jawsurgeryforums.com
General Category => Functional Surgery Questions => Topic started by: Lazlo on April 11, 2019, 04:16:52 PM
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So I had bi-max and genio with Dr. SInn, advancement was only 6mm mostly just linear advancement with a bit of ccw maybe.
I still feel my jaws are very narrow and I still look like a f**king CLASS 2 with a weak lower jaw despite a 9mm genio.
Today I consulted with the top doc in Canada Dr. Marco Caminietti. He said I wasn't advanced enough and that my teeth look the same as they did before surgery. Moreover he said both my jaws are collapsed in on the transverse (width) access.
He said he can't fix all my problems but he CAN advance me significantly more. He said my lower jaw needs almost 1 cm of advancement still. And that it will involve both jaws and will be mostly a linear advancement. He said he might widen the upper a bit (maybe 5mm) and if absolutely necessary he would do a midline osteotomy to the mandible and widen that a bit too, but he was hesitant to do that since its a major operation etc.
I asked him about CCW and Wolford. Gunson etc. and he basically said it's highly unstable, I don't really need it, its mostly for sleep apnea issues and moreover it proclines the upper teeth which he said isn't good. He said he does CW or CCW depending on how the bite should fit not based on it as a principl
He also was very tight-lipped about what he would do. He said he wouldn't tell me the exact millimeters, he wouldn't guarantee anything, he could only promise that he would give me a stronger lower jaw in profile but not any promises about the transverse width being fixed. He wasn't as open to discussion etc. as most American docs I've seen.
SO WHAT SHOULD I DO? OPTIONS:
a) have re-do surgery with Dr. Marco Caminetti. This would be fully covered by Canadian Health Insurance as I am a Canadian, the overall cost would be 7 grand (how much the digital planning etc. costs). I think he's a straightforward, technically very competent doc who sees my issues clearly and clearly identified I need a much greater lower jaw advancement. It would be relatively cheap for me but and I think he would do an "okay" job at least. He said I need about 6-8 months in braces first to set me up and then do the surgery. He said there was definitely risk of further nerve damage (I already have an affected lower lip).
b) Get GUnson to look at me again, chief plus here being Gunson would be able to do futher cosmetic improvements maybe since he uses HA paste? Also, one would have to weigh in on whether CCW is indeed better. I don't think Gunson would attempt any lower jaw expansion cause I don't think he does the midline osteotomy/widening on the lower jaw. but I do think he does surgical widening of the upper jaw. I really don't know, Gunson is heralded as a top surgeon yet main drawback VERY, VERY EXPENSIVE and long wait time for surgery.
c) Wolford: Again does strong CCW, so is that what I really need?? I believe Wolford also does both lower jaw and upper jaw widening but I have not consulted with him, nor have I consulted with Gunson since AFTER my Sinn surgery. Wolford would also be less expansive than Gunson but still mega-expensive compared to Caminetti.
I have to get my result right this time. Caminetti I've had some relapse but he couldn't tell whether it was the maxilla that moved back or the mandible that moved forward. Caminetti said he's done a lot of re-dos of all the top american surgeons like Sinn, and Gunson and Arnett but I don't know if he was just boasting. He also said, they've probably done a bunch of revisions of his work as well.
So I really don't know what to do. I want to get a revision but I don't know who to go with. I guess the next option is to just visit Gunson and Wolford again. That is just gonna waste so much money again on travel and hotels and s**t and maybe they won't tell me anything better than Camenetti. The only reason to go to Wolford or Gunson is if I believe CCW philosophy is truly the way to go. Also, I would have to make a decision between Gunson and Wolford. How do I choose between them? The only thing I know is that Gunson/Arnett do a lot more cosmetic stuff and would have a lot more frills like all the HA paste and after care etc. But I don't want to have to waste more precious time putting my life on hold in braces and all this s**t. I dunno, what would you guys think? What would you do?
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I should add, just based on before/afters I like Wolford's strong, predictably good looking results where the lower jaw is indeed brought forward a fair bit.
But I think overall Gunson's results look more aesthetic. That may be because of the much better lighting and whatnot his photographs are presented with, so who knows, but he seems to achieve a more aesthetic result with the face more balanced and whatnot.
A f**k, now I have to make this decision. I'm basically having the surgery for free if I trust Caminetti that his 9-1cm milimeter linear advancement will do the trick. But what if I'm still f**ked up? And what if it still doesn't get me to the class 1 goal. He did say that he could definitely give me a stronger lower jaw.
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And I don't even know if Dr. Zarrinibal is a good option. I feel like I should see him cause he's really into doing DO to expand the lower arch and stuff like that apparently. What do you people think? I really need help and the collective intelligence of this forum to make a decision.
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How bad is your class 2? I’m worried about how large your upper jaw movement will have to be if your bite is basically okay.
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What did he mean by unstable? What kind of a&g issues did he revise?
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You're asking for opinions with no ceph, c'mon dude you know better than that lol.
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How bad is your class 2? I’m worried about how large your upper jaw movement will have to be if your bite is basically okay.
yeah so, in that case CCW would be better cause its less upper jaw movement. He wanted to move my jaw down and out like 9 mm upper jaw movement and like a cm lower jaw. Though he was like I'm not going to tell you the exact movements. He pulled this whole "patients like you are very particular," and I can't possibly manage to satisfy all your concerns. I didn't even get into my concerns, I was more like just told him about the tongue space issue and let him do the analysis.
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You're asking for opinions with no ceph, c'mon dude you know better than that lol.
yeah you're right, I'll post a ceph bro.
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What did he mean by unstable? What kind of a&g issues did he revise?
He didn't go into it. He wasn't particularly into discussing anything in depth. I think he's very weary of the type of patients that come into his office and isn't into guaranteeing patient satisfaction. He just said I could give you a stronger looking lower jaw, didn't mention how it would affect the upper jaw or anything. He did say there was transverse "collapse" but I have no idea what that means!? Was that caused by the orthodontist or was that caused by the jaw surgery!!?? I mean he said your bite is fine, your teeth are straight. So I mean that being the case, the bite being fine, I only "look" class II, I'm not actually class 2 because that is a bit issue isn't it??? I mean you can have a class I bite but still look class 2, right?
And yeah, in my case he would probably do a big maxilla forward movement with a big mandible linear movement.
I doubt he'll go into a discuss about what A and G cases he's revised. He's a very high volume surgeon, had a resident there observing and watching what he was doing. I felt like he was impatient with my questions and rushing me. But does that mean he won't do a good job? I don't know. Sinn was very very patient and answered every question carefully. that's why I really liked him. But apparently he never advanced me even close to as much as I should have been.
This caminetti guy was like "patients like you who know to the mm what movements they've had are hard to satisfy," I wanted to be like f**k you motherf**ker --wouldn't you only expect patients to want to know what movements they've had so they can feel some sense of control and responsibility over a massive operation where their f**king heads are being reconstructed!?
It's not that I disliked him. He maybe an amazing surgeon. But discussion-wise he just wasn't interested in giving me detailed answers to my questions.
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You say "Get Gunson to look at me again".
Have you had Gunson look at you at your current state? If so, what was his opinion?
25mm total advancement from your starting point is a significant advancement, I've seen one other post on this forum that had this suggested. Do you know how the additional advancement will be distributed, even more genio, or only by bsso cut?
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yeah so, in that case CCW would be better cause its less upper jaw movement. He wanted to move my jaw down and out like 9 mm upper jaw movement and like a cm lower jaw. Though he was like I'm not going to tell you the exact movements. He pulled this whole "patients like you are very particular," and I can't possibly manage to satisfy all your concerns. I didn't even get into my concerns, I was more like just told him about the tongue space issue and let him do the analysis.
I think you’re at very high risk of ‘chimp lip’ with that degree of advancement. You’ll end up with a longer mandible, but your lower jaw may still end up looking weak relative to your face because everything is being advanced together. The chimp look compounds this.
It could help your tongue issues though
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As to the lower jaw advancement, it depends how the UPPER jaw advancement would look on you to to get it.
If he's not doing CCW, then he would have to advance upper jaw more in order to get the lower jaw advancement he wants.
He doesn't have to tell you the exact mm advancement. But given he told you the APPROXIMATE lower jaw advancement, I'm surprised he didn't tell you the approximate upper jaw advancement.
The things he doesn't like about the type of CCW Gunson does, for example proclining the front teeth, are the things that help MITIGATE unfavorable nose base changes.
I guess the most salient question to ask him is whether or not the advancement to upper jaw will give unfavorable changes in particular the 'chimp lip'.
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yeah so, in that case CCW would be better cause its less upper jaw movement. He wanted to move my jaw down and out like 9 mm upper jaw movement and like a cm lower jaw. Though he was like I'm not going to tell you the exact movements. He pulled this whole "patients like you are very particular," and I can't possibly manage to satisfy all your concerns. I didn't even get into my concerns, I was more like just told him about the tongue space issue and let him do the analysis.
I hate how they act like wanting to know details means you must be some difficult patient. These days most patients get a print out of their movements from the VSP down to like a 0.1 of mm anyway. So what's the big deal. If you can afford Gunson I would just go see him.
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IIRC Prior to your first surgery, you were deciding between Dr.Sinn and Dr.Gunson after a consultation with both. What stopped you going through with, Dr.Gunson?
Personally, I would be extremely hesistant to go through surgery for a second time if you have no functional problems, the amount of financial, emotional and physical cost associated with JS just isn't worth it.
As for mandible expansion, I would be extremely reluctant to believe what the Dr. says, until he gives you firsthand evidence of the number he performs a year, the previous patients who have had it done, as well as possibly being given their contact details to connect with them and ask them about the surgery. From what I've heard even Stanford surgeons who are experts in sleep medicine are extremely unlikely to recommend or proceed with mandible widening osteotomy as it's not 'stable'.
Dr.Gunson definitely does segmental lefort to widen the maxilla, don't know the movements he can get, but from the various post by people who have undergone surgery with him, none have complained about 'stability' issues. Due to the vast amount of people who post online, who have undergone surgery with him compared to other surgeons, I think we would have heard about it by now had their been 'stability' issues.
I would consult with Dr.Gunson, again. Raise your concerns with him and then take it from there, as you had a consultation with him they probably still have your record, giving you a breakdown of your pre and post movements of your first surgery, and what can be achieved.
As for expense, I wouldn't think twice about if it's affordable, this surgery will most definitely cost me an arm and a leg, but it's worth it for the peace of mind knowing I put my face and well being in the most reputable of hands. I don't want to be a revision case and it's worth paying the extra to hopefully get it right the first time.
Gunson is heralded as a top surgeon yet main drawback...long wait time for surgery.
Oh, God. How 'long' are we talking? His consultation waiting list has already made me wait over half a year. Then comes the likely 6-8 month wait for orthodontist to get the bite right for surgery.
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I mean he said your bite is fine, your teeth are straight. So I mean that being the case, the bite being fine, I only "look" class II, I'm not actually class 2 because that is a bit issue isn't it??? I mean you can have a class I bite but still look class 2, right?
I think you can have a dental class 1 bite (where the molars, canines etc are all fitting together in their correct spots) while still having a class 2 skeleton
I think Wolford is a good option too btw (not just Gunson). But you know the warning, if he wants to replace your joints - run.
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Having seen your result, I say don't even bother with revision. It's an acceptable result, even if it is slightly class 2 still.
That said, that first plan sounds awful and is sure to result in a "chimp" look. It will also elongate your face since a linear movement on a high jaw angle results in moving downward.
Proclining the teeth a little is okay, but if done in excess it causes gum recession. The teeth shoudln't be used to compensate for the jaw movement; that's when problems arise.
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Thank you April, Kavan, GJ, Journey et al. I appreciate your feedback. I will have new cephs etc. done and will post them on this forum for you guys to see.
I chose Sinn instead of Arnett (who was practicing at the time) because he was cheaper and also was super, super attentive. I'm not saying Sinn did a bad job, but I do think I needed a greater advancement for sure.
Thanks all of you, I appreciate it. I'm going to have more consults and then we'll see. This will be a long road ahead.
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Having seen your result, I say don't even bother with revision. It's an acceptable result, even if it is slightly class 2 still.
That said, that first plan sounds awful and is sure to result in a "chimp" look. It will also elongate your face since a linear movement on a high jaw angle results in moving downward.
Proclining the teeth a little is okay, but if done in excess it causes gum recession. The teeth shoudln't be used to compensate for the jaw movement; that's when problems arise.
There's proclination via orthodontics, then there's proclination via ccw. In the latter case the teeth are normally proclined relative to the occlusal plane, but more proclined relative to the horizontal.
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Dr.Gunson definitely does segmental lefort to widen the maxilla, don't know the movements he can get, but from the various post by people who have undergone surgery with him, none have complained about 'stability' issues. Due to the vast amount of people who post online, who have undergone surgery with him compared to other surgeons, I think we would have heard about it by now had their been 'stability' issues.
Gunson, like others, has had some shockers as well. Also, I wouldn't say he's super high volume. There are quite a few who have done more. He's quite young for a surgeon, and, to his credit, doesn't just pump the cases through.
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I chose Sinn instead of Arnett (who was practicing at the time) because he was cheaper and also was super, super attentive. I'm not saying Sinn did a bad job, but I do think I needed a greater advancement for sure.
Pretty sure Arnett retired by the time you finally decided on Sinn. Did Sinn look inside your mouth, measure your face, give you plan?
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Pretty sure Arnett retired by the time you finally decided on Sinn. Did Sinn look inside your mouth, measure your face, give you plan?
No, not like Arnett did. Thing is I gave him Arnett's plan to do, and then on the day of the surgery he showed me his plan and it was different. It was kind of a shocker but he explained this would be a good plan for me. It included 6mm upper jaw advancement, 9mm lower jaw and 9 mm chin advancement. With all of that said, the result doesn't look as all of that sounds. I could email you his operating report where he relays in detail everything he did. Whether that's really what he did or whether that relapsed a bit I don't know. But immediately after surgery I still looked class 2 and other surgeons have commented the same. That said, when I asked Sinn about that he said that's they way your bite is set up after bicuspid extractions. That's what has caused me to permanently look class 2 because my already narrow and short bite has been made even more retrusive so the advancement can only do so much. What I really need is a way for my lower jaw to go further in front of my upper jaw yet keeping my bite in a proper set up. Like when I just my lower jaw out and bite in what is clearly a Class III position, I look skeletally good. So I don't know how that result could be achieved with orthodontics and surgery yet keeping my bite in a class 1 position!? Do you kind of understand what I'm saying?
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No, not like Arnett did. Thing is I gave him Arnett's plan to do, and then on the day of the surgery he showed me his plan and it was different. It was kind of a shocker but he explained this would be a good plan for me. It included 6mm upper jaw advancement, 9mm lower jaw and 9 mm chin advancement. With all of that said, the result doesn't look as all of that sounds. I could email you his operating report where he relays in detail everything he did. Whether that's really what he did or whether that relapsed a bit I don't know. But immediately after surgery I still looked class 2 and other surgeons have commented the same. That said, when I asked Sinn about that he said that's they way your bite is set up after bicuspid extractions. That's what has caused me to permanently look class 2 because my already narrow and short bite has been made even more retrusive so the advancement can only do so much. What I really need is a way for my lower jaw to go further in front of my upper jaw yet keeping my bite in a proper set up. Like when I just my lower jaw out and bite in what is clearly a Class III position, I look skeletally good. So I don't know how that result could be achieved with orthodontics and surgery yet keeping my bite in a class 1 position!? Do you kind of understand what I'm saying?
This is insane. You were told he was going to do one thing, and on THE DAY OF SURGERY (after you were paid up in full i presume) he changes the plan, contrary to what you paid for? this is madness. id lose my s**t. i also dont know what you look like, perhaps he was right? i know you look OBJECTIVELY BETTER than you did pre op? sounds like if you were to rate your surgery from 1 (failure) to 10 (perfect success) it would lean towards a success? If thats the case, and you still want some refinement you need a perfectionist surgeon (gunson comes to mind) who can apply his specific aesthetic artistry to your case. Otherwise youre shooting in the dark as to weather youl come out better or worse than you are now.
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No, not like Arnett did. Thing is I gave him Arnett's plan to do, and then on the day of the surgery he showed me his plan and it was different. It was kind of a shocker but he explained this would be a good plan for me. It included 6mm upper jaw advancement, 9mm lower jaw and 9 mm chin advancement. With all of that said, the result doesn't look as all of that sounds. I could email you his operating report where he relays in detail everything he did. Whether that's really what he did or whether that relapsed a bit I don't know. But immediately after surgery I still looked class 2 and other surgeons have commented the same. That said, when I asked Sinn about that he said that's they way your bite is set up after bicuspid extractions. That's what has caused me to permanently look class 2 because my already narrow and short bite has been made even more retrusive so the advancement can only do so much. What I really need is a way for my lower jaw to go further in front of my upper jaw yet keeping my bite in a proper set up. Like when I just my lower jaw out and bite in what is clearly a Class III position, I look skeletally good. So I don't know how that result could be achieved with orthodontics and surgery yet keeping my bite in a class 1 position!? Do you kind of understand what I'm saying?
You cannot achieve your goals without CCW. But only you can decide if the risk is worth it.
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You cannot achieve your goals without CCW. But only you can decide if the risk is worth it.
Word. I heart that. I have a feeling it's gonna have to be gunson. I just wish there was someone out there who could grow my dental arches so they were wider and longer and then did the jaw surgery. I mean without having to put in implants. But f**k, I think I have an appointment with Gunson scheduled within the next few months so I'll have to see what he says.
I don't know if I should even bother consulting with Wolford.
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I don't know if I should even bother consulting with Wolford.
I would.
If Sinn bait and switched you like you said, then technically you have grounds to sue. What he did was unethical. You paid for one thing and he used your emotional momentum, financial commitment to make you agree to something else entirely.
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I would.
If Sinn bait and switched you like you said, then technically you have grounds to sue. What he did was unethical. You paid for one thing and he used your emotional momentum, financial commitment to make you agree to something else entirely.
I feel like it wasn't a bait and switch as much as it was him convincing me his new plan was better. I can't emotionally go through a lawsuit.
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So who is more of a perfectionist? Gunson or Wolford. I'm going to do this right this time.
I'm guessing it is Gunson, but I want your input.
I have to go through a f**king slew of consultations again, have braces put on, and get this f**king done right. I will consult with Dr. Kasey Li and wolford as well. I will update you all over the next several months.
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In a perfect world what I really wish could happen is the following:
use sarpe to expand my upper jaw
use distractor on mandible to widen my lower jaw.
then move both jaws forward with lower jaw coming more forward.
Why the f**k can't this be done? It would create space for my tongue on the transverse axis and anterior posterior space. I realize my tongue moves with the lower jaw so I might still have some posterior anterior constriction but at least there would greater space at the back.
If anyone knows of a doc who can do this type of work let me know.
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So who is more of a perfectionist? Gunson or Wolford. I'm going to do this right this time.
I'm guessing it is Gunson, but I want your input.
I have to go through a f**king slew of consultations again, have braces put on, and get this f**king done right. I will consult with Dr. Kasey Li and wolford as well. I will update you all over the next several months.
Based on hearsay, Gunson. But consult with everyone.
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So who is more of a perfectionist? Gunson or Wolford. I'm going to do this right this time.
I'm guessing it is Gunson, but I want your input.
I have to go through a f**king slew of consultations again, have braces put on, and get this f**king done right. I will consult with Dr. Kasey Li and wolford as well. I will update you all over the next several months.
If Li is the sleep apnea guy, then Wolford will have revised tons of his monkey results.
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If Li is the sleep apnea guy, then Wolford will have revised tons of his monkey results.
Oh s**t, yeah he is. I was warned off him by someone else too. But he's the only guy who says on his website he does mandibular expansion and cuts.
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Oh s**t, yeah he is. I was warned off him by someone else too. But he's the only guy who says on his website he does mandibular expansion and cuts.
Splitting the mandible at the front and distracting it is unstable and hard on the condyles. Wolford will do a subapical osteotomy on you if you're willing to risk more numbness.
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Thanks Plosko, and thanks everyone Kavan, etc. for your responses.
Honestly, I'm experiencing some PTSD from this new revelation that I need a revision and that I'm still Class II and well my tongue space has been a nightmare.
I'm not exactly sure what a subapical osteotomy is Plosko, can you explain it to me.
I'm going to try and check in on this forum a little less than normal because I dont think its good for my mental health. And I need to live my life and not worry about this all the time --I can't help it cause it's hard to forget a constantly constricted tongue. God bicuspid in moderate cases should be made illegal. So many orthos and dentists warn against it now explicitly as causing all kinds of problems from tongue thrust to sleep apnea to narrow arches etc. etc.
Anyway, if any of you wanna reach me faster just PM me with any news or advice. I'll still check in once every couple days for sure. Thanks all of you. You're the only ones who truly know the hell that this whole process can be when mismanaged.
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Gunson, like others, has had some shockers as well. Also, I wouldn't say he's super high volume. There are quite a few who have done more. He's quite young for a surgeon, and, to his credit, doesn't just pump the cases through.
If you don't mind, can you expand on those 'shockers'? Has he offered those patients, a solution?
The worst I've heard has been about a girl who suffered a stroke which iirc was due to pregnancy pills. After that, one didn't have their bone density correctly assessed and as a result suffered complications, as well as a guy who had the nerve of his lower jaw accidentally severed, but both went on to mention that Gunson was upfront about it, stuck by them and offered solutions. Out of all the surgeons I've heard about, he seems to be the most attentive to detail as well as the most ethical.
In a perfect world what I really wish could happen is the following:
use sarpe to expand my upper jaw
use distractor on mandible to widen my lower jaw.
then move both jaws forward with lower jaw coming more forward.
Why the f**k can't this be done? It would create space for my tongue on the transverse axis and anterior posterior space. I realize my tongue moves with the lower jaw so I might still have some posterior anterior constriction but at least there would greater space at the back.
If anyone knows of a doc who can do this type of work let me know.
I have asked myself this question a million times. In an ideal world, we would be able to do this and get a stable result. It's a shame as we possibly could have benefitted massively using expanders or trying out the IMDO technique during our growth window.
Thanks Plosko, and thanks everyone Kavan, etc. for your responses.
Honestly, I'm experiencing some PTSD from this new revelation that I need a revision and that I'm still Class II and well my tongue space has been a nightmare.
Chin up, bud. Keep the faith that it will all work out in the end.
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I had surgery with Gunson, and could not be more dissapointed. I have no ability to chew normally, have nerve damage, my mandible is reabsorbing in the area of the surgery, My airway is smaller transversely after surgery. I have a class 3 bite post surgery and i am in pain 24/7 from this.
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I had surgery with Gunson, and could not be more dissapointed. I have no ability to chew normally, have nerve damage, my mandible is reabsorbing in the area of the surgery, My airway is smaller transversely after surgery. I have a class 3 bite post surgery and i am in pain 24/7 from this.
Holy s**t..
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I had surgery with Gunson, and could not be more dissapointed. I have no ability to chew normally, have nerve damage, my mandible is reabsorbing in the area of the surgery, My airway is smaller transversely after surgery. I have a class 3 bite post surgery and i am in pain 24/7 from this.
oh f**k. please say this person is a bot or something? can you tell us more about your case? It could potentially save a lot of people a lot of money and pain.
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I had surgery with Gunson, and could not be more dissapointed. I have no ability to chew normally, have nerve damage, my mandible is reabsorbing in the area of the surgery, My airway is smaller transversely after surgery. I have a class 3 bite post surgery and i am in pain 24/7 from this.
How long post op are you?
Have you seen Gunson since you've noticed the problems?
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Why don't you consider to visit Raffaini instead of Gunson?
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Holy s**t..
Is it really surprising?
I can name half a dozen people (Joy, Cmonster, ck, et al) from this forum alone who hated their results and/or had complications.
The reality is all surgeons have bad cases. If there was one guy who never messed up we'd all be going to him.
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Is it really surprising?
I can name half a dozen people (Joy, Cmonster, ck, et al) from this forum alone who hated their results and/or had complications.
The reality is all surgeons have bad cases. If there was one guy who never messed up we'd all be going to him.
yeah but there are degrees of complications. like a bit of nerve damage is common. but serious bite issues and massive relapse is scary. i mean i don't have problems to that degree from the jaw surgery (yes i do from the orthodontics though).
Any people hate their results from Wolford out there?
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Is it really surprising?
I can name half a dozen people (Joy, Cmonster, ck, et al) from this forum alone who hated their results and/or had complications.
The reality is all surgeons have bad cases. If there was one guy who never messed up we'd all be going to him.
You mean they had surgery with Gunson and hated their result? Why exactly?
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Is it really surprising?
I can name half a dozen people (Joy, Cmonster, ck, et al) from this forum alone who hated their results and/or had complications.
The reality is all surgeons have bad cases. If there was one guy who never messed up we'd all be going to him.
I think you shall be able to assume that a surgeon won't "mess up". But no surgeon can promise no complications, and what's important is how they handle it if it happens. If it's as bad as described above, the sensible thing would be to try to fix it.
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Any people hate their results from Wolford out there?
Yeah, but it's mostly related to Wolford's obsession with TJR.
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I think you shall be able to assume that a surgeon won't "mess up". But no surgeon can promise no complications
Semantics, but yes.
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Semantics, but yes.
Just meaning, there are surgeons who truely mess up and do things where the consensus is that it's bad practise.
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In a perfect world what I really wish could happen is the following:
use sarpe to expand my upper jaw
use distractor on mandible to widen my lower jaw.
then move both jaws forward with lower jaw coming more forward.
Why the f**k can't this be done? It would create space for my tongue on the transverse axis and anterior posterior space. I realize my tongue moves with the lower jaw so I might still have some posterior anterior constriction but at least there would greater space at the back.
If anyone knows of a doc who can do this type of work let me know.
Why would you want your lower jaw to come more forward aesthetic or functional benefit?
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Why would you want your lower jaw to come more forward aesthetic or functional benefit?
functional benefit to create more space for my tongue. But of course it would look better too.
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functional benefit to create more space for my tongue. But of course it would look better too.
So you would want a slight underbite?, rami malek know for having a great jaw and has a slight underbite as well
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So you would want a slight underbite?, rami malek know for having a great jaw and has a slight underbite as well
no i would then have my upper jaw brought forward so I don't have an underbite.
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no i would then have my upper jaw brought forward so I don't have an underbite.
I don't think you need it any more forward. CCW rotated in place, if not with setback.
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I don't think you need it any more forward. CCW rotated in place, if not with setback.
The LF1 advancement could help with his tongue space issue whereas I think just ccw-r might not.
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If Caminiti’s PLAN is good, and it makes perfect sense for your unique case and face, I have no reason to believe his surgical skills or competency won’t give you the result you’re looking for. Although I may be biased because I got a good result from a Canadian surgeon, I think ruling out Canadian surgeons should mostly be based on whether the plan is good or bad, not necessarily the surgical skills. I could be wrong.
At this stage you need to focus on what will simply be the best plan for you. Focus on surgeons later.
These are your options:
Linear advancement:
1.Conservative linear bi-max to get a slightly stronger upper and lower jaw without risking chimp lip.
2. Aggressive linear bi-max to get a much stronger lower jaw but risking chimp lip (Caminiti’s plan).
CCW-r
3. CCW-r plus bsso to create enough overjet to get a moderate advancement of the lower jaw while leaving the upper jaw where it is, negating any potential adverse aesthetic outcome of the upper jaw (Plosko’s recommendation).
4. CCW-r plus bi-max to get the STRONGEST lower jaw advancement possible, but also a strong upper jaw advancement which, again, puts you at risk for chimp lip.
You need to figure out a few things:
-What’s the position of your upper jaw? Like SNA angle? Is your upper lip contour enough or can it be improved? What’s the limit you can advance the upper without getting a convex lip?
-What’s the position of your lower jaw? How much advancement do you need for a satisfactory result, how much do you need for an ideal result?
Then weigh all these facts in with what you desire to get out of surgery, whether that be a conservative or strong result, to go with a more cost effective surgeon or not, etc.
Start ruling out each option one by one until you arrive at the best plan. For example, it seems like Caminiti is offering you option 2. So get him (and other surgeons of course) to explain to you very clearly his rationale for why he thinks an extra 9 mm lefort on an already advanced upper jaw by 6 mm will not result in chimp lip. If he’s vague or brushes off the concern, it’s a bad sign.
If he says something like well your upper lip is still pretty flat and could use some more projection, then you can consider it. It sounds crazy with his offering 9 mm, but it’s a possibility. I was warned by many on this forum that I was at great risk for chimp lip but my surgeon did not think so at all and it turns out he was right. Bring pictures of chimp lip cases to Caminiti so he fully understands what you mean. If he gives you a strong rationale for why you won’t get a chimp lip, option 4 may also be on the table for you. I will say, however, I agree with the others that his plan seems too extreme.
If he concedes that a chimp lip is an unfortunate possibility, and this is unacceptable to you, you only have option 1 or 3 left, etc.
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If Caminiti’s PLAN is good, and it makes perfect sense for your unique case and face, I have no reason to believe his surgical skills or competency won’t give you the result you’re looking for. Although I may be biased because I got a good result from a Canadian surgeon, I think ruling out Canadian surgeons should mostly be based on whether the plan is good or bad, not necessarily the surgical skills. I could be wrong.
At this stage you need to focus on what will simply be the best plan for you. Focus on surgeons later.
These are your options:
Linear advancement:
1.Conservative linear bi-max to get a slightly stronger upper and lower jaw without risking chimp lip.
2. Aggressive linear bi-max to get a much stronger lower jaw but risking chimp lip (Caminiti’s plan).
CCW-r
3. CCW-r plus bsso to create enough overjet to get a moderate advancement of the lower jaw while leaving the upper jaw where it is, negating any potential adverse aesthetic outcome of the upper jaw (Plosko’s recommendation).
4. CCW-r plus bi-max to get the STRONGEST lower jaw advancement possible, but also a strong upper jaw advancement which, again, puts you at risk for chimp lip.
You need to figure out a few things:
-What’s the position of your upper jaw? Like SNA angle? Is your upper lip contour enough or can it be improved? What’s the limit you can advance the upper without getting a convex lip?
-What’s the position of your lower jaw? How much advancement do you need for a satisfactory result, how much do you need for an ideal result?
Then weigh all these facts in with what you desire to get out of surgery, whether that be a conservative or strong result, to go with a more cost effective surgeon or not, etc.
Start ruling out each option one by one until you arrive at the best plan. For example, it seems like Caminiti is offering you option 2. So get him (and other surgeons of course) to explain to you very clearly his rationale for why he thinks an extra 9 mm lefort on an already advanced upper jaw by 6 mm will not result in chimp lip. If he’s vague or brushes off the concern, it’s a bad sign.
If he says something like well your upper lip is still pretty flat and could use some more projection, then you can consider it. It sounds crazy with his offering 9 mm, but it’s a possibility. I was warned by many on this forum that I was at great risk for chimp lip but my surgeon did not think so at all and it turns out he was right. Bring pictures of chimp lip cases to Caminiti so he fully understands what you mean. If he gives you a strong rationale for why you won’t get a chimp lip, option 4 may also be on the table for you. I will say, however, I agree with the others that his plan seems too extreme.
If he concedes that a chimp lip is an unfortunate possibility, and this is unacceptable to you, you only have option 1 or 3 left, etc.
Thanks O-Dog, you're right, this gives me a good strategy with which to rule out options. f**k, I don't really want to see Caminetti again since he was already brushing off my concerns when I was there in consultation with him. He seemed like super busy and not that interested in having a discussion with me. He also had a resident in the room which I found annoying.
Hmmm..... maybe I'll see Tocchio again.
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Hi Lazlo,
I consulted with Tocchio about CCW + bsso last year and was scheduled for surgery this month, but I backed out. For one, I had read some studies that expounded the instability of the CCW rotation with the presence of TMJ issues. I definitely have TMJ issues and I felt like Tocchio was brushing them off without thoroughly assessing joint health. Given that my TMJ issues are stable I decided it wasn't worth the risk of making them worse. Also was ready to do a consult with Gunson, but they wanted me to go through a convoluted process of visiting an orthodontist and getting a bunch of scans, so I backed out. I'm not getting a CBCT done for an initial assessment--don't need that radiation exposure.
It's too bad, because my facial profile is really f**cked up. I hate it, but I've just resigned to the fact that medical technology hasn't advanced to the point yet where the surgery that I need is high-confidence/high-stability. When I save up some money, I'll likely get the best camouflage genioplasty money can buy and then forget about it. I can totally related to the confidence issues etc, but it's better than have TMJ pain for the rest of my life or never being able to bite into a steak again. I'm hoping that when I'm 45 they'll have made some advancements by then and I'll be able to get it done. PM me if you wanna talk more. I'm in Toronto (sounds like you are too). Also have thought about going to see Mesami at Yorkville Oral Surgery. Have you talked to her?
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Hi Lazlo,
I consulted with Tocchio about CCW + bsso last year and was scheduled for surgery this month, but I backed out. For one, I had read some studies that expounded the instability of the CCW rotation with the presence of TMJ issues. I definitely have TMJ issues and I felt like Tocchio was brushing them off without thoroughly assessing joint health. Given that my TMJ issues are stable I decided it wasn't worth the risk of making them worse. Also was ready to do a consult with Gunson, but they wanted me to go through a convoluted process of visiting an orthodontist and getting a bunch of scans, so I backed out. I'm not getting a CBCT done for an initial assessment--don't need that radiation exposure.
It's too bad, because my facial profile is really f**cked up. I hate it, but I've just resigned to the fact that medical technology hasn't advanced to the point yet where the surgery that I need is high-confidence/high-stability. When I save up some money, I'll likely get the best camouflage genioplasty money can buy and then forget about it. I can totally related to the confidence issues etc, but it's better than have TMJ pain for the rest of my life or never being able to bite into a steak again. I'm hoping that when I'm 45 they'll have made some advancements by then and I'll be able to get it done. PM me if you wanna talk more. I'm in Toronto (sounds like you are too). Also have thought about going to see Mesami at Yorkville Oral Surgery. Have you talked to her?
Sounds paranoid. I bet you have no problem with lithium-ion batteries sitting next to your nuts all day.
By contrast from a CBCT scan that orthos do would increase your risk of exposure-induced death by cancer increases by a fraction of the order 10^(-7) or 1/10,000,000 (https://bmcoralhealth.biomedcentral.com/articles/10.1186/s12903-018-0592-5)
There are much better reasons to be apprehensive about jaw surgery than the radiation from a cbct scan.
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Hi Lazlo,
I consulted with Tocchio about CCW + bsso last year and was scheduled for surgery this month, but I backed out. For one, I had read some studies that expounded the instability of the CCW rotation with the presence of TMJ issues. I definitely have TMJ issues and I felt like Tocchio was brushing them off without thoroughly assessing joint health. Given that my TMJ issues are stable I decided it wasn't worth the risk of making them worse. Also was ready to do a consult with Gunson, but they wanted me to go through a convoluted process of visiting an orthodontist and getting a bunch of scans, so I backed out. I'm not getting a CBCT done for an initial assessment--don't need that radiation exposure.
It's too bad, because my facial profile is really f**cked up. I hate it, but I've just resigned to the fact that medical technology hasn't advanced to the point yet where the surgery that I need is high-confidence/high-stability. When I save up some money, I'll likely get the best camouflage genioplasty money can buy and then forget about it. I can totally related to the confidence issues etc, but it's better than have TMJ pain for the rest of my life or never being able to bite into a steak again. I'm hoping that when I'm 45 they'll have made some advancements by then and I'll be able to get it done. PM me if you wanna talk more. I'm in Toronto (sounds like you are too). Also have thought about going to see Mesami at Yorkville Oral Surgery. Have you talked to her?
Irrational, self negating response. If you 'definitely' have TMJ issues, then you definitely need the scans to assess joint health especially if you are wanting CCW that could put excess pressure on someone with TMJ issues.
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lithium-ion batteries sitting next to your nuts all day.
Well, that's not healthy so...
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Well, that's not healthy so...
Yeah, for clarification I was talking about our smart phones which sit in our pockets all day.
I always find it comical when people have no problem going through the airport scanners, flying, using smartphones etc etc. but then refuse to have a cbct scan for a medical consultation to check the state of their jaw joints.