of people drawn to blog about it in the first place. Bloggers by and large are drama queens to begin with.
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The risks from jaw surgery are very minor, especially relative to a sliding genio
Not sure what you mean there, maybe I'm overthinking this statement.
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Not sure what you mean there, maybe I'm overthinking this statement.
Sliding genio can permanently numb the lower lip just as well as a BSSO, and lower lip numbness is the biggest jaw surgery complaint.
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Sliding genio can permanently numb the lower lip just as well as a BSSO, and lower lip numbness is the biggest jaw surgery complaint.
True, but SG risks seem to stay at a certain area that makes it so that if it goes very wrong, you can still live with it(unless we're talking general anesthesia complications). BSSO Jaw surgery however has a long list of potential complications and although they are rare, it's a much bigger deal imo. And I really don't mean to scare anyone with this or act like a fear mongerer, but I've read that standard Lefort 1's have even caused blindness in people(tiny percentage of course).
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The complication rate is 1%. Of those, many problems are addressable. For a example, a repeat surgery can address a non-union. You can get a veneer or implant for a dead tooth. Big name surgeons will always have a few bad cases but like a few out of a few thousand. Many of those are exceptional in some way as well, either they have other disorders that put them at greater risk, they're a high risk group (ie old), they didn't follow directions, early in their careers, and yes, sometimes mistakes are made. I don't mean to blanket justify surgery, as every one is different. Do enough procedures and the odds catch up with you. Hit the low hanging fruit and remember to always compare against the alternative, as the status quo isn't perfect either whether you realize it or not. I'm bringing this up now because sleep apnea is prevalent (and increasing actually, along with allergies) and commonly missed. I don't want you to have to learn the hard way and then have to redo it later when the risks are greater. If you don't have it, then you are right, stick to the SG.
Your chin is quite weak, however people with weak chins usually have humped noses. Did you have a rhinoplasty already? Perhaps there is hope for you.
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I dont think an SG would address sleep apnea...
Sleep apnea is cured by the advancement of the pre-maxilla and lower jaw so that the tongue and more room in a forwards position. Also it opens up the airways. An SG just stretches the skin in your chin making you look nicer.
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I see mixed opinions about that. Some day that since the tongue is attached to the chin, advancing it opens up the airway behind. Trouble is, there's like 4 spots where the tongue typically collapses and it only addresses one of them. Unclear to me how much the advancement translates to, if it's even true. Does 1mm to chin imply 1mm to airway?
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Hey everyone!! Thank you so much for your posts they have been SO helpful and informative (even with the back and forth - this is how we learn!). I am definitely planning on doing the CEPH to see if i might be in the sleep apnea range and go from there for a sleep study if necessary. Thanks Terry for the PM as well!!!
Re: Rhinoplasty. I fell on my face when i was about 8 years old and broke my nose and opened up my upper gums. Fell about 2 metres onto concrete face first. Was then rushed to the hospital and spent the night there having stitches and xrays. 16 years later i finally got a rhinoplasty (2 months ago) to remove the bump and fix my severely deviated septum (one nasal valve was completely blocked). The surgeon had to pull out bone fragments during surgery :/
Please continue to provide guidance and thoughts!!! I know my chin is very weak at this point - i am just hoping that the results SG or jaw provide will be worth it from an aesthetic perspective (and health if i have sleep apnea).
Thank you so much again!!
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Wow, your surgeon did a really good job! It looks great. Also, that explains it now. See, we know our stuff :) 45yo you just gave you a pat on the back. Your plan is a good one. Good luck!
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True, but SG risks seem to stay at a certain area that makes it so that if it goes very wrong, you can still live with it(unless we're talking general anesthesia complications). BSSO Jaw surgery however has a long list of potential complications and although they are rare, it's a much bigger deal imo. And I really don't mean to scare anyone with this or act like a fear mongerer, but I've read that standard Lefort 1's have even caused blindness in people(tiny percentage of course).
That's like a handful of cases out of many thousands of operations. But I don't want to trivialise anything. In fact, my upper lip is still partially numb 6 months after the operation. And they only ever warn you about the possibility of lower lip numbness. (And I thought I got a lucky break with needing only a single-jaw surgery).
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Hi Everyone!!
Quick update - got my X-Rays today thanks to TERRY!! Thank you thank you thank you!!!
I am posting them here to hear your thoughts :) Based on my consult with the orthodontist. IF i had jaw surgery I would need upper and lower jaw surgery as my bite is good already. She recommends just doing the genioplasty and is referring me to Dr. Tocchio in Toronto.
She also thinks my airways look large enough (RE:SLEEP APNEA) but I would like to hear your thoughts - she gave me the caveat she isn't an ENT so its just her opinion. Please let me know if you think I should still do the sleep study. Who would be the right person to show the CEPH to for medical verification?
Thank you guys so so so much!!!
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^Looking at your airway, it appears to be large enough(almost the same size as mine and I don't have breathing/sleeping problems) and better than most people here who have posted xrays and talked about breathing problems. Maybe the mouth breathing is just a habit? I think that this is when the oral posture theories could really help here. If you keep your tongue on the roof of your mouth(and sticks and stays there because of saliva helping with that) while you're laying in a comfortable position I don't see how snoring or sleep apnea could develop. If the sleep study is expensive IMO it wouldn't be worth it but it's all up to you of course, just my 2cents.
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I don't have my ruler with me now. It's certainly not a the stereotype floss or straw airway but then again, neither is mine. Using a paper quickly and my memory of the norms, I see one spot of concern otherwise not huge but normal. Right now I'd guess she has mild sleep apnea and if so, sliding genioplasty might address this spot as might other conservative surgeries. I'll double check the numbers tonight.
Either way, I still think spending $400 on a home sleep study before surgery is a good idea. She's going to spend much more than that on the surgery itself likely.
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Get the sleep study because it's free for us Canadians. So blessed lol.
Tell your doctor you have a hard time sleeping and you feel tired when you wake up. Say an ortho recommended a sleep study. And he'll give you a refferal. I'm going to get one done soon. Also if you do end up going to jaw surgery route. I spoke to one of the best jaw surgeons in Toronto and he said it'd only cost 5,000. Ohip covers everything but ortho work and surgeon fees.
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Ok I doubled checked my numbers. For reference, here's the diagram (http://www.arnettgunson.com/fab-treatment-planning/airway/sleep-apnea-diagnosis/cephalometric-airway-measurement) I'm comparing to. Here's your numbers:
upper retropalatal:~11.4mm (normal is 15-20mm)
lower retropalatal: 13.6mm (normal is 10-16mm)
upper retroglossal: 9mm (normal is 10-17mm)
I didn't both measuring your lower retroglossal space because your face is so long it's completely outside the bounds of obstruction but strictly speaking, it looks more than adequate. My airway is almost identical to yours, except your lower retropalatal is few mm bigger than mine. See how your mandible plane radically changes behind your molars? It's the reason for your weak chin.
I suspect your case is bad enough that any sleep lab could pick it up but to be sure, see if you can swing by Stanford or look for the biggest center nearby if not. Check that they can diagnose UARs. Short term symptoms to watch out for are nocturnal bruxism, tongue thrust, nocturnal reflux/acid damage, morning headaches, chronic fatigue, somnolence, nocturia, elevated blood pressure, and anxiety/depression. Long term symptoms are... just bad. Other indicators would be a high malampati score, high/narrow arch, oversized tongue (w/scalloping), and long soft palate.
Please remember to return and let us know the study results! Even if it comes out negative, try to remember that it's age/weight dependent so you should recheck it every decade to make sure it stays that way.
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jesus molestrip, you're like a friggin MD. Impressed. Are you male or female? How old are you? And also what are you main concerns. Sorry I've only been reading posts piecemeal these days.
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Ok I doubled checked my numbers. For reference, here's the diagram (http://www.arnettgunson.com/fab-treatment-planning/airway/sleep-apnea-diagnosis/cephalometric-airway-measurement) I'm comparing to. Here's your numbers:
upper retropalatal:~11.4mm (normal is 15-20mm)
lower retropalatal: 13.6mm (normal is 10-16mm)
upper retroglossal: 9mm (normal is 10-17mm)
I didn't both measuring your lower retroglossal space because your face is so long it's completely outside the bounds of obstruction but strictly speaking, it looks more than adequate. My airway is almost identical to yours, except your lower retropalatal is few mm bigger than mine. See how your mandible plane radically changes behind your molars? It's the reason for your weak chin.
I suspect your case is bad enough that any sleep lab could pick it up but to be sure, see if you can swing by Stanford or look for the biggest center nearby if not. Check that they can diagnose UARs. Short term symptoms to watch out for are nocturnal bruxism, tongue thrust, nocturnal reflux/acid damage, morning headaches, chronic fatigue, somnolence, nocturia, elevated blood pressure, and anxiety/depression. Long term symptoms are... just bad. Other indicators would be a high malampati score, high/narrow arch, oversized tongue (w/scalloping), and long soft palate.
Please remember to return and let us know the study results! Even if it comes out negative, try to remember that it's age/weight dependent so you should recheck it every decade to make sure it stays that way.
Thanks for the info now I can check my own as well.
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I'm 35/male. I took the MCAT but am not a doctor, though I did stay in a Holiday Inn Express once (bad joke, I know!).
OSA has caused me so much pain, it pretty much ruined my 20s. Gastroparesis, chronic conjunctivitis, CPPS, anxiety, jaw pain, BFS, tooth wear, and more. I need a cheat sheet to remember it all but basically anything that breaks when the nervous and immune systems start failing. I was so sleep deprived for so long that not only did I stop dreaming, I stopped getting sleepy. Not tired but can't sleep like an insomniac. Weird, huh?
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@ molestrip - How did u stop osa? Cpap machine?
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Yup, been on CPAP for 5 years now. I tolerate it relatively well but they discontinued my mask and none of the others fit well. It's like they're designed for normal faces or something. However, my sleep study at Stanford showed that I still get a lot of RDIs despite high pressures. Sure it's much better than before but not perfect. I think loose tissue doesn't respond as well as fat tissue does. Despite being "C" for continuous, the machine actually does a lot of work to maintain a comfortable feeling pressure and I think it screws up a lot. And I'm a skinny young guy now, what's it gonna be like in 20-30 years? They still don't know what the long term effects are to the ears and I suspect they miss the stomach too. It doesn't matter anyway because my bite is so f**ked up that if I don't get surgery I won't have molars in a decade and I sure as hell ain't doing a single jaw surgery that will f**k my face up even more so fixing the sleep apnea is the only sensible option at this point.
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@Molestrip - thank you SO much for taking that time to measure my CEPH vs. the arnett gunson study. There is room for error though correct? Based on what I saw there were some areas with >3SD of figures. Please confirm that these are for airway norms for people POST surgery not just the average person? I am so sorry that you have to live with this at such a young age. I read about laser therapy as one of the options in relieving sleep apnea. What are your thoughts on this? Again thank you so much! I will be pursuing the sleep study to find out more and to learn more about my sleep pattern/behaviour. I do plan to keep everyone updated.
On a separate note - I emailed my CEPH to Dr. Jamali and he doesn't think that I have sleep apnea based on it. Not sure what to think here? Since you said my airway is very similar to yours!! :S Is there something I am missing?
I know i am not really a candidate for upper and lower surgery as my bite is already good so it would mean bringing all of my teeth forward and making my face look off balanced (correct me if you think otherwise). So if I do have sleep apnea or get it in the future its CPAP or this laser therapy i believe ?
Thank you all again!!!
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There's room for error, maybe 1-2mm. I measured it by hand and it would have been better with a CBCT. I think these numbers are from all their patients and most probably weren't (knowingly) seeking surgery for sleep apnea so I'd expect it to be in line with the general non-OSA population. OSA is thought to be a normal finding in the general population at some age btw. The question is when we get it. It started for me in my teens I think, some in their 40s-50s, and most normal people in their 80s-90s I'd guess. I'd love to see a study here. Our airways shrink as we age, due to weight gain and muscle sagging. If you don't have it now, then I'd venture that you'd be in the middle crowd.
It is a big surgery so I don't know that I'd go down that route without a sleep study confirming you have it. Most good surgeons would agree I think. In that case, doing a SG now and watching for OSA would be prudent I think. Not all sleep labs are created equal, if you want to be sure you need to visit Stanford. A related disorder in women called UARS is often missed by other labs. I strongly advise against any soft tissue surgeries, especially in a person who'd be low risk for jaw surgery, and I think Stanford is moving this way too now. There are some relatively minor bone movements that can be done which might be ok. I don't think this problem will have any revolutions in treatment going forward. Jaw surgery technology will certainly improve and treatment options will improve but no cure in sight. The best hope is a pharmacological treatment, the idea being to modulate sleep so that your muscles don't relax at night. That's bound to have undesirable side effects.
I wouldn't trust Dr Jamali's opinion here. I've had an ENT, two oral surgeons, and two sleep doctors (one Mayo trained) look at my airway with puzzlement and tell me I should be fine. The sad reality is that they learn an immense amount in school and their knowledge is either dated, fuzzy, or a combination of the two. He's probably operated on less than 100 sleep apnea patients and it's just not worth his time to learn about the disorder in more detail. You are a good candidate for jaw surgery. You'd have other reasons if you also had a malocclusion (people like us tend to open bites). It's hard to describe in text but double jaw surgery is an alternative to SG. They cut and rotate the mandible forward. The maxilla is advanced forward to meet it and sometimes rotated. The aesthetic gain in the right surgeon is considerably better than a SG even as you could get a flat profile without messing up your labiomental fold. You probably couldn't get a flat profile with a SG alone anyway. Done by the wrong surgeon and it will probably look similar to a SG.
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Thanks Molestrip. A few questions:
1)How much does the Stanford sleep study cost? In Canada a sleep study would be free for me so i want to understand the incremental cost. I am 100% going to get one just need to figure out the best one here or go to Stanford depending on price.
2) How exactly would I do a double jaw surgery if I have a good bite already (orthodontist lady wasn't too keen on the idea when I told her)? All my teeth are straight and aligned. I felt that made me more of a bad candidate, especially since they will move my whole mouth forward which i'm not sure will look good aesthetically.
3) Look at the attached results. Photo 1 is before (recessed chin), photo 2 is a badly positioned implant, photo 3 is implant removal and SG alone. I am looking for results like this (aesthetically) It was performed by Jamali btw. I feel this gives her a way better profile. Let me know what you think.
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1) Insurance paid $8k I think. Often times you can get a better rate out of pocket. See if Canadian insurance would cover it and, if not, look into buying private insurance. Compared to costs down the line and money spent on these surgeries, it's peanuts, not to mention that it's your health. I'd start with a local study and only travel to Stanford if it comes back negative.
2) Get used to being your own advocate. You're going to encounter a lot of opinions along the way and they'll all be confident and different. The main implication and is that unless your arch is narrow, you may not need orthodontics. Lucky you :) Not all surgeons are comfortable with this approach so shop around. If you can make it to A/G, then they can give you a simulation of what to expect so you can see for yourself. Otherwise, you just need to trust us that it'll look very good. If you have sleep apnea, then you might need some aesthetic compromise but it'll still likely be a big win compared to your starting point.
3) Seeing your photos now, wow. Knowing what I know now, surgeons should be liable for malpractice for putting in implants and performing SG on patients who obviously are likely to have OSA. It's sooo common it's ridiculous that there's like only a dozen people on the planet who understand it. Studies report only 1-2% of the population has skeletal sleep apnea but I think that's based on diagnosed cases, which are known to only constitue 20% of all cases. That puts the number at closer to 5-10% of the general population, which is in line with what I see in public. Think about that for a second. 1/10 people in the world has a major health problem and many of those are getting surgery to fix the aesthetics. The wrong surgery. How does this happen today?? And half these guys will be retiring in the next 5 years.
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Thanks for the info!!
Regarding point 3. He does mention in another one of his results ( posted below) that the patient didnt want to go ahead with Jaw surgery even though that's what he suggested and she only wanted the SG. I guess for some people they don't know the long term impact or they choose to ignore it.
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Little blurb!
Obstructive sleep apnea (OSA) is a common disease. A recent analysis concluded that 1 in 5 American adults has at least mild OSA. That translates to 40 million people. About one-third of that number has moderate or severe sleep apnea.
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It's worse than that. Why? We have a population bulge in baby boomers. Now you might say that the number should be better then, since prevalence increases with age right? The reason is that the incidence of allergies has increased substantially over the last century, while nutrition quality has decreased and Pottenger's Cat effects continue unabated. In other words, the number of 20-30 somethings who are destined to have/will develop moderate-severe sleep apnea is far greater now than it was for the boomer population. This is all in Sleep, Interrupted but analysis has shown that OSA is, in fact, on an epidemic trajectory if it's not addressed.
I personally believe we should be screening kids in public school along with Scoliosis, when it can still be address non-surgically. It should then be tested for again as prerequisite for entering college and every decade after like colonoscopy, breast cancer screening, etc. With the cost of home sleep studies so ridiculously low now, the payoff would be huge. Think of all the medical conditions affected by it? Heart disease, metabolic syndrome, type 2 diabetes, etc. All the major diseases are aggravated by sleep apnea. Savings would be huge, not to mention improvements in quality of life!
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Hi Everyone!
Quick Update!!
I am seeing Dr. Jamali for an in person consult next week . Costs $250. I will let you know how that goes.
I have also been in touch with Arnett + Gunson. They are supposed to be THE guys in jaw surgery in North America/world. I sent them my patient info, photos, ceph etc. I asked if they thought top level if I would require Sliding Genioplasty or jaw surgery and they had Dr. Gunson's surgical team member review to give me an idea. Preliminary is that SG will be sufficient as she did not see any clear reasons to do the jaw surgery. I am now booked for an in person consult in May as I want to hear from Dr. Gunson if he thinks SG will be good enough and then how much it would cost (his jaw surgeries are like $50k :O ) . I'll let you know more about that later on - but for now i am crossing my fingers that SG will be all i need.
I also plan to book a sleep study in the next month to see what that tells me overall.
Thank you all so so much for your insight/support. It has been an eye opener for me and I am now trying to make sure I make the best/right decision.
Anyone know where I can see a before/after gallery of A+G work ?
Thanks!
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Your plan sounds perfect. There are some pictures on the A/G website but you'll plenty more in the office.
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Your plan sounds perfect. There are some pictures on the A/G website but you'll plenty more in the office.
Thanks Molestrip- Have you consulted with Arnett or Gunson regarding you case ? How was it if you have ?
Thanks again for everything!
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Hi Everyone!
Time for an update!!!! In the past month I have gone to NYC to consult with Dr. Jamali and to Santa Barbara to consult with Dr. Gunson from the 'famous' Arnett+Gunson duo.
Dr. Jamali was VERY nice and patient. I will upload his hand drawn treatment plan for me. He said that I have a recessive jaw and would require Upper Jaw surgery to do a rotational jaw movement + a genio on top OR I could just do the genio - they netted out looking pretty similar and the genio has less complications and I recently had a rhinoplasty so the idea of going through my nose (which is what he said we would need to do) was off the table. He recommended a straight 5mm advancement. You can PM me for pricing info if you like :) Jamali took xrays and ceph and used them to draw out the results for me.
Dr. Gunson
WOW - what a team. These guys know what they are doing! Lena/Lina was my co-ordinator. Super sweet and helpful. I learnt SO much from this consult ($250 - the same as Jamali's but a lot more detail) but it was SO comprehensive!!! Loved it!!
1) They took molds of my teeth
2) They took 3D XRAYs of my skull
3) Dr. Gunson measured all aspects of my face, mouth, teeth etc
4) Gunson did a questionnaire with me and analyzed my face visually
5) They took photos and panoramic photos as well (that would later be layered onto my skull xray so cool)
6) Gunson then went to do his analysis for about 30 mins to come up with a treatment plan
7) Lena then walked me through their process and gave me other information
So Dr. Gunson did all of his analysis and it pointed towards double jaw surgery to give me 'ideal facial proportions'. He also did a genio plan and the difference was only 2mm so in the end his recommendation was to just do a genio as the double jaw surgery would only have a 2mm difference and I don't have any functional issues such as joint problems, sleep problems, bite problems. He also looked at the size and volume of my airway and it was all well above the average Sleep Apnea patient. I am still going to do a sleep study to 100% rule it out (didn't have time before the consult sadly) at least for now in my life. I really liked how comprehensive everything was at AG. Dr. Gunson is also going to be making a 3D visual of how i would look after the Genio advancement. Based on the model (black and white lines it looked great).
The other thing to note is that he does not want to do a straight genio rather a rotational genioplasty. He would shorten my chin by about 2mm, advance it 5mm (same number as Jamali) but with the rotation it would equal 6mm added projection. He doesn't want to do a straight one because my chin bone is flat so it would just move the flat portion of my chin forward. Making the rotation would give it a more natural look. He would then fill in the gaps with HA paste. We also discussed jaw contouring with HA as he wanted to do a higher genio but my nerve wont permit it as it goes very low on my jaw. In photos now if i tilt my face down slightly my lower third disappears and it is only my lips haha so this would solve the problem. I'd love to get your thoughts on all of this :) I am waiting for the hospital portion of the quote but Gunson's genio fee + HA contouring was very reasonable especially given his reputation etc. PM if you would like to know the details.
At this point - i need to see the hospital portion of Gunsons quote but I am leaning towards him as he has so many reviews on forums and blogs of real patients and I think he has a good overall aesthetic. Also the fact that he went into so much detail was really appreciated and showed me that he knows what he is doing and that he would get it right! Ill share the 3D once i receive it. Please let me know if you have any thoughts. Has anyone had a rotational genioplasty ? I'd love to know more about it.
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Thanks do the update. Really interesting read. A&G really make an effort.
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Sounds like a good consultation. Money well spent. Shame that Gunson+Arnette don't have a UK branch! :)
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Great to hear
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Hey Everyone! I received a rough 3D morph of what to expect from the surgery from Dr. Gunson. This is not 100% accurate because it does not include the rotational aspect but it does include the 1-2mm shortening of my chin. I'd love to hear your thoughts. It has taken me a while to post because i didn't like it at first but now it has grown on me. I think I found that I looked VERY different.
Anyways - please let me know your thoughts!!!
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^Looks really good, it balances your profile nicely.
When is your surgery? And it would be great if you will update us when the time comes.
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It looks nice. The result rarely turns out exactly like the morph though but this should be an easy surgery for someone as experienced as Gunson.
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Very impressive.
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Looks good but the first pic is with your mouth open so it kind of throws off the before and after.
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^Thanks! It's my mouth in a rested position. My teeth are actually touching but i have lip incompetence. Gunson believes he will be able to solve some of that by doing the rotational genioplasty. So my lips should be closer together at rest. For my lips to touch right now i have to actively think about it.
Thanks everyone for your feedback so far :)
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^Looks really good, it balances your profile nicely.
When is your surgery? And it would be great if you will update us when the time comes.
Surgery has not been booked. Hoping for October.
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I live in NY (close to NYC) and was considering going to Jamali. It sounds like you liked him.
Is it worthwhile traveling to California for A&G when I can so easily see Jamali? Is there anyone else in the NYC area I should be aware of? I know A&G get great reviews, but they can't be the only ones who can do a great job. I'm hoping Jamali or someone in NYC is equally talented.
Anyway, just curious to get your (and others) opinion on it since you've been there. Thanks!
I have what actually seems a similar recession to you... never had issues with sleep apnea (I'm 28) or anything. Still, I was always a mouth breather so even with straightened teeth after braces I have a slight open bite, teeth tilted forward (even then I feel like my tongue doesn't have quite enough space, definitely not enough width, though my palette could be worse). I have lip incompetence also, though have been able to train myself to keep tongue on rood of my mouth and lips closed (though slight strain... but I can grow facial hair so hides it).
Double jaw surgery makes me nervous, but so does sliding genioplasty... since both have nerve damage risks.
Plus, I wonder if now that my teeth are "fixed" if insurance will cover it. My insurance says open bite has to have no overlap, but depending on how I close my jaw, there is a slight overlap... but my incisors always uncomfortably touch and it hurts sometimes. My gums suck because of the mouth breathing. It is more of a struggle to breath from nose sometimes, especially when exercising. I'm afraid I'll develop sleep apnea one day.
Anyway, I'm rambling... sorry!
GL on everything. Any help with Jamali or other NYC area surgeons is appreciated. Thanks!
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Hello GPSeeker,
I think it really looks good! I wish you very good luck with your surgery.
I am in the same boat as you, my chin is also recessed and I have lip incompetence also. I am also considering having a genioplasty. I was wondering: will the genio completely solve your lip incompetence or just a bit of it? Do you show your upper or lower teeth at rest now? I have about 10 mm lip incompetence now and mainly my lower incisors show.
Once again, I wish you all the very best. You are already beautiful and will become even more beautiful soon!
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@needadvancement
My surgery is booked for October 15th!!! I will keep you all up to date on my progress.
@JayJaw
Jamali is excellent and very nice and patient. Just that Dr. Gunson was a lot more comprehensive and is going to not only move the chin forward but rotate it AND use HA paste to contour my jawline. It will be more expensive but worth it in terms of aesthetics. He also has a lot more experience than Dr. Jamali who has been in practice for a shorter period of time. I believe both would give great outcomes but I feel more comfortable going with AG because i get the imaging etc.
@Anna5
Thank you!! I have read elsewhere that it doesnt normally help and i have read that it can (Dr. Eppley). I spoke to Dr. Gunson and he said there will be an improvement especially since we are rotating the chin bone. That's what it shows in the imaging as well. Right now i have about 7mm if i remember correctly in lip incompetence it should go down to 2-3mm. Right now only my upper teeth show at rest.
@herecticx
It can if you want it to - they can shave the bone to become more pointy (this is done in Asia normally to give a more feminine face). If you have a pointy chin to begin with it could look more pointy after surgery since it is brought forward.
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Nice keep us posted!
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I'd skip the HA paste.
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Thanks everyone!!
@PloskoPlus
Is it because of resorption ? I am trying to do as much research as possible right now on HA. Please share any reviews or resources you know of to help with my decision. I really like the idea of contouring with it on the jaw line and have read some good reviews so far. I am even tempted to do cheekbone enhancement with HA. I'd love to know your thoughts on the matter.
Thanks!!!
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Here is the detailed calculation simulation from Gunson. This model does not take into account rotation which would give me added projection. For those of you who know how to interpret this please let me know your thoughts :)
Thanks!
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Thanks everyone!!
@PloskoPlus
Is it because of resorption ? I am trying to do as much research as possible right now on HA. Please share any reviews or resources you know of to help with my decision. I really like the idea of contouring with it on the jaw line and have read some good reviews so far. I am even tempted to do cheekbone enhancement with HA. I'd love to know your thoughts on the matter.
Thanks!!!
I've never seen HA paste actually do anything. Filling notches from genioplasty, a bit of contouring of the jaw, that's about it. The risks are infection (especially as it goes through the mouth), unpredictable resorption. Some here have had their bones go soft from the HA paste. Granted, HA paste formulations are different. Maybe A&G have some formula that doesn't have these problems. Modern HA paste is expensive in itself and I heard A&G charge an arm and a leg for application as well. TBH, I'm just cynical and I think it's an easy money maker for them.
Jaw contouring, cheekbone enhancement are best done with osteotomies - chin wing and zygomatic osteotomies respectively. FWIW, I don't see you as having flat cheeks.
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I researched the HA paste as well. Not a fan. Not sure about zygomatic osteotomy either but better than HA paste.
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Hi Everyone! I am about a month from surgery. Booking tickets and lodging etc. Just SUPER SUPER nervous. I have read numerous horror stories about sliding genioplasty but I want to put my trust in Dr. Gunson as he performs multiple jaw surgeries and genioplasties a year.Please PM your photos if you have had surgery with Gunson or an isolated genioplasty from another surgeon. I have re-attached the morph he provided me with in case you have additional thoughts.
Thanks!!
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I researched the HA paste as well. Not a fan. Not sure about zygomatic osteotomy either but better than HA paste.
What is so negative about HA paste?
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Wow Dr. G is only doing a isolated genio on you? I was under the impression they always do at least single jaw surgery with or w/out a genio. I know for a fact one of their staff years ago said they exclusively did jaw surgery. I wonder if it's a recent change. That's cool though, you are in really good hands.
HA Paste is apparently hit an miss.
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Wow Dr. G is only doing a isolated genio on you? I was under the impression they always do at least single jaw surgery with or w/out a genio. I know for a fact one of their staff years ago said they exclusively did jaw surgery. I wonder if it's a recent change. That's cool though, you are in really good hands.
HA Paste is apparently hit an miss.
Yes- that's what I was told by other people as well. I went in for a consult just to be sure and at first he was going to recommend jaw surgery but after his analysis it was a difference of 2mm (SG vs. Jaw) and I don't have any issues such as TMJ, OSA, bite, or pain. So he said he could do a rotational sliding genio for me. Thanks for letting me know I am in good hands. I really am nervous right now!!!
Re: HA Paste. I have done a bunch of research. I have come across people with great results and some where I can see no difference at all. I will not be having any cheekbone augmentation. Just sliding genio and i believe they will use HA to fill in the notches on my jaw/contouring. I haven't found any studies stating high deterioration with HA only that it stood up very well after 2-5 years still. Honestly there is not enough information on this. I asked Dr.G about HA and he has used it for over 10 years and says that it lasts and he hasn't seen any major complication with it.
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Awesome! I wish I only needed a genio when I had jaw surgery with Dr. G. I had already gotten one years before that didn't really address my issues. But my result with Dr. G was good overall though. You can check out my pics in the overbite forum. I had HA paste put along my jawline and cheekbones too which made them prominent. I guess that's unusual. keep us updated!
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Foreverdet - your results are AMAZING. He did an amazing job. Did you manage to get back all of your sensation ? How was the recovery from your first genioplasty ?
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Nice hope everything goes well! Keep us posted!
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Yes- that's what I was told by other people as well. I went in for a consult just to be sure and at first he was going to recommend jaw surgery but after his analysis it was a difference of 2mm (SG vs. Jaw) and I don't have any issues such as TMJ, OSA, bite, or pain. So he said he could do a rotational sliding genio for me. Thanks for letting me know I am in good hands. I really am nervous right now!!!
Re: HA Paste. I have done a bunch of research. I have come across people with great results and some where I can see no difference at all. I will not be having any cheekbone augmentation. Just sliding genio and i believe they will use HA to fill in the notches on my jaw/contouring. I haven't found any studies stating high deterioration with HA only that it stood up very well after 2-5 years still. Honestly there is not enough information on this. I asked Dr.G about HA and he has used it for over 10 years and says that it lasts and he hasn't seen any major complication with it.
By the way, did they mention that a SG can improve the airways too? I've been reading about it, it's about how advanging the chin tightens the tissue and changes the position of the tongue a bit.
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By the way, did they mention that a SG can improve the airways too? I've been reading about it, it's about how advanging the chin tightens the tissue and changes the position of the tongue a bit.
Based on the model I posted earlier that shows all of the calculations it looks like my airway will get larger. I asked Dr. G about this and he said that its not 100% it could potentially get larger but not significantly. Go look at the image and you will see that the model predicts my airway getting slightly larger with the red line.
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Based on the model I posted earlier that shows all of the calculations it looks like my airway will get larger. I asked Dr. G about this and he said that its not 100% it could potentially get larger but not significantly. Go look at the image and you will see that the model predicts my airway getting slightly larger with the red line.
Yes and right on the lower spot of the airway just like I've been reading. You'll also get an improved contouring on your neck which is attractive. Sliding Genioplasty is a simple surgery(for the right surgeons) but it can do quite a lot to improve you. I can't wait to get mine.
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Hey SG,
I'm meeting with Dr. G in october for an SG. The morph you have looks good, evens things out. Its amazing what a chin can do to someones looks. I too have done all my research and it seems like Dr. G is the go-to doctor for this procedure.
Did Dr. G mention anything about metalis strain or anything? I noticed in the 1st pic, your lips don't touch. Did he say that would be improved?
Best,
T
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What perfect calculations give a surgeon ? if most of them do not use navigation during surgery ?
Is it possible to set the bone manually exactly as it was planned ? Shorty after first incision a soft tissue become swollen and since that time not everything is clearly visible
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What perfect calculations give a surgeon ? if most of them do not use navigation during surgery ?
Is it possible to set the bone manually exactly as it was planned ? Shorty after first incision a soft tissue become swollen and since that time not everything is clearly visible
It takes a few hours for the swelling to truly kick in. Also, in orthognathic surgery the bite splint is used as a guide.
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oh yes... bite splint. in my case too ;) but in other way ;) They are gonna put into my mouth a device as a reference point used by navigation - of course it's another thing :) but as I see teeth can be used as a reference point in many ways
I've heard that swelling start to appears within 30 minutes ...Hence surgery lasts about few hours, a surgeon can't see results at the end.
Who knows how it really is ?
and if a surgeon performs surgery based on calculations, what kind of measure devices he uses ? only the eyes :P ?
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oh yes... bite splint. in my case too ;) but in other way ;) They are gonna put into my mouth a device as a reference point used by navigation - of course it's another thing :) but as I see teeth can be used as a reference point in many ways
Will you have surgical guides as well?
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I will be demonstrated a day before surgery. They need to perform CT for CAS. My right zygoma is going to be set based on my left side (mirroring) and eventually slight corrections may take place. Configuration will be saved and the surgeon can look at the screen how the bone is actually set comparing to plans.
The surgeon mostly do it manually, but he may check the real exact position whenever he wants. Especially just before and after osteosynthesis - crucial moments
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Hey SG,
I'm meeting with Dr. G in october for an SG. The morph you have looks good, evens things out. Its amazing what a chin can do to someones looks. I too have done all my research and it seems like Dr. G is the go-to doctor for this procedure.
Did Dr. G mention anything about metalis strain or anything? I noticed in the 1st pic, your lips don't touch. Did he say that would be improved?
Best,
T
Thanks for your thoughts. Yes the mentalis strain would improve. That is why in the morph model i have lip incompetence before at rest to less/no lip incompetence after. The hope is that at rest my lips would touch.
Let me know if you have any other questions :)
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I will be demonstrated a day before surgery. They need to perform CT for CAS. My right zygoma is going to be set based on my left side (mirroring) and eventually slight corrections may take place. Configuration will be saved and the surgeon can look at the screen how the bone is actually set comparing to plans.
The surgeon mostly do it manually, but he may check the real exact position whenever he wants. Especially just before and after osteosynthesis - crucial moments
SG should take anywhere from 45mins to 2 hours (max) :) I think you need to trust in your surgeons skills and results.
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Oops never answered the question on the last page.
Nope, still partially numb on my lower lip, lower gums and entire chin area. That's partial though so I still feel it, I can feel pain (although much less) and I'm not burdened by it. Plus I already had partial numbness on half my lower lip and part of my chin from the genio I had back in 07.
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Maybe one of you two above can answer this. Still have yet to have my consulation, so I will ask this question but..
The one thing I wonder about is if or how an SG will affect my smile? For example, the chin is brought out a bit, would that mean more lower teeth are shown?
Also, what is part of the lower lip is numb as mentioned above; will they make my smile uneven?
Overall, my main concern with SG are my lips and smile. Don't want my smile to change at all. And lips and smile go hand in hand.
Love to hear a response!
Thanks
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Maybe one of you two above can answer this. Still have yet to have my consulation, so I will ask this question but..
The one thing I wonder about is if or how an SG will affect my smile? For example, the chin is brought out a bit, would that mean more lower teeth are shown?
Also, what is part of the lower lip is numb as mentioned above; will they make my smile uneven?
Overall, my main concern with SG are my lips and smile. Don't want my smile to change at all. And lips and smile go hand in hand.
Love to hear a response!
Thanks
I don't have an answer but I'd love to read one. I believe the hope is that it would not change too much but you never know there are risks.
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Maybe one of you two above can answer this. Still have yet to have my consulation, so I will ask this question but..
The one thing I wonder about is if or how an SG will affect my smile? For example, the chin is brought out a bit, would that mean more lower teeth are shown?
Also, what is part of the lower lip is numb as mentioned above; will they make my smile uneven?
Overall, my main concern with SG are my lips and smile. Don't want my smile to change at all. And lips and smile go hand in hand.
Love to hear a response!
Thanks
It's variable like everything..
But my smile improved when I had the genio by itself. Reason being it affected my lower lip position so when I smiled, I showed less lower teeth. It was excessive before. I had a horizontal genio (with slight upward tipping) so I showed more or less the same amount of lower teeth in repose after.
The rotational genio that Gunson is proposing for SGseeker will apparently improve lip incompetence by changing the posture of the lower lip when relaxed which means more lower lip is covering the lower lip.
After swelling subsides and your muscles have adapted, (partial) numbness shouldn't make your smile uneven by itself. It's purely a sensation issue. At least for most people.
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3 days until surgery. So scared! I'll keep you guys updated. Please send over any recovery tips that you might have. I brought my vitamix all the way to California from Canada for this :D
Thanks for all the help so far everyone :)
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Good luck! A&again are one of the best. You'll be on good hands.
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Hey SG,
Had my consult! I have a few questions if you don't mind a PM.
Thanks!
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So I'm guessing today is the big day ;) I'm looking forward to you updating us. You've been an inspiration for SG surgery so I hope everything goes well for you.
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I think its tomorrow! Anyway, really look forward to hearing from you SG. Gunson is awesome. Let us know how it goes! :D :D :D
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Good luck! Also an A&G patient here, you're in good hands :D
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Hi Everyone! Thanks for the support. Here is a small update.
Tuesday 13th
I had my pre-op with Dr. Gunson on Tuesday afternoon. He took all of my measurements again and walked me through what was going to happen during the procedure.
He also flagged that my mentalis nerve was very low and he is requesting a an additional 3D model of my nerve in relation to my jaw so he knows where to go and where not go.
Kimberly was very helpful and gave me good tips and advice. Everyone in Dr. Gunsons office have been super accommodating and friendly.
[bWednesday 14th[/b]
I went to the hospital for pre-admission. They took 2 blood tests in case i needed to have a blood transfusion. I met the nurses who would take care of me before and after surgery. Again, everyone was super attentive and patient.
Thursday 15th
Dr. Gunson came to see me while i was in the hospital bed before going into surgery. He showed me my 3d model and where he would make the cuts and where he would place the grafts etc. Surgery was at 9:30 am. I woke up in some pain 2 hours later in recovery. No nausea (whew). I stayed in recovery for about 2 hours and only left the hospital at around 4 pm. Dr. Gunson spoke with my boyfriend who is my care giver at the moment about the surgery. I had quite a bit of pain at home. I think my pain killers weren't strong enough.
Friday 16th
Went to Dr. G office per schedule. He took an xray to make sure everything is in the right place. I told him i needed stronger pain killers so he prescribed them to me. I have been feeling a lot better now with the new one. I keep drifting in and out of sleep today and yesterday. Dr. G also removed the big bandage from my face on Friday as well.
OVERALL
Looking good. Very similar to the morph. Swelling today has gone up significantly from yesterday and day of the operation. It should start going down at day 4/5 post op.
I can feel my lips YAY! Top teeth I can feel. Lower teeth feel numb. Chin area - i can feel it but i would say half numb. I am at day 2post op so more sensation should come back . Sorry
I will post more photos in the next post below.
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Photos with kast post.
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Congratz on the surgery. I know there is still swelling but it already looks promising! And about the swelling, is it still at peak or going down(not sure which day you are post-op) just wondering how badly people you know would notice..
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Congratz on the surgery. I know there is still swelling but it already looks promising! And about the swelling, is it still at peak or going down(not sure which day you are post-op) just wondering how badly people you know would notice..
I am only 2 days post op. I had surgery on the 15th. Swelling has been getting worse and worse. They say it peaks on day 4. I don't plan on seeing anyone until Nov 1st btw.
Thanks!
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I see. How's eating going? Most SG blogs I've read say that the first few days they have to stick to liquid diets.
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I see. How's eating going? Most SG blogs I've read say that the first few days they have to stick to liquid diets.
Eating is tough . AG told me only liquid for 2 weeks. Everything needs be particle free / go through a strainer. So no beans/lentils/noodles. After 2 weeks I can eat again.
It's been but I am not that hungry due to the meds. Luckily my throat wasn't tooooo sore this time so I am able to have juices and tomato soups etc. I have been surviving on water , Amy's organic soups, bone broth, green smoothies & Ensure/boost protein shake things. I started to drink prune juice to counteract the constipation that the painkillers cause.
Today is day 3 post op and swelling has gone up vs yesterday. It's really tough to look in the mirror. I look like Guagmire from family guy . Crazy!!! Crossing fingers that it is not permanent.
Let me know if you have any other questions.
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Sounds like everything is going to plan. If your result is similar to your morph, then you've got a great result - congrats! Hope the swelling subsides and you're feeling better soon! I'm also looking into Dr Gunson for a genioplasty, do keep us all posted!
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Sorry, I just noticed you also posted photos. You're looking great! How far were you advanced?
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Sorry, I just noticed you also posted photos. You're looking great! How far were you advanced?
No problem. Thanks for reading through my post.i got 6mm forward and 2 mm upward. I am no where near the final result but dr.gunson believes it will look amazing and feels very confident. So fingers crossed.
I'll keep you all updated :)
I can tell you this- it's a tough recovery. I had septorhinoplasty in January and this was been a lot Harder. I have even more respect now for those members on here's how have double jaw or single jaw and genio. I feel very depressed about the swelling but I know it's not going to last. Anyways let me know if you other questions :)
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Hang in there, the swelling can make everything very deceiving. I'm 3 months post-op from a Lefort1+BSSO+genio and my profile is still changing on a weekly basis due to it. Do you have any befores we can compare with?
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Hang in there, the swelling can make everything very deceiving. I'm 3 months post-op from a Lefort1+BSSO+genio and my profile is still changing on a weekly basis due to it. Do you have any befores we can compare with?
Thanks for the support . Good to know there will still be lots of changes 1/3 months from now. If you look at the two posts from Oct17th there are two before shots. 1) I am wearing an over ear headset (before) and 2) in the second photo post on this page it's called Image 2.. (ftp://If you look at the two posts from Oct17th there are two before shots. 1) I am wearing an over ear headset (before) and 2) in the second photo post on this page it's called Image 2..)blinks below. The other photos are afters.
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Hey SG! Thanks for updating. How is the pain and swelling? Almost at the one week mark!
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Hey SG! Thanks for updating. How is the pain and swelling? Almost at the one week mark!
Hey! So it has been super tough this past week. Being only on liquids and no particles either has been tough. Swelling was/is insane!!! To be honest it has been a lot harder than I expected. I had a septo-rhinoplasty in January and the recovery didn't feel this hard. I have HA on my jaw to hide the step offs. This has been VERY swollen similar to ForeverDet's situation. The HA swells you up a lot. For more information, it takes 6 weeks for it to "solidify" so I cant sleep on my side or touch my face for 6 weeks pretty much. I also have to come back to SB a few times for him to adjust and make sure it is healing correctly. So yesterday I went in for him to check and make adjustments. I took 2 oxycodone and 2 advils (per Dr. G's orders) and STILL it was SO SO painful. He is pretty much adjusting the HA on the area where he sawed the bone. I have another appointment next week YAY. But all of this is worth it to get a great result. I am very happy so far with my side profile. From the front I look like Quagmire from Family Guy ... First 4 days were obviously the worst swelling and today I saw some slight improvement. The stitches in my mouth are irritating with the swelling but there is nothing I can do. Honestly I am just in shock that I have actually done this and went ahead with it. I am happy that I did so I can now move on (crossing my fingers that there are no complications).
In summary: Pain for the first 4 days was a 9/10 I stayed strictly on my meds bringing it to 2/10. I was on Tramadol the first night and it wasn't strong enough so I asked Dr. G for something stronger which brought it to a 2. Swelling: 9/10 for the first 4/5 days. It gets worst form day 1 - 4. It has been VERY hard to look in the mirror. Luckily I have had facial surgery before so I somewhat knew what to expect. Oh and one other thing - NAUSEA - WOW - I have been getting a lot. I am guessing its because i am on liquid particle free diet so all of the meds and antibiotics with on liquid food has been tough on my stomach.
Attached is a photo from last night. I will share a front one when I am feeling better about it haha. As of right now it is just toooooo much!
Please let me know if you have any other questions :)
Also- Lip incompetence is like 99% gone! WOW
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It brings so much balance to your profile. I think you made a fantastic choice with this surgery.
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Wow indeed! You were obviously pretty to begin with, but you're looking absolutely amazing now! There's no awkward deep mento-labial fold or anything, your chin runs smoothly and it looks very natural. Can I ask what was done regarding the lip incompetence, and where the paste was actually applied? Dr Gunson mentioned that I too have this, and that he could 'address it'... but I'm not really sure what that involves.
Thanks for sharing your story. I've been thinking about a genioplasty with Dr Gunson and seeing your result, I think I might just be sold! Hope you continue to have a smooth recovery.
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It really does look good so far even with the swelling. Can't wait to see how it turns out in the coming weeks! Keep us posted!
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I'm just catching up to your progress, I haven't been on here in weeks.
Congratulations! And looking good. Swelling doesn't look too bad but I understand, the front is always much worse.
I'm glad you got stronger meds, no need to suffer.
Keep up updated :)
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Wow indeed! You were obviously pretty to begin with, but you're looking absolutely amazing now! There's no awkward deep mento-labial fold or anything, your chin runs smoothly and it looks very natural. Can I ask what was done regarding the lip incompetence, and where the paste was actually applied? Dr Gunson mentioned that I too have this, and that he could 'address it'... but I'm not really sure what that involves.
Thanks for sharing your story. I've been thinking about a genioplasty with Dr Gunson and seeing your result, I think I might just be sold! Hope you continue to have a smooth recovery.
Thank you so much. He moved my chin forward 6mm and up 2mm. He spent about 1 hour deciding between 8mm and 6mm in the operating room apparently. 8mm looked too much like a 'door knob' to quote Dr. G.
I also have HA on the sides (don't kill me! I know some people were against it but I decided to go forward with it. I'll post more on that in my update). The HA is for the step off on the side. He also did jaw angle grafts.
Regarding the lip incompetence he moved my chin forward and it closed my lips closer together. They practically touch at rest now maybe 1-2 mm MAX seperation . Yesterday he was still in shock by how well the surgery addressed it. My lower lip used to hang, now it just goes inside my mouth properly - don't know how to describe it but it is A LOT better. Dr. Gunson is really sweet and knows what he is doing - based on my experience so far. Two days before surgery I asked if we could reverse it if I didn't like the outcome and he said we could but he wouldn't reverse it rather he would find a way to make me happy/make it better. I really liked that response because he clearly knew that where I was before was not acceptable and we would find a solution together.
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Hi Everyone! First - THANK YOU SO MUCH FOR THE SUPPORT !!! Just letting you know I survived my flight back to Toronto. 2 Hr bus ride from Santa Barbara to LAX then a 4.5 hour flight to TO. I'm very swollen now but I will post photos in the next couple days. Things are looking good so far. I really love my profile so far. SO SO swollen in the front BUT it has gone down. I will post a photo of the day after surgery vs. today and i am like 2-3x the size but it is slowly going back to normal.
To be transparent to whoever is reading, I feel that the genioplasty recovery was ok but the HA paste recovery is tougher than I expected. The adjustments Dr. G has to do after are KILLER.... whew. Also I have more incisions in my mouth due to that as well. Swelling is also A LOT worst due to the HA. Also didn't realize that. Just wanted to write it for someone else who wants to do this - HA paste WILL cause swelling and it is not as easy as you might imagine it to be (or as I thought it would be). Between the swelling and adjustments it is pretty intense. Anyways- fingers crossed all of this yields great results. I'm heading back to SB in a couple weeks for 2 more adjustments with Dr. G YAY ..... Luckily he and Kim are super nice and sweet so it makes it all better.
Edit: also thought I should comment on numbness - I am 13 days out of surgery and I have regained sensation of my lips and my chin is just a bit sensitive but no longer numb. I feel all of my gums but my lower teeth are still numb. Not as numb as day 1 which shows improvement but not as normal as I would like. I'm hoping it will get better over the next few weeks. Top teeth and gums are feeling perfect now - felt a bit weird before as Dr. G had to put in a screw on my top and lower gums to keep my jaw stable as he sawed my chin (sounds soooo gory) . This was to avoid any injury to my joints.
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Glad to hear you're doing well SGseeker! That's rough having to go back to SB from Toronto. I'm from LA and I thought my trip was pretty gruesome =p
Just want to reiterate that Dr. G and his team are the best :)
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Thank you so much. He moved my chin forward 6mm and up 2mm. He spent about 1 hour deciding between 8mm and 6mm in the operating room apparently. 8mm looked too much like a 'door knob' to quote Dr. G.
I also have HA on the sides (don't kill me! I know some people were against it but I decided to go forward with it. I'll post more on that in my update). The HA is for the step off on the side. He also did jaw angle grafts.
Regarding the lip incompetence he moved my chin forward and it closed my lips closer together. They practically touch at rest now maybe 1-2 mm MAX seperation . Yesterday he was still in shock by how well the surgery addressed it. My lower lip used to hang, now it just goes inside my mouth properly - don't know how to describe it but it is A LOT better. Dr. Gunson is really sweet and knows what he is doing - based on my experience so far. Two days before surgery I asked if we could reverse it if I didn't like the outcome and he said we could but he wouldn't reverse it rather he would find a way to make me happy/make it better. I really liked that response because he clearly knew that where I was before was not acceptable and we would find a solution together.
Did he say anything else about reversing/not reversing it? Looking to reverse mine and I really want him to do it.
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Did he say anything else about reversing/not reversing it? Looking to reverse mine and I really want him to do it.
Hi Serra,
I am not at a point where I want to reverse it. In our pre-surgery discussion he said that we would work to find the best solution. Obviously I wasn't happy before and that is why i got this surgery. So for me reversing it would just put be back to where i was before (unhappy) vs making an adjustment. So he said we would work so that I was happy not to just go back to where i was before. I think for you since you had it plus jaw surgery it shouldn't be a problem if you aren't happy with it. Maybe it wont be a reversal but rather an adjustment back slightly.
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EDIT - just in case you read my last reply.
I thought you had your primary with Dr. Gunson. If you didn't it might be more complicated for him to reverse but he seems to be skilled enough to do it.
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Two weeks out and a couple photos - including one from the front. It is so much larger than before - i hope it goes down --- A LOT! I know he put HA past but this is way larger. It must be swelling or muscle tension. It feels squishy then hard on the sides. Let me know what you guys think. The side I am happy with but the front is making me a bit depressed. I'm supposed to go back to work on Monday and I am terrified.
** Please PM me for before/after shots**
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Thanks for adding pictures. Definitely some swelling left. How much, hard to tell but I'm sure your surgeon will predict it most accurately. I didn't realise you had HA paste on your jawlines too.
Perhaps in the mean time you can try to style your hair in a way to make the bottom half of your face look smaller, if it's bothering you.
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Thanks!! Dr. Gunson said that I wouldn't be "presentable" until 1 month really and a better idea of the results before month 3. Soooo yea it's just really hard. I don't know what I am going to say to people that ask either! The HA on the jawline was Dr. Gunsons recommendation as my jaw dropped quite vertically so pushing the chin forward alone would make my jawline unharmonious.
If anyone else has had HA please let me know how the swelling was! Thanks!
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Thanks for your response, SGseeker. I wouldn't be surprised if I had the most complicated genio case there ever was. It's that bad.
You're extremely swollen around the HA, clearly. I think your swelling will take a long time to go down. I remember the notches in my jawline felt like rocks for months, apparently from bruising/blood.
PS: We're both from the best cities in Canada. Let me know about costs by PM if you can.
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Hi Serra, sorry to hear you had so many complications. I'll PM you info. Yea the notches on my jaw are tough and painful. Yay Canada. I really wish Dr.G was in TO haha but SB is an amazing place so beautiful! So I don't mind being there either hehe I hope Dr. G will be able to help you. Wishing you the best - I can't imagine what you must be going through.
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Something else I just remembered and wanted to share. In my consult Dr. Gunson did all of the math for me to have full double jaw surgery. After doing this he saw that most of the issue was in my chin area and he would have to do a 6mm SG along with the upper and lower jaw. The difference in aesthetics was about 2mm of projection between dbl jaw and just sg. Since I don't have any functional issues at the moment (bite, sleep apnea, tmj) it didnt make sense to go the whole 9 yards. This makes me happy because if I do develop any of these issues I can go back to Dr. Gunson for the other part of the surgery. He wouldn't have to change my genioplasty as if it was overcompensating for a recessive jaw. Just thought I should share that with you all as it gives me peace of mind.
Photo attached that makes me think it was worth it so far.
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Photo above looks good! Thanks for answering my questions. Have you regained feeling in your lower teeth yet? Would love to see a before and after photo once the swelling goes down! :)
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So far great results
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Thanks!! Dr. Gunson said that I wouldn't be "presentable" until 1 month really and a better idea of the results before month 3. Soooo yea it's just really hard. I don't know what I am going to say to people that ask either! The HA on the jawline was Dr. Gunsons recommendation as my jaw dropped quite vertically so pushing the chin forward alone would make my jawline unharmonious.
If anyone else has had HA please let me know how the swelling was! Thanks!
How are you feeling after a month? How's the swelling going? Hope your recovery is going well :)
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This are coming along ! Feeling positive. Dr. G says it will be 12-16 weeks until I can really see final results. Attached are photos for you all.
Your results look amazing. Did Gunson only do HA paste on your jawline? Was this due to any asymmetry from before the surgery or was it to fill in gaps due to the actual surgery?
Yes my jaw line only BUT it accentuates my cheekbones now. It was for the notches from SG plus jawline definition.
Lower teeth are like 50% - still have stitches in there. Fingers cross I get back to 100%. Things are looking good - im happy with the results so far and the swelling continues to go down.
Let me know if you have any questions!
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Beautiful... it's perfect, really complements your other features. So natural too, congratulations!
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You look stunning! Dr. G is awesome, love your results :D
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Wow, just wow :) Freakin awesome
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omg you're so hot. i would definitely have a great night of slip and slide with you. if you wanna grab drinks I'm in toronto too! ; ) PM me.
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Ha, I believe she has a boyfriend! Anyway, Lazlo, you know it would never work... what would you tell your grandkids when they ask how you guys met...
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Hey SGseeker,
How everything is going well on your end! Was hoping you could post a before and after from the sides... and maybe even the front or angle? Having a 2nd consult this week, and look forward to it! That said, just was interested to see a side by side comparison. Also, how is the mentalis strain, and lip incompetence now that it has healed up a bit. Is your original lip incompetence shortened or gone away?
Lastly, are you happy with the outcome? Do you feel more confident? Just looking for more insight! Thanks again for providing all of the updates. Really is helping me personally.
Happy Holidays :)
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Hey SG!
Hope all is going well! Just wanted to see if you had anymore updates for us :) Are you back to smiling normally?
Look forward to hearing from you!
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Probably out there enjoying life with the newly improved looks as she deserves. No life is complete without a chin.
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No life is complete without a chin.
yup thats true. people assume weak chins = weak personalities
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Love to hear an update though ::)
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Hello Everyone!
It has now been well over a year since my SG with Dr. Gunson.
I just want to let you all know that I AM VERY VERY happy with the results of this surgery!
Results are natural I can't recommend Dr. G or his team more.
Only thing I read about but did not know how it would be are the step offs on the jaw.
I can feel them when i touch along my jawline. No one has noticed or said anything about it. Honestly not really visible unless i am looking for it in the mirror while tilting my head back. I think that it is more mental than anything. I rather the step offs now vs. where i was before. Dr. G is amazing! Work is amazing! Healing was hard but very bearable. Change is significant with only 5 mm adjustment. No major residual numbness. I do feel like my 4 lower teeth are not 100% normal maybe like 70-80% there. Nothing crazy and I really dont notice it. Could also just be in my head. I think it is maybe just more tight. It has only been a year and i believe it will only get better.
Any questions please let me know. Just wanted to check in and let you all know that I am 100% happy with my results.
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Do you show more lower teeth when talking after the surgery? Has the ability to close your lips change at all?
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What was the mm size of your airway? I wish Gunson still did that 3D analysis to see the change with jaw surgery, etc.. He didn't take a panoramic shot when I consulted with him. His reasoning for bimax also was as robust as a house of cards.
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Do you show more lower teeth when talking after the surgery? Has the ability to close your lips change at all?
Nope - same/normal amount as before.
Yes ability to close lips has changed for the better. Resting lips are also closer together. Lower lip hangs less.
Very very happy!
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What was the mm size of your airway? I wish Gunson still did that 3D analysis to see the change with jaw surgery, etc.. He didn't take a panoramic shot when I consulted with him. His reasoning for bimax also was as robust as a house of cards.
No idea. He did a 3d analysis but it was so long ago i don't remember. Honestly don't think there was a difference in my airway after the SG.
Thanks!
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No idea. He did a 3d analysis but it was so long ago i don't remember. Honestly don't think there was a difference in my airway after the SG.
Thanks!
just wanted to know do you have any residual numbness or change in feeling?
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just wanted to know do you have any residual numbness or change in feeling?
No residual numbness. I would say that it feels a little tight sometimes - primarily in the morning after drinking alcohol the night before. Like puffy face in general. No numbness that I know of. I would say i am 9.5/10 back to normal in terms of feeling. There is something very very slightly different vs. what i remember from before. Hope that helps!
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just wanted to know do you have any residual numbness or change in feeling?
I have passive residual numbness near the mentolabial fold but I can't say that it bothers me that much. barely notice it.
just remembered I had it reading this post actually...then it creeped me out lol