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General Category => Aesthetics => Topic started by: Austinou88 on May 26, 2019, 11:18:10 PM
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Recently had a digital consult with Gunson. And also saw 2 of his main Ortho's in-person that he regularly uses.
He's proposing
- Le Fort I Osteotomy Multi-segment w/bone grafting
- Bilateral Sagittal Split Osteotomies w/bone grafting
- Chin Repositioning
- Cheekbone Augmentation
Do you think what he's proposed will make much of a difference in terms of aesthetics? I plan on bringing his Surgery Plans with me to my Military MaxFac.
https://imgur.com/a/vFqfBG8
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The displacements are significant and will make a noticeable difference in aesthetics.
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Looks like most of the movement is linear. So lesser surgeons should be able to execute the plan. Not even sure if 2 mm posterior downgraft will make much difference.
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It will make a huge difference in terms of aesthetics. He might even put midface augmentation on top which will help alot imo.
However, you should be more concerned with correcting your "severe obstructive sleep apnea".
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I'd see him in person. "Can't tell from photos" would not make me feel great.
Your ortho will be prepping you based on Gunson's interpretation of photos, so the surgical plan could change dramatically the day of surgery because of this.
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Looking at the diagram it seems your nasolabial angle will become too narrow possibly giving you the dreaded "chimp lip".
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Looking at the diagram it seems your nasolabial angle will become too narrow possibly giving you the dreaded "chimp lip".
Chimps don't have a narrow nasio-labial angle. They have an exaggerated conVEX lip.
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The angle of your head in your profile shot is being partially obscured by your jacket, but looks like you have forward head posture. I did a quick morph assuming what your head angle would be possibly looking straight ahead. One issue you'd have with these movements is that the angle of your nose currently matches your current facial development and has a low angle. If you went ahead with these movements, assuming you didn't do something about your nose angle, it would be heavily compressed by the forward movement and you'd have the wide flat nose look. I changed this in the morph too.. so I guess it works if you factor all that in?
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Recently had a digital consult with Gunson. And also saw 2 of his main Ortho's in-person that he regularly uses.
He's proposing
- Le Fort I Osteotomy Multi-segment w/bone grafting
- Bilateral Sagittal Split Osteotomies w/bone grafting
- Chin Repositioning
- Cheekbone Augmentation
Do you think what he's proposed will make much of a difference in terms of aesthetics?
https://imgur.com/a/vFqfBG8
Look at the contour displacement diagram, (the one where YOUR profile is shown in black and the proposed displacement contour is shown in red). From there, you should at least be able to self IDENTIFY with your OWN profile contour and SEE whether or not the proposed one (in red) makes a POSITIVE difference to your profile. Whether or not the proposed contour changes will make much of an aesthetic difference should be SELF EVIDENT. You should at least be able to observe which contour looks better. If not, there is no point in discussing 'aesthetics', motivation for 'better aesthetics' in the absence of knowing whether or not you could recognize one if you saw it diagrammed on your own face.
Here, you were given a visual. So, what does it look like to YOU...better aesthetic or not?
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Look at the contour displacement diagram, (the one where YOUR profile is shown in black and the proposed displacement contour is shown in red). From there, you should at least be able to self IDENTIFY with your OWN profile contour and SEE whether or not the proposed one (in red) makes a POSITIVE difference to your profile. Whether or not the proposed contour changes will make much of an aesthetic difference should be SELF EVIDENT. You should at least be able to observe which contour looks better. If not, there is no point in discussing 'aesthetics', motivation for 'better aesthetics' in the absence of knowing whether or not you could recognize one if you saw it diagrammed on your own face.
Here, you were given a visual. So, what does it look like to YOU...better aesthetic or not?
When I first noticed something was wrong, I could not put my finger on it for the longest time. Is it my chin? my nose? my maxillas fine, no my maxillas narrow, no recessed, no its my orbitals, must be my superior orbit, no my inferior orbit etc etc. Maybe I'm aesthetically blind, but it took me a lot of research, morphing, analyzing to understand facial aesthetics. Maybe there are others like me, to varying degrees.
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When I first noticed something was wrong, I could not put my finger on it for the longest time. Is it my chin? my nose? my maxillas fine, no my maxillas narrow, no recessed, no its my orbitals, must be my superior orbit, no my inferior orbit etc etc. Maybe I'm aesthetically blind, but it took me a lot of research, morphing, analyzing to understand facial aesthetics. Maybe there are others like me, to varying degrees.
I hear what you're saying about how it's hard to put one's finger on what's wrong on ones face. It's just that here, I want him to look at the contour diagram because I want to know how evident to him the aesthetic change is. Indeed, it takes some work to understand aesthetic relationships. But the first step is observing a change, relative to one's own face, here a contour diagram and knowing whether one likes it or not. Well, I need to know someone has that baseline before I start addressing other questions.
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I hear what you're saying about how it's hard to put one's finger on what's wrong on ones face. It's just that here, I want him to look at the contour diagram because I want to know how evident to him the aesthetic change is. Indeed, it takes some work to understand aesthetic relationships. But the first step is observing a change, relative to one's own face, here a contour diagram and knowing whether one likes it or not. Well, I need to know someone has that baseline before I start addressing other questions.
I think what OP meant to ask more specifically was: will the change in aesthetics be worth the hefty pricetag, recovery, and everything else that goes along with JS.
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I think what OP meant to ask more specifically was: will the change in aesthetics be worth the hefty pricetag, recovery, and everything else that goes along with JS.
He didn't mean to ask that because he's not getting surgery with Gunson. He's just getting a plan/assessment from Gunson so he can take it to a military doctor.
ETA: To the best of my knowledge, military doctors are on his insurance plan and the military pays for surgery or most of it.
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If you take this to a military doc to follow, know that this would still be considered a tentative plan. Think of it more as a guide. This is not because you need extensive ortho work first - you don't - but it's because Gunson hasn't evaluated in person and even if he had, his final plan for his patients isn't made until the week of surgery when he does the VSP. So basically what I'm saying is your military doc might not follow this to a T, but he can use it as a guide.
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The displacements are significant and will make a noticeable difference in aesthetics.
So, would you consider me one of those cases that could end up benefiting greatly?
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I'd see him in person. "Can't tell from photos" would not make me feel great.
Your ortho will be prepping you based on Gunson's interpretation of photos, so the surgical plan could change dramatically the day of surgery because of this.
Dang, yeah you're right. That doesn't make me feel too sure about his plans now.
Should I try and setup an in-person followup then, based upon my concerns with that part?
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Chimps don't have a narrow nasio-labial angle. They have an exaggerated conVEX lip.
Man, I loved the job Rohrich did on my nose. But I wish I would of known better, and waited till after I addressed my lower third issues.
How bad do you think it's going to end up being/changing after all these movements?
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The angle of your head in your profile shot is being partially obscured by your jacket, but looks like you have forward head posture. I did a quick morph assuming what your head angle would be possibly looking straight ahead. One issue you'd have with these movements is that the angle of your nose currently matches your current facial development and has a low angle. If you went ahead with these movements, assuming you didn't do something about your nose angle, it would be heavily compressed by the forward movement and you'd have the wide flat nose look. I changed this in the morph too.. so I guess it works if you factor all that in?
Man, I wish I would of known better before getting my Rhinoplasty. So this is certain to change for sure than?
Well I think I will just go and see Maubrie than for some temporary fillers afterwards, at least until I can get in for a revision.
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Look at the contour displacement diagram, (the one where YOUR profile is shown in black and the proposed displacement contour is shown in red). From there, you should at least be able to self IDENTIFY with your OWN profile contour and SEE whether or not the proposed one (in red) makes a POSITIVE difference to your profile. Whether or not the proposed contour changes will make much of an aesthetic difference should be SELF EVIDENT. You should at least be able to observe which contour looks better. If not, there is no point in discussing 'aesthetics', motivation for 'better aesthetics' in the absence of knowing whether or not you could recognize one if you saw it diagrammed on your own face.
Here, you were given a visual. So, what does it look like to YOU...better aesthetic or not?
Ah okay, thanks for explaining that Kavan. Looking at it now more clearly, the advancements look huge! I like it, everything looks more balanced and projected.
I guess my question should of also included, is Gunson giving me the most max asthetic plan possible? Are there any movements that he could of changed (gone further on, not do, do, tweaked, and etc.) that he didn't do?
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Dang, yeah you're right. That doesn't make me feel too sure about his plans now.
Should I try and setup an in-person followup then, based upon my concerns with that part?
I would if it's not too much a ha$$le to get there.
Good planning is a big % of the success with this surgery. I don't see how it's possible to have good planning via distance vs in the flesh. The latter is just not going to be as accurate.
If it's too much a hassle to go in-person then this will have to do, but just realize the odds for problems go up a bit. If anything is really amiss the day of surgical prep Gunson will likely call it off.
PS. The plan looks fine from what I can gather. Some linear and some CCW. The linear should open the upper airway, and the CCW should open the lower airway (more linked to apnea). I think your profile looks alright right now, so it will probably be a bit extreme in terms of how masculine you look after. If that's the look you want, this should do it. Since you're going in for (severe) apnea treatment you might just have to accept the aesthetics.
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Dang, yeah you're right. That doesn't make me feel too sure about his plans now.
Should I try and setup an in-person followup then, based upon my concerns with that part?
Why bother if you've already decided you will use another surgeon? You've got the concept of what Gunson would do to you, the difference will probably be to fine tune the mm's. What's interesting that you can bring from this is that he doesn't see any need for any big rotations etc, mainly a straight advancement. No other surgeon will be able to replicate down to the mm any way, probably not even Gunson if he would do your case twice.
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Why bother if you've already decided you will use another surgeon? You've got the concept of what Gunson would do to you, the difference will probably be to fine tune the mm's. What's interesting that you can bring from this is that he doesn't see any need for any big rotations etc, mainly a straight advancement. No other surgeon will be able to replicate down to the mm any way, probably not even Gunson if he would do your case twice.
BINGO! But he hasn't made clear to GJ (or anyone else in his initial string) that he's not going to Gunson.
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Austin,
I'm sorry, but I'm not going to address every spin off question you have because I want to see less ENTROPY in the way you relay and respond to information and more ORDER in processing it. What I mean by 'entropy' is the act of expanding 'all over the place' with questions that don't reflect you've 'crystallized' the purpose of the information given. Let me just say that the level or type of information I will give to people has to be contingent on my recognizing they can process it in an orderly way.
Let's take a closer look here. An entry is made where a person giving you advice doesn't observe something that's obvious; he doesn't see that chimps have overly conVEX muzzles (chimp lip) and not 'narrow' nasio-labial angles.
Looking at the diagram it seems your nasolabial angle will become too narrow possibly giving you the dreaded "chimp lip".
I clarify so that you don't get confused by his entry or think the plan will give you chimp lip or otherwise make you look worse.
Chimps don't have a narrow nasio-labial angle. They have an exaggerated conVEX lip.
...and what happens next, the clarification given so you DON'T WORRY that this plan is going to make you look worse spring boards off of someone who made a faulty observation and you want to know how 'bad' I think you are going to look. Entropy question. So, I'm only going to address questions that I feel are logical extensions of the prior information given and not those that I feel come out of an ENTROPY generator and mind you, a number of people here said the plan would give great improvement.
Man, I loved the job Rohrich did on my nose. But I wish I would of known better, and waited till after I addressed my lower third issues.
How bad do you think it's going to end up being/changing after all these movements?
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Let's take another example of entropy in this string.
Lefortitude responds to my first entry to you where he might think I'm being too harsh by telling you to observe what should be self evident to you (as to whether you like the contour diagram change or not).
When I first noticed something was wrong, I could not put my finger on it for the longest time. Is it my chin? my nose? my maxillas fine, no my maxillas narrow, no recessed, no its my orbitals, must be my superior orbit, no my inferior orbit etc etc. Maybe I'm aesthetically blind, but it took me a lot of research, morphing, analyzing to understand facial aesthetics. Maybe there are others like me, to varying degrees.
With his statement, although this is something where you KNOW your going off topic, you want to engage him in a bullet list of EYE topics. That's entropy; going all over the place with questions that are not really extensions of what the other person said or even the topic of your string. However, if he wants to indulge in that with reference to your photos where you have the eyes WHITED OUT, it's his shot to call.
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Then we have some posters, to whom you have not MADE CLEAR you went to Gunson for a PLAN to take to your military doctor and you are not actually getting the surgery with Gunson.
There's O'Dog trying to explain what you mean from your question, thinking you're asking because you want to know if the surgery is worth Gunson's HEFTY PRICE tag. Also, GJ tells you to go IN PERSON so that Gunson can solidify his plans so there are no changes the day of surgery. So, there you have people giving feedback based on their ASSUMPTION you are having this surgery with Gunson where they would have known you were not getting surgery with him if you had stated that in your first post and clarified it was a plan that you wanted to take to the military doctors.
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Last but not least is the question for me.
Ah okay, thanks for explaining that Kavan. Looking at it now more clearly, the advancements look huge! I like it, everything looks more balanced and projected.
I guess my question should of also included, is Gunson giving me the most max asthetic plan possible? Are there any movements that he could of changed (gone further on, not do, do, tweaked, and etc.) that he didn't do?
The plan reflects Gunson's aesthetic and his ability to balance all of the many individual parts for aesthetic balance and correction of sleep apnea. That is what you went for; a PLAN that reflected his aesthetics combined with correcting apnea. You got what you went to get; a PLAN to to show your military doctors that shows them how CCW can be used to optimize aesthetics while correcting sleep apnea. All you need to know is that YOU LIKE the aesthetic shown in the plan. It's not needed for me to critique his plan in terms of which displacements he could have done to give the max aesthetic possible. What's needed is for you to FOCUS on being able to identify on the illustration with it coming very close to an aesthetic you would like, realizing the plan is to OPTIMIZE sleep apnea problem with GOOD aesthetic balance. So, entropy question of what movements he could have should have done to 'maximize' aesthetics is disqualified here.
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I would if it's not too much a ha$$le to get there.
Good planning is a big % of the success with this surgery. I don't see how it's possible to have good planning via distance vs in the flesh. The latter is just not going to be as accurate.
If it's too much a hassle to go in-person then this will have to do, but just realize the odds for problems go up a bit. If anything is really amiss the day of surgical prep Gunson will likely call it off.
PS. The plan looks fine from what I can gather. Some linear and some CCW. The linear should open the upper airway, and the CCW should open the lower airway (more linked to apnea). I think your profile looks alright right now, so it will probably be a bit extreme in terms of how masculine you look after. If that's the look you want, this should do it. Since you're going in for (severe) apnea treatment you might just have to accept the aesthetics.
Yeah I'm going to check on that tomorrow just to see if nothing else.
Apologize, one thing I did forget to mention was that I brought Gunsons plan to the Military MaxFac, and showed them it. The Resident asked who did it and I told him Arnett & Gunson. He then showed it to the Military MaxFac in charge of him, who is the one I requested by name, and he said the same thing. He trained under Wolford for a while, and everyone at the facility, and other facility's, say he's the best. The plan isn't too complicated for a decent surgeon to execute is it?
They didn't agree to the plan, but I tried pushing it as much as possible. I'm waiting to hear back from the surgeon, but I spoke with him the other day and he said he had a couple of different treatment options open to me. Just need to send over my Sleep Study Results once I get them, just did my second sleep study last night.
I noticed that the technology they use at the Military Hospital though doesn't seem like it's the most up to date and advanced stuff. Since it's a Residency Facility, I think they are probably also doing more an old school style way of teaching, instead of all virtual. Not sure though.
At my consult with the Military MaxFac I brought in all the records I've acquired so far. He was really happy for some reason, probably because I had basically everything he needed to plan out the surgery.
Just curious though, does good, high quality imaging also play an important role in a successful surgery outcome?
Is there any important imaging besides the typical Ceph, Pan, CT Scans, and Photographs I should obtain and send them? Anything that would help my surgeon out tremendously? I've heard about things such as 3D Ceph Analysis (from Cephx?), Cone Beam CT (CBCT), Frontal Ceph, and iTero Scan.
As long as it looks better, I'm open to as much change as possible lol. More worried about my facial front though. Hope that can be a lot more balanced out.
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Austin,
I'm sorry, but I'm not going to address every spin off question you have because I want to see less ENTROPY in the way you relay and respond to information and more ORDER in processing it. What I mean by 'entropy' is the act of expanding 'all over the place' with questions that don't reflect you've 'crystallized' the purpose of the information given. Let me just say that the level or type of information I will give to people has to be contingent on my recognizing they can process it in an orderly way.
Let's take a closer look here. An entry is made where a person giving you advice doesn't observe something that's obvious; he doesn't see that chimps have overly conVEX muzzles (chimp lip) and not 'narrow' nasio-labial angles.
I clarify so that you don't get confused by his entry or think the plan will give you chimp lip or otherwise make you look worse.
...and what happens next, the clarification given so you DON'T WORRY that this plan is going to make you look worse spring boards off of someone who made a faulty observation and you want to know how 'bad' I think you are going to look. Entropy question. So, I'm only going to address questions that I feel are logical extensions of the prior information given and not those that I feel come out of an ENTROPY generator and mind you, a number of people here said the plan would give great improvement.
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Let's take another example of entropy in this string.
Lefortitude responds to my first entry to you where he might think I'm being too harsh by telling you to observe what should be self evident to you (as to whether you like the contour diagram change or not).
With his statement, although this is something where you KNOW your going off topic, you want to engage him in a bullet list of EYE topics. That's entropy; going all over the place with questions that are not really extensions of what the other person said or even the topic of your string. However, if he wants to indulge in that with reference to your photos where you have the eyes WHITED OUT, it's his shot to call.
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Then we have some posters, to whom you have not MADE CLEAR you went to Gunson for a PLAN to take to your military doctor and you are not actually getting the surgery with Gunson.
There's O'Dog trying to explain what you mean from your question, thinking you're asking because you want to know if the surgery is worth Gunson's HEFTY PRICE tag. Also, GJ tells you to go IN PERSON so that Gunson can solidify his plans so there are no changes the day of surgery. So, there you have people giving feedback based on their ASSUMPTION you are having this surgery with Gunson where they would have known you were not getting surgery with him if you had stated that in your first post and clarified it was a plan that you wanted to take to the military doctors.
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Last but not least is the question for me.
The plan reflects Gunson's aesthetic and his ability to balance all of the many individual parts for aesthetic balance and correction of sleep apnea. That is what you went for; a PLAN that reflected his aesthetics combined with correcting apnea. You got what you went to get; a PLAN to to show your military doctors that shows them how CCW can be used to optimize aesthetics while correcting sleep apnea. All you need to know is that YOU LIKE the aesthetic shown in the plan. It's not needed for me to critique his plan in terms of which displacements he could have done to give the max aesthetic possible. What's needed is for you to FOCUS on being able to identify on the illustration with it coming very close to an aesthetic you would like, realizing the plan is to OPTIMIZE sleep apnea problem with GOOD aesthetic balance. So, entropy question of what movements he could have should have done to 'maximize' aesthetics is disqualified here.
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Oh wow, I didn't even realize I was doing that. I guess I felt like I needed to respond to each reply, otherwise I would come off disrespectful. I see how that can end up being counterproductive now, my apologies. And I understand your points raised. I'll make sure to correct the way I go about my responses here out.
I guess I should of been more straight forward with Gunson, on how my focus is actually 100% asthetics. I asked him if this was maxing out asthetics though, which he replied yes. That I'd get the benefit of both. But maybe that meant only in terms of working alongside and correcting the sleep apnea, like you mentioned?
If better asthetics would be possible, with disregard for fixing the sleep apnea, then that's a plan I would be more interested in for sure! I know that may sound crazy, but it seems my sleep apnea is almost entirely central apnea instead of obstructive.
I don't have anything I'm particularly ooking for in terms of asthetics, just whatever movement will yield the most pleasing results. Change as much as required to give the greatest pleasing results. Pretty much the same thing I told Rohrich on my nose.
I do like the illustration though, and I guess my question should of been, can anything be changed further for even better pleasing asthetics.
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Oh wow, I didn't even realize I was doing that. I guess I felt like I needed to respond to each reply, otherwise I would come off disrespectful. I see how that can end up being counterproductive now, my apologies. And I understand your points raised. I'll make sure to correct the way I go about my responses here out.
I guess I should of been more straight forward with Gunson, on how my focus is actually 100% asthetics. I asked him if this was maxing out asthetics though, which he replied yes. That I'd get the benefit of both. But maybe that meant only in terms of working alongside and correcting the sleep apnea, like you mentioned?
If better asthetics would be possible, with disregard for fixing the sleep apnea, then that's a plan I would be more interested in for sure! I know that may sound crazy, but it seems my sleep apnea is almost entirely central apnea instead of obstructive.
I don't have anything I'm particularly ooking for in terms of asthetics, just whatever movement will yield the most pleasing results. Change as much as required to give the greatest pleasing results. Pretty much the same thing I told Rohrich on my nose.
I do like the illustration though, and I guess my question should of been, can anything be changed further for even better pleasing asthetics.
You can respond to each reply, but stick to questions that would follow from the reply. Gunson told you right when he said you would get benefits of both. Keep in mind that your insurance is paying for sleep apnea surgery and not for 'aesthetics alone' and if you can get the military doctors to follow plan as close as possible, then you will have both.
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Good to go. Is it possible Gunson would of came up with a different approach if it was just for asthetic reasons only?
Yeah, but since I have to have it at the Military Facility, the insurance doesn't pay anything. I'm concerned though because a Resident will be involved in some of the surgery. I can't remove him from the equation. He works under the staff surgeon I requested, who's pretty good. Then again, I remember Rohrich suprising me with some Resident the day of my surgery. Everything turned out fine though.
So, was that morph just what a Genio would look like on me?
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Good to go. Is it possible Gunson would of came up with a different approach if it was just for asthetic reasons only?
Yeah, but since I have to have it at the Military Facility, the insurance doesn't pay anything. I'm concerned though because a Resident will be involved in some of the surgery. I can't remove him from the equation. He works under the staff surgeon I requested, who's pretty good. Then again, I remember Rohrich suprising me with some Resident the day of my surgery. Everything turned out fine though.
So, was that morph just what a Genio would look like on me?
Gunson's suggestion incorporated more aesthetic changes simply because he suggested HA bone granules to augment some of the bone structure which is something your military doctors probably will not do for 'aesthetics only'.
I suppose, perhaps there could be a different approach IF it were just for aesthetics 'only'. I mean I can't rule out that possibility. But I CAN'T PONDER all the possible combinations and permutations of movements just to address the question. If that's a burning question for you, ask Gunson.
The salient thing is that you have a plan from Gunson that includes a posterior down graft and that is associated with both better aesthetics and better breathing and the plan shows you a profile contour that should be enough for you to determine IF you like that and that profile contour is CONSISTENT with A GOOD aesthetic.
I don't know WHAT 'morph' you are talking about. My comments on this string refer to Gunson's contour diagram and not to any morphs.
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The posterior downgraft is so small relative to other movements it will probably make little difference.
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The posterior downgraft is so small relative to other movements it will probably make little difference.
It could make THE difference though, otherwise it would probably be omitted. It's unclear to me what multiplicative impact small OP angle variations have on the horizontal displacements.
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The posterior downgraft is so small relative to other movements it will probably make little difference.
He got the plan with the objective of getting the Gunson DIFFERENCE relative to what another doc might do (or not do). So the downgraft would be considered that difference. Although the difference might be subtle, it's done with objective of optimizing aesthetics with breathing function. Can't say all sleep apnea plans have the same objective to optimize aesthetics.
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Man, I would rather achieve better asthetic results (if possible), and just use a CPAP long term for my sleep apnea. So maybe I should get another consult (Wolford?) with the approach of asthetics only, and see if there is a difference in the plans?
I just sent an email over to Gunsons office in regards to this question. Maybe a bold move, doesn't hurt to ask right?
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Man, I would rather achieve better asthetic results (if possible), and just use a CPAP long term for my sleep apnea. So maybe I should get another consult (Wolford?) with the approach of asthetics only, and see if there is a difference in the plans?
I just sent an email over to Gunsons office in regards to this question. Maybe a bold move, doesn't hurt to ask right?
Reserving judgement on this decision, that could hurt your application for insurance coverage because they are covering your operation for the functional issue. So yes it could hurt your wallet to ask this question in writing.
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Well I'm planning to have surgery with the Military MaxFacs anyway, so it wouldn't really affect anything. Also, the insurance reimbursement for Gunson is barely anything at all.
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Well I'm planning to have surgery with the Military MaxFacs anyway, so it wouldn't really affect anything. Also, the insurance reimbursement for Gunson is barely anything at all.
The insurance reimbursement on SURGICAL fees is barely anything. What about hospital costs?
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Man, I would rather achieve better asthetic results (if possible), and just use a CPAP long term for my sleep apnea. So maybe I should get another consult (Wolford?) with the approach of asthetics only, and see if there is a difference in the plans?
I just sent an email over to Gunsons office in regards to this question. Maybe a bold move, doesn't hurt to ask right?
It's basically malpractice to do a surgery with the anticipation to have you use CPAP for the rest of your life. I would stay away from any surgeon offering you that. Hopefully you will agree to this some time as well.
But it is also that aesthetic and function is very well connected. What is considered aesthetic is often a healthy look. Aestetically retruded jaws and narrow airways are connected and advancement solves both.
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The insurance reimbursement on SURGICAL fees is barely anything. What about hospital costs?
Well its 66k in surgical fees. So with insurance, that's 1,250 out of 66k. Not sure on Hospital costs, I didn't see it listed.
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It's basically malpractice to do a surgery with the anticipation to have you use CPAP for the rest of your life. I would stay away from any surgeon offering you that. Hopefully you will agree to this some time as well.
But it is also that aesthetic and function is very well connected. What is considered aesthetic is often a healthy look. Aestetically retruded jaws and narrow airways are connected and advancement solves both.
Yeah I agree, I understand what you mean.
What I meant is, if you were approaching treatment toward asthetics only. Because surely something already recessed, wouldn't be recessed further for better asthetics?
Here's what Gunsons Treatment Coordinator said though.
"The treatment “plan” itself should not change. Your treatment plan is based on your individual face and function.
Do you have a copy of the sleep study? It would be nice to have on file at our office, although unlikely, it “could” influence the treatment “movements” slightly."
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Well its 66k in surgical fees. So with insurance, that's 1,250 out of 66k. Not sure on Hospital costs, I didn't see it listed.
My hospital fees were upwards of 50k and that's what insurance covered. I don't know what Gunson's hospital costs, but insurance is a big deal for most JS patients.
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From what I have seen American hospital fees are a bit of an insurance scam. Fees for self-funded patients are often significantly less.
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Yeah that's pretty good coverage. I think when I was a civilian and had private insurance, my hospital costs were about the same, for my UPPP Surgery. Insurance covered 100% of it.
With the Military it's a strict HMO plan (MTF's only). Very frustrating, but I am wanting to take Gunsons plan (if it's really the best plan for asthetics) and have my Military Surgeon do it.
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He got the plan with the objective of getting the Gunson DIFFERENCE relative to what another doc might do (or not do). So the downgraft would be considered that difference. Although the difference might be subtle, it's done with objective of optimizing aesthetics with breathing function. Can't say all sleep apnea plans have the same objective to optimize aesthetics.
I just think it's good that the "most aesthetically minded surgeon" recommended a largely linear plan. Most competent surgeons should be able to carry out. I do think they may not downgraft at the back thinking 2mm won't make much difference, the patient is unlikely to notice and it's more stable.
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Is the large linear movements just to open up the airways, or is that also contribute some to the asthetics? What's the down grafting in the plan for?
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The angle of your head in your profile shot is being partially obscured by your jacket, but looks like you have forward head posture. I did a quick morph assuming what your head angle would be possibly looking straight ahead. One issue you'd have with these movements is that the angle of your nose currently matches your current facial development and has a low angle. If you went ahead with these movements, assuming you didn't do something about your nose angle, it would be heavily compressed by the forward movement and you'd have the wide flat nose look. I changed this in the morph too.. so I guess it works if you factor all that in?
Thanks for doing the Morph. So, I guess I'll be needing a revision afterward. But still, it's got to be worth the trade off.
Are you able to make a prediction on what the changes would look like on the frontal possibly?
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I just think it's good that the "most aesthetically minded surgeon" recommended a largely linear plan. Most competent surgeons should be able to carry out. I do think they may not downgraft at the back thinking 2mm won't make much difference, the patient is unlikely to notice and it's more stable.
Looks to me that the 2mm posterior down graft COULD be with aim to preclude or cut down on unfavorable lip changes with 7.4mm horizontal ANS advancement. CCW via downgraft is usually with aim of cutting down on such a possibility. Without it the ANS will have to be advanced more via 'linear' advancement than it would be with the CCW of 2mm downgraft offered. That is to say, advancement over a DIAGONAL where no CCW is planned (linear advancement) would also have a VERTICAL element to it which is what Gunson is wanting to avoid.
So, PERHAPS if he wanted a straighter contour to the lip and had no issue with the possibility of it looking on the 'conVEX' side (even if remote) or just didn't like the (imo) pleasing nose to lip angle in the contour diagram, he could disregard Gunson's plan.
Personally, I won't opine on a 'who knows what' plan that another doctor might have for which I CAN'T SEE. The one I CAN see--Gunson's--looks very good to me.
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Man, I would rather achieve better asthetic results (if possible), and just use a CPAP long term for my sleep apnea. So maybe I should get another consult (Wolford?) with the approach of asthetics only, and see if there is a difference in the plans?
I just sent an email over to Gunsons office in regards to this question. Maybe a bold move, doesn't hurt to ask right?
Better aesthetic results than WHAT, the contour diagram you were given to determine if you liked the changed contour of the plan? Unless you are in the capacity to DRAW a 'better' aesthetic CONTOUR as to SHOW what YOUR concept of a 'better aesthetic' is and then ask IF your contour diagram of your preferred aesthetic can be achieved, than asking about a 'better aesthetic' that you can't define yourself or SHOW via a proposed different contour diagram, goes NO WHERE, NOR will a consult with Wolford in the event he also gives you a contour diagram and you need to ask the same questions as to whether or not he could have given a 'better aesthetic'.
It's a MEANINGLESS question to ask if you are not in the capacity to DRAW a contour diagram showing what you mean by 'better aesthetic' or don't have another plan by another doctor where people can SEE what aesthetic his contour plan has. No one can answer this based on your question alone in the absence of actually SEEING another doctor's plan for comparison.
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Or at least describe what is meant by ‘better aesthetic’.
Does anyone know if you can make certain requests of Gunson? For example, if he wanted a stronger chin could he request a slightly stronger genio? (Assuming he went with Gunson)
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Or at least describe what is meant by ‘better aesthetic’.
Does anyone know if you can make certain requests of Gunson? For example, if he wanted a stronger chin could he request a slightly stronger genio? (Assuming he went with Gunson)
Yes, one could request a stronger chin if he were in capacity to SHOW one by drawing one to his contour diagram OR if he could show a stronger chin proposed by ANOTHER surgeon. However, just asking about possibility for a 'better aesthetic' with NO visual demonstration of what he means by such and lacks knowledge of aesthetic relationships such that he doesn't even know what is meant by a 'better aesthetic', is a meaningless question to those to whom it's asked and goes NOWHERE.
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Yes, one could request a stronger chin if he were in capacity to SHOW one by drawing one to his contour diagram OR if he could show a stronger chin proposed by ANOTHER surgeon. However, just asking about possibility for a 'better aesthetic' with NO visual demonstration of what he means by such and lacks knowledge of aesthetic relationships such that he doesn't even know what is meant by a 'better aesthetic', is a meaningless question to those to whom it's asked and goes NOWHERE.
I think what the question resolves to is if there are any aesthetic trade offs in the plan to handle the functional issues. There is quite some research on the aesthetic guidelines and goals to balance the face with the soft tissue TVL, amount of tooth show, proportions of the face etc. Gunson is of course aware about all of this, but what I figure Austinou88 is grasping for is if Gunson on purpose have done any step of from these aesthetic guidelines in favour for treating the medical issues. "Best" aesthetic outcome can be interpreted in 2 ways, either objectively what is considered most aesthetic, or subjectively from patient preferences. No one can advice on subjective preferences, but objectively it can be discussed. From my own plan I know that if I would've had a plan from a less skillfull surgeon and complain about breething, I would probably be offered a plan without posterior down grafting, which probably would be a clear step off from the best aesthetic result, but solving the functional issues.
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I think what the question resolves to is if there are any aesthetic trade offs in the plan to handle the functional issues. There is quite some research on the aesthetic guidelines and goals to balance the face with the soft tissue TVL, amount of tooth show, proportions of the face etc. Gunson is of course aware about all of this, but what I figure Austinou88 is grasping for is if Gunson on purpose have done any step of from these aesthetic guidelines in favour for treating the medical issues. "Best" aesthetic outcome can be interpreted in 2 ways, either objectively what is considered most aesthetic, or subjectively from patient preferences. No one can advice on subjective preferences, but objectively it can be discussed. From my own plan I know that if I would've had a plan from a less skillfull surgeon and complain about breething, I would probably be offered a plan without posterior down grafting, which probably would be a clear step off from the best aesthetic result, but solving the functional issues.
From my perspective, someone with sleep apnea (or sleep issues)--or just say someone who could stand to have their airway open more-- is NOT an 'aesthetics only' patient. An 'aesthetics only' patient is someone with NO OTHER functional issues and is all SELF PAY. In addition to that, from my POV, an 'aesthetics only' patient, needs to express, in no uncertain terms, preferably through a VISUAL depiction--but also could be by clear verbal description-- of a change on his own face as to what his PREFERRED aesthetic is.
It is because insurance will pay for some of this on grounds of FUNCTIONAL problem and also because he's not demonstrating capacity to define any preferred aesthetic he has as his objective that I don't view him as 'aesthetics only' patient and therefore don't engage in 'aesthetics only' questions.
From my POV, I expect an 'aesthetics only' patient to be able to define and make clear what aesthetic they are going for and THEN get feedback from others as to whether or not they think it's a good aesthetic preference or even possible with surgery. In situations where an 'aesthetic only' patient needs others to define, explain, depict aesthetics FOR THEM because they have no concept of what aesthetic they want, I don't engage with them too much either on 'aesthetics only' either. At most I will tell them whether or not I think a DEFINED aesthetic plan (for example one coming from a doctor with a contour diagram) is one I find aesthetically pleasing or a good aesthetic and I've already told him I think it's a good aesthetic.
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From my perspective, someone with sleep apnea (or sleep issues)--or just say someone who could stand to have their airway open more-- is NOT an 'aesthetics only' patient.
I agree, but just clarifying what question he is asking. "I would rather use CPAP for the rest of my life than not getting optimal aesthetic result", tells us a bit about his mindset.
I of course think this is ridiculous and it would be to shoot yourself to not resolve the functional issues. It's a setup for regret.
But I do think it's possible for someone planning the surgery or other who is knowledgable to say if there are any side steps from objectively aesthetic guidelines to treat the functional problems.
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I agree, but just clarifying what question he is asking. "I would rather use CPAP for the rest of my life than not getting optimal aesthetic result", tells us a bit about his mindset.
I of course think this is ridiculous and it would be to shoot yourself to not resolve the functional issues. It's a setup for regret.
But I do think it's possible for someone planning the surgery or other who is knowledgable to say if there are any side steps from objectively aesthetic guidelines to treat the functional problems.
Thanx for the clarification. Problem is that he does not 'see' that the plan he got gives an optimal aesthetic result and no one else SEES what ever other possible 'aesthetics only' visual he might have in mind whereas he might not have any other aesthetic in mind. I contend that the 'aesthetics only' whether one likes them or not can be judged by simply LOOKING at the contour diagram. It is sufficient to determine 'only' the aesthetic improvement.
Besides, Gunson's office already told him the plan was based on both aesthetics and function and basically shows an aesthetic vision that is unlikely to change.