jawsurgeryforums.com
General Category => Functional Surgery Questions => Topic started by: golden280 on March 28, 2015, 07:43:09 AM
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Im 22 years old male. I met with a maxfac surgeon this past week twice to plan out what we might be doing this past year. Im a typical mouth breathing case (narrowish palate, recessed mandible, high gonial angle, sloping forehead etc) that was "fixed" with orthodontics when I was 13 (brought the lower teeth in a lot to make it seem I had a normal bite).
My surgeon was against 3d computer imaging as he thought it made him "dumber" and instead used drew out on pieces of paper what the before and after would essentially be. I thought it was impressive, although bear in mind the before might be exaggerated a little bit because my family didn't recognize that as my "completely" natural profile.
It would be a year and a half in braces, removing two premolars on the bottom, and then leaving me essentialy with a class 3 bite after 5mm bsso (and 5-6 mm genio).
Do you think this is a dangerous thing to do? Involving removing two teeth and leaving a bad bite afterwards? I don't like my profile at all, my mandible is messed up and genioplasty alone won't fix it (I'm willing to upload some photos of myself) so please, please any help would be great as id ideally like to start with the braces asap.
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Hi! Which surgeon was this ?
Thanks!
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This was Dr. Jamali in NYC
I had heard many great reviews about him, especially for sliding genioplasty and he seemed very competent and knowledgeable in person.
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That's what I thought. I am considering him for my sliding genioplasty. Where did you hear great reviews btw? I have found some on Make Me Heal and Real Self. Do you have friends that went with him??
Regarding your question - everything he suggested sounds normal to me for jaw surgery BUT i am not an expert. I am sure some of the members on here will help you out :)
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I prefer the computer models. Surgeons make measurement errors. But paper plans are ok I think, especially for a very experienced surgeon. The bigger issue is that he's given you a bad plan. The typical mouth breather needs a double jaw surgery with CCW rotation. It may or may not include a sliding genioplasty, depending on the surgeon and specific case. I myself have this choice and am unclear which way I want to go, will be consulting a plastic surgeon to see what his thoughts are. The issue is that we often have normal labiomental folds and wouldn't want to screw that up.
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Molestrip
He mentioned something about how my maxilla is in pretty much decent condition based on his measurements relative to a point on the forehead so he wouldn't want to touch that, however the mandible had "moderate" recession and wanted to focus on only bsso+genio.
I don't know whether or not to go through with this, as theoretically my face could use some width as its narrow now so implants may balance out my features in a much less invasive and inexpensive way. I might also consider rhino + chin implant instead, however I'm also hesitant to do this as it might be like the orthodontics at 13 was (masking the underlying problem).
Very nervous about all of this, thanks for the replies, anything would help
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Your surgeon is wrong. SGseeker has the same problem with the same surgeon. You have a high arch, it needs to drop 2-4mm posterior. You likely have sleep apnea and will likely still have or will have it after that BSSO. Your Maxilla is also too short, you likely have a long soft palate. Your face might be in balance now but fixing your airway will require a compromise in that balance.
Dr Posnick would be the closest good option for you. Otherwise, do what everyone else here does and travel to Dr Gunson. There's a few other good options too, none close to you but send me a PM if you want the names.
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Here are the pics of the profile
Dont mind the eyebrows, I messed them up pretty bad recently, they're normally much more full and long.
I dont snore at night but I suspect my breathing is not 100% and I might have some form of moderate sleep apnea as my mouth is hung open during sleep and i wake up from time to time, and am exhausted in the morning
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IMO, your profile actually looks pretty good. I'd be happy with this. Maybe Jamali has a point in that having only bsso would make your profile look good but would your teeth function properly with all the cusps aligning. not sure. Also it looks like your maxilla is in a good position as well. So even if you did have upper and lower jaw surgery the upper jaw movements would be minimal.
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interesting terry, thanks for the response
im not sure what I'm seeing i guess because when i look at those pics it looks like something is off/reccessed. so I'm willing to maybe think that I'm overanalyzing it a bit
you make a good point about teeth functioning properly afterwards, especially considering he would be creating a class 3 now after the surgery (without any maxilla movement) so i don't know if all this is worth the hassle.
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He looks pretty recessed to me. His nose is slightly upturned and relatively straight, which is unusual in these cases. I'd almost think his maxilla was overdeveloped except for the drawing. His nose looks huge but not because it's big, the rest of the face is just so backset. His forehead is very sloped so I'm thinking nose developed that way just because of the angle of the face. This is a really tough case. What's interesting is that Dr Jamali's drawing shows a different forehead. And chin for that matter.
I'd say he'd be a great candidate for Dr Gunson. Make a flat profile with the jaws, fix the sleep apnea/breathing issues, and build out some cheekbones. The forehead will just be but I think humans are pretty tolerant of one or two off features once the rest of the face is in balance. He wouldn't be hot but he would be moderately attractive.
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Hmm I see. Post a ceph. It'd be easier to see what's going on
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wow thats really in depth analysis molestrip.. terry i don't have the ceph but ill request it next week
dr gunson in california? wow thats quite the trip, but i guess it would be worth it if he's the best and I'm going all in. whats my next step a sleep study? does insurance cover that and do they conduct them in nyc?
plus purely hypothetically speaking, would a forehead implant (if they even exist) and a rhino essentially even out the face to almost the same degree? just wondering here, as it would probably be much less expensive and invasive. the max amount of money i would be willing to spend here is like 20 grand and even thats pushing it
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That was a stupid question especially considering this is a jaw surgery forum. plus forehead implant? I must be out of my mind.. it just sucks that i will progressively lose hair though so it will keep getting worse.
I'm just really frustrated that my case has to be this complicated. And a potential fix could cost upwards of 25k. Im not even looking to be "hot" (sure it would be nice) but just generally attractive and not "recessed" anymore. Plus something that will work for me as I keep getting more and more bald. I WISH this was only a case of something implants can fix but I guess not. Thanks for the replies though, any help I get here is appreciated.
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The surgical plan is good.
DOn't touch your upper jaw.
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Thanks Sean
Do you think it would be a bad idea to create a bad class 3 molar bite afterwards? Im pretty nervous about that
I was wondering if sliding genioplasty alone would give me decent results as well. I understand the mandible is recessed, but the difference is finances/healing time/year and a half of braces plus what I've mentioned above definitely makes me hesitate.
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That was a stupid question especially considering this is a jaw surgery forum. plus forehead implant? I must be out of my mind.. it just sucks that i will progressively lose hair though so it will keep getting worse.
They do such implants in South Korea, but I'm not sure if that's such a good idea, because they're massive and probably don't make good contact with the underlying bone very well and can shift around. If you're prone to hair loss, the scars will become visible eventually.
I'm just really frustrated that my case has to be this complicated. And a potential fix could cost upwards of 25k. Im not even looking to be "hot" (sure it would be nice) but just generally attractive and not "recessed" anymore. Plus something that will work for me as I keep getting more and more bald. I WISH this was only a case of something implants can fix but I guess not. Thanks for the replies though, any help I get here is appreciated.
You have an ante-face like I do - forward jaws, sloping profile, sloping forehead. Except I was class III before my jaw surgery. I too want to rebalance my face. With surgery you can do either of the two things - add or take away. For perfect balance you usually need both. Nose jobs are often combined with chin implants for this very reason. And it's probably better to do 2 small operations (small augmentation and small reduction) rather than one large one (big augmentation or reduction). It may not even be possible to do a single very large movement.
I consulted with a PS and he told me that forehead augmentation with HA paste would "make the rhinoplasty look better".
tldr; I think you need to fix the fundamental issues first and foremost and maybe others stuff later, if you have the money (or the energy). If your bite is bad, I'd definitely fix that (your maxilla looks good, BTW) first. And any additional stuff after that would be smaller (i.e. smaller rhino, smaller forehead augmentation).
Alternatively, you could probably get a Chin Wing osteotomy done by Dr Zarrinbal in Berlin and it would completely mask your Class II (ask Sean89 all about it!). Given how low the Euro is vs the USD, it would probably be even cheaper. Your call.
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Thanks Plosko, I guess I really need to assess if this is all worth it
I have a class 2 at the moment (according to my dr) but its not causing any MAJOR functional issues.. so to go through braces, extractions, bsso and genio to then give me a class 3 that MIGHT give me issues and might not even be the best course of treatment is very worrisome to say the least.
It is also why I was wondering whether or not a standard rhino (to shave the bump) and a chin implant or genioplasty might be the best course of actions given the circumstances. Obviously id look a lot more balanced if my forehead didn't slope tremendously but from what I've read, there isn't really much I could do that is practical (which is unfortunate because i think forehead is a huge part of a persons profile that gets overlooked all the time).
Regarding the chin wing... damn that looks risky cutting the mandible like that. And no doctors in the US perform it? How expensive is it? Still, unless I see more about it with before and after pics and testimonials Im probably staying away for now. Did Sean get that? Ill pm him.
Essentially what Im asking is whether or not masking this with the rhino+implant/genio would give me positive enough results for me to come away with a more balance profile and more attractive look overall? I don't know. I feel like God just gave me a generally average, imbalanced face that is hard to modify with surgery and its just up to me to accept it. Its a tough pill to swallow to know that mouth breathing and improper oral posture for 20 years essentially aggravated the problem (i looked like a completely different person as a kid) but oh well.
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honestly, you might be slightly tipping your head back (based on your neck curve) making your forehead look more recessed than it is. Save your money on the forehead implant and get a hair transplant.
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Eh i think I've figured it out anyways.. its my damn head shape thats completely sloped, resembling like those early dolichocephlic egyptian skulls (3 of my 4 grandparents were from egypt too).. it throws the whole thing out of proportion. Like an alien. I guess its kinda neanderthal too, who knows. I guess if the skull were straightish upright(picture it stopping around just past the ears) it changes everything. Couple that with the forehead that slopes (really not sloping, just the head brought the forehead back) and there you have it. ill probably never look gold bald as well which sucks. I'm still debating whether or not even a sliding genioplasty would be worth it in the end, perhaps it would even just a smidgen and I would wait until better hair loss products or transplants come out (by then i might be dead lol)
thanks for the replies anyways