jawsurgeryforums.com
General Category => Aesthetics => Topic started by: trandom on January 19, 2021, 11:31:45 AM
-
Hi everyone!
I visited the doctor about my DJS and he said that I'm a really good candidate for a couple of reasons:
- Bumpy & downward nose tip
- Deep labiomental fold
- Both upper and lower jaws need advancement
- My chin has a good amount of tissue beyond the bone (he said that's what saves me right now from looking REALLY recessed)
- Strong top half of face
My doctor said that we're going to move the lower jaw around 7mm and the upper one about 4mm, to me it seems like it would make too little of a change since I've heard that other people are doing much bigger movements.
I'd like to get a second opinion from you guys.
-
Advancement of the upper jaw will give better support to the base of your nose and help reverse the downward rotation of your tip.
Advancement of the lower jaw would be with aim of balancing it with the upper and in that way your chin would move forward with the advancement without needing a sliding genio to the chin and thereby AVOID making the lower lip to chin groove DEEPER.
That's the basic 'translation' of what he's telling you.
-
From your eyeing, do you think 3mm upper + 7mm lower will do the job here?
-
From your eyeing, do you think 3mm upper + 7mm lower will do the job here?
I think that would look good/natural, but not uber masculine. So it depends what you want.
Your soft tissue appears to be on the thicker side, so you could maybe get away with more bony movement. That's up to you and the surgeon.
-
I don't opine on EXACT mm movements for the following reason:
A 'forward' advancement has 2 displacement vectors; a horizontal and a vertical. In the absence of ceph displacement proposal where it would have a read out of the displacement vectors, there's no 'exact' displacements for me to opine on.
-
7mm is not a small movement when it comes to your face, you will notice it. The problem with large movements is that even tough it might make the profile line up perfectly, it can look unnatural since you move some isolated parts of your entire skull. I had 16mm and even though the profile looks great, I sometimes think my jaw looks too prominent in relation to my facial structure.
Do you know if your doctor is capable of doing ccw rotation? It looks like you might be a candidate for it.
-
7mm is not a small movement when it comes to your face, you will notice it. The problem with large movements is that even tough it might make the profile line up perfectly, it can look unnatural since you move some isolated parts of your entire skull. I had 16mm and even though the profile looks great, I sometimes think my jaw looks too prominent in relation to my facial structure.
Do you know if your doctor is capable of doing ccw rotation? It looks like you might be a candidate for it.
He is within the range of NORMAL MPA (17 deg to 28 deg). He's in approx 25 deg range and his OP is not steep. He is NOT a clear cut candidate for CCW and could have linear advancement.
-
If you want to change the shape and rotation of your nose - why not just get a rhinoplasty?
Your chin and labiomental fold looks good. Your face looks balanced. Your airway doesn't look narrow.
I would not consider any surgery in your case.
-
Update: Just gotten a plan from out of the surgeons I spoke with.
I'd like to hear your guy's opinion on it, and maybe simplify it for me, I'm not 100% clear on what it means exactly, I just know that it's a DJS with CCW.
-
I have included some annotations beside your read out to explain what the displacements of some salient areas mean.
I DON'T wish to posit about what all the stuff below your displacement read out means because I'm not familiar with all surgeons sub notes.
The CCW-r is significant enough for the chin point to be horizontally displaced by 20 mm (and vertically displaced upward) without having to do a genioplasty.
About half of the CCW-r is an anterior impaction, the other half is a posterior downgraft.
The extent of the anterior impaction in addition to the horizontal displacement to the front of the maxilla would tend to kick up visible changes to the base of the nose which might be favorable to someone with a short and furled upper lip and and a downwardly rotated nose tip such as yourself. Because advancing the front of maxilla and also raising it up by impaction would tend to look like a rhinoplasty.
Whether or not you will like the changes can't be answered from here (from me). Nor can piece meal questions about stuff like; 'Is this or that millimetre movement too much or too little?'
If you have any questions about how the extent of the displacements 'sound' relative to how they will LOOK, what you will need to do is request the surgeon who planned the displacements to provide you with VISUAL that SHOWS you how all of the displacements would look together. That can be as simple as displacement profile CONTOUR diagram that outlines your present profile contour and on it, superimposes a projected NEW contour diagram. That is because VISUALS that show a patient a potential contour change outcome assist a patient to determine for him/herself if they like the look of the proposal.
A diagram is included with this post.
-
Thank you very much for taking your time kavan.
Basically, the reason I'm in doubts is that another doctor, who is also aesthetically oriented and is experienced with doing this procedure, was suggesting much more subtle changes, I'll compare between the 2:
Doctor from my country:
Who he is: He's a known max fac from my country, a lot of experience, aesthetically oriented.
What I told him I want: My meeting with him was before I discovered this forum, I came with 0 knowledge, thinking I needed a genioplasty, maybe that's why his "verbal plan" was on the cautious side.
What he suggested: Around 7mm mandible movement and 3-4mm maxilla movement, did not talk about CCW.
High profile doctor - the one that made the plan I posted:
Who he is: High profile doctor from Europe, one of the big names.
What I told him I want: I came to the meeting with more preparation than the first doc, I told him that I want a big, dominant change, we talked about CCW too.
What he suggested: The 2nd plan, which I posted here.
I am questioning things because to me it's very confusing that these plans are so different (well, the 1st plan isn't actually a plan, the doc just told me what he thinks we'll do), I'd be more comfortable if they were at least closer in terms of movement.
I must say though, that I stressed to the high profile doc that I want an ante-face and dominant lower half, I guess that also plays a part in why the plans are so different.
After seeing how the 2nd plan looks, I have a feeling that the 1st plan would leave me with a still recessed face - yes, 7mm is a lot, it will surely bring me into the normal range, but like GJ said before, it won't be uber-masculine, not even close to it from my understanding.
Also, I do have a diagram showing the visual of the plan, I REALLY like it, if there was a sure way to know that that's it's gonna look the same in real life, I wouldn't think twice.
What makes me doubt it:
I know that soft tissue reaction is not always anticipated easily.
The first plan was much less dramatic.
I've never seen such a good result as this visual.
Visual of the 2nd plan - https://imgur.com/a/aBXyXpo
-
Maybe you can check with your first surgeon if the suggested movements would include any rotation (maybe through anterior impaction). Do you have a gummy smile?
-
Hi everyone!
I visited the doctor about my DJS and he said that I'm a really good candidate for a couple of reasons:
- Bumpy & downward nose tip
- Deep labiomental fold
- Both upper and lower jaws need advancement
- My chin has a good amount of tissue beyond the bone (he said that's what saves me right now from looking REALLY recessed)
- Strong top half of face
My doctor said that we're going to move the lower jaw around 7mm and the upper one about 4mm, to me it seems like it would make too little of a change since I've heard that other people are doing much bigger movements.
I'd like to get a second opinion from you guys.
Yes, you would benefit from the potencial aesthetic effects of an adequately planned jaw surgery.
-
Thank you very much for taking your time kavan.
Basically, the reason I'm in doubts is that another doctor, who is also aesthetically oriented and is experienced with doing this procedure, was suggesting much more subtle changes, I'll compare between the 2:
Doctor from my country:
Who he is: He's a known max fac from my country, a lot of experience, aesthetically oriented.
What I told him I want: My meeting with him was before I discovered this forum, I came with 0 knowledge, thinking I needed a genioplasty, maybe that's why his "verbal plan" was on the cautious side.
What he suggested: Around 7mm mandible movement and 3-4mm maxilla movement, did not talk about CCW.
High profile doctor - the one that made the plan I posted:
Who he is: High profile doctor from Europe, one of the big names.
What I told him I want: I came to the meeting with more preparation than the first doc, I told him that I want a big, dominant change, we talked about CCW too.
What he suggested: The 2nd plan, which I posted here.
I am questioning things because to me it's very confusing that these plans are so different (well, the 1st plan isn't actually a plan, the doc just told me what he thinks we'll do), I'd be more comfortable if they were at least closer in terms of movement.
I must say though, that I stressed to the high profile doc that I want an ante-face and dominant lower half, I guess that also plays a part in why the plans are so different.
After seeing how the 2nd plan looks, I have a feeling that the 1st plan would leave me with a still recessed face - yes, 7mm is a lot, it will surely bring me into the normal range, but like GJ said before, it won't be uber-masculine, not even close to it from my understanding.
Also, I do have a diagram showing the visual of the plan, I REALLY like it, if there was a sure way to know that that's it's gonna look the same in real life, I wouldn't think twice.
What makes me doubt it:
I know that soft tissue reaction is not always anticipated easily.
The first plan was much less dramatic.
I've never seen such a good result as this visual.
Visual of the 2nd plan - https://imgur.com/a/aBXyXpo
My hunch, when looking at just the read out along with the absence of information on your part as to your communication with the doctor and the visual was that the extent of the advancement must have arisen from a direct request on your part for something very dramatic.
The displacement plan along with the visual IS very much CONSISTENT with accommodating a request for significant advancement. It IS NOT one that would arise in the ABSENCE of such a request.
Hence, that indeed is the basic explanation behind why the plans from different doctors dramatically differ.
-
Thank you very much for taking your time kavan.
Basically, the reason I'm in doubts is that another doctor, who is also aesthetically oriented and is experienced with doing this procedure, was suggesting much more subtle changes, I'll compare between the 2:
Doctor from my country:
Who he is: He's a known max fac from my country, a lot of experience, aesthetically oriented.
What I told him I want: My meeting with him was before I discovered this forum, I came with 0 knowledge, thinking I needed a genioplasty, maybe that's why his "verbal plan" was on the cautious side.
What he suggested: Around 7mm mandible movement and 3-4mm maxilla movement, did not talk about CCW.
High profile doctor - the one that made the plan I posted:
Who he is: High profile doctor from Europe, one of the big names.
What I told him I want: I came to the meeting with more preparation than the first doc, I told him that I want a big, dominant change, we talked about CCW too.
What he suggested: The 2nd plan, which I posted here.
I am questioning things because to me it's very confusing that these plans are so different (well, the 1st plan isn't actually a plan, the doc just told me what he thinks we'll do), I'd be more comfortable if they were at least closer in terms of movement.
I must say though, that I stressed to the high profile doc that I want an ante-face and dominant lower half, I guess that also plays a part in why the plans are so different.
After seeing how the 2nd plan looks, I have a feeling that the 1st plan would leave me with a still recessed face - yes, 7mm is a lot, it will surely bring me into the normal range, but like GJ said before, it won't be uber-masculine, not even close to it from my understanding.
Also, I do have a diagram showing the visual of the plan, I REALLY like it, if there was a sure way to know that that's it's gonna look the same in real life, I wouldn't think twice.
What makes me doubt it:
I know that soft tissue reaction is not always anticipated easily.
The first plan was much less dramatic.
I've never seen such a good result as this visual.
Visual of the 2nd plan - https://imgur.com/a/aBXyXpo
Who are the doctors?
-
Had another consultation with the more experienced maxfac and he suggested we move both the mandible and the maxilla in a way that would not alter the bite, which basically means there's no need for ortho treatment afterwards.
Since I am seeking good amount of forward movement I am not sure why not move the mandible forward to correct my overbite & get an extra 2-4mm projection @ POG.
I'm attaching the photos again through imgur, together with the first plan (where the bite is altered).
I've also edited the simulation to showcase how I'm going to look if the plan is the same expect that the bite also stays the same.
I think the issue with this simulation is that it does not account for soft tissue "bounce back" as the thickness of the soft tissue stays the same (length between POG - skin stays the same)
https://imgur.com/a/2lnbao7
-
Had another consultation with the more experienced maxfac and he suggested we move both the mandible and the maxilla in a way that would not alter the bite, which basically means there's no need for ortho treatment afterwards.
Since I am seeking good amount of forward movement I am not sure why not move the mandible forward to correct my overbite & get an extra 2-4mm projection @ POG.
I'm attaching the photos again through imgur, together with the first plan (where the bite is altered).
I've also edited the simulation to showcase how I'm going to look if the plan is the same expect that the bite also stays the same.
I think the issue with this simulation is that it does not account for soft tissue "bounce back" as the thickness of the soft tissue stays the same (length between POG - skin stays the same)
https://imgur.com/a/2lnbao7
you wouldnt need any braces? does the movement include any rotation?
-
you wouldnt need any braces? does the movement include any rotation?
Yes, I won't been any braces.
The plan is to displace both the maxilla and the mandible in a way that keeps the bite as it is right now.
He's also planning to rotate the maxilla with posterior downgraft (which is a bit odd to me since I have a little too much gum show) and move both the maxilla and the mandible forward a lot, with POG movement of around 20mm.
-
so you can rotate a jaw without changing the bite?
-
so you can rotate a jaw without changing the bite?
If you rotate both the maxilla and mandible the same amount, why not?
-
Who did the 2nd plan? you can pm me if you may if you dont want to publice the name. just for interest, it looks ofc like a photoshop version of a surgery and will not be like that in real life, but it shows the doctor has a great understanding of how a jaw area should look like to be aesthetically pleasing.
-
There's 1 thing I don't really understand, surgeon #2 says that he's going to keep the bite the same, yet in the simulation, the relationship between my lips changes a lot, and in the simulation, they actually meet perfectly (instead of my upper lip being forward).
I understand that the CCW might have an effect on this one, but is it enough to fix it?
-
If you rotate both the maxilla and mandible the same amount, why not?
i dont know i just read here a lot that surgery without braces is so uncommon and rare. maybe its a european thing to do it without braces
-
If your bite is good you don’t need braces, you basically don’t need any pre or post op treatment, some call it “surgery last”
-
If your bite is good you don’t need braces, you basically don’t need any pre or post op treatment, some call it “surgery last”
And some call it "asking for errors"...
-
And some call it "asking for errors"...
And why is that?
-
And why is that?
Obviously if you can only move the jaws and not the teeth, the margin for error becomes extremely slim. Most good, successful jaw surgery is within 1mm of accuracy. So being 1mm off is a success with the bony movement. If you have no braces to refine the teeth that extra 1mm you are screwed, unless the surgeon somehow nails the surgery to .01mm of accuracy, which is possible, but not probable.
-
This is doable only in case that this margin of error can be corrected with Invisalign, like in my case, I'm meeting with Prof. A next week, will update on my proposed plan.
-
This is doable only in case that this margin of error can be corrected with Invisalign, like in my case
The margin of error for any surgery is 1mm, and if your bite is off 1mm, it won't be able to be corrected with Invisalign.
If you get a sub 1mm outcome, which is possible but not probable, then yeah, it's possible to avoid braces. I'd put the odds of success with that around 5-10%.
-
The margin of error for any surgery is 1mm, and if your bite is off 1mm, it won't be able to be corrected with Invisalign.
If you get a sub 1mm outcome, which is possible but not probable, then yeah, it's possible to avoid braces. I'd put the odds of success with that around 5-10%.
so basically all surgeries that are done for the purpose of sleep apnea (most people have an ok bite) will destroy the bite. because braces are not common in that regard?
and any idea why the "surgery first approach" is so much more common in europe in comparison to the usa?
-
and any idea why the "surgery first approach" is so much more common in europe in comparison to the usa?
My guess would be the court system - harder to bring a malpractice claim in Europe.
I'm not positive, though. It's possible they genuinely think it's a good idea, I guess.
-
My guess would be the court system - harder to bring a malpractice claim in Europe.
I'm not positive, though. It's possible they genuinely think it's a good idea, I guess.
I'm doing my surgery with Alfaro, it's hard for me to believe that he'll do something that the success rate for will be so low like you mentioned.
Maybe it's a matter of skill that most don't have.
-
I'm doing my surgery with Alfaro, it's hard for me to believe that he'll do something that the success rate for will be so low like you mentioned.
Maybe it's a matter of skill that most don't have.
You can believe what you want. This is what you're about to deal with, though. So reality and belief are not in alignment with you.
So, what's the downside of not having braces with jaw surgery?
Braces is needed to fine tune the position of the teeth, which is an integral part of an aesthetic and pleasing smile, as well as good biting efficiency. Without braces, we cannot achieve the optimal aesthetics and function. In addition, it also increases the degree of positional change that often occur after corrective jaw surgery as the bite will not be as stable and that can cause deviation to the jaw position before healing is complete.
The lone exception is VME cases, which sometimes do not need braces. To my understanding, that's not you.
Either way, good luck. I hope you're a rare case where it works.
-
You can believe what you want. This is what you're about to deal with, though. So reality and belief are not in alignment with you.
The lone exception is VME cases, which sometimes do not need braces. To my understanding, that's not you.
Either way, good luck. I hope you're a rare case where it works.
Thank you, I will update you about the final plan after the 3D scans and all this week, let's see if anything changes from what he said in the video call to where he has his tests done.
-
My guess would be the court system - harder to bring a malpractice claim in Europe.
I'm not positive, though. It's possible they genuinely think it's a good idea, I guess.
maybe the usa is just a bit behind:
Introduction: Compared to the conventional approach to orthognathic surgery, "surgery first" protocols could be advantageous in terms of shortened treatment times and immediate esthetic improvement. However, consensus regarding patient selection, technical protocol, and stability is still lacking.
Methods: A systematic review of the scientific literature on surgery-first treatment (January 2000 to January 2015) was performed. The PubMED and Cochrane Library databases were accessed. Patient selection criteria, specific surgical-orthodontic protocol, treatment duration, patient and orthodontist satisfaction, and stability of results were compared with a similar population treated conventionally.
Results: The search yielded 179 publications. The application of strict selection criteria gave the final group of 11 articles. In total, 295 patients were managed with a surgery-first approach. A Class III malocclusion was the most prevalent underlying malocclusion (84.7%). Total treatment duration was shorter in surgery-first patients than in those treated conventionally. There was substantial heterogeneity among articles and high reporting bias regarding the inclusion and exclusion criteria, the orthodontic and surgical protocols, and the stability of results. A meta-analysis of combined data was not possible.
Conclusions: The surgery-first approach is a new treatment paradigm for the management of dentomaxillofacial deformity. Studies have reported satisfactory outcomes and high acceptance. However, the results should be interpreted with caution because of the wide varieties of study designs and outcome variables, reporting biases, and lack of prospective long-term follow-ups.
https://pubmed.ncbi.nlm.nih.gov/27021449/
-
maybe the usa is just a bit behind:
Yeah, I'm sure that's it.
-
so basically all surgeries that are done for the purpose of sleep apnea (most people have an ok bite) will destroy the bite. because braces are not common in that regard?
and any idea why the "surgery first approach" is so much more common in europe in comparison to the usa?
Are you are asking this question to GJ based on anything the OP (trandom) conveyed to you or GJ?
If so, trandom has reached the point where he is beyond help by the mods here. Posters reach the point where they are beyond help when they become over confident that that their thinking process is grounded on the right premise when the premise it's grounded on is actually faulty.
Note how GJ is having a hard time getting through to him about the need for braces. That's what happens when you get sucked into someones erroneous thinking process and let's face it, some people on this board would need a brain transplant to overcome the confusion they generate for themselves. From my perspective it's a futile endeavor if I see that type of pattern going on and being used to contend things based on belief systems that have nothing to do with how things work.
Trandom's premise here is that he actually BELIEVES he can take the visual proposal of one doctor and CHANGE it to apply to what A DIFFERENT doctor TOLD him. https://imgur.com/a/2lnbao7
"Right: 1st proposed plan
Left: I edited the photo in photoshop so that the bite stays the same, it's basically a simulation of how the plan is going to look if the bite is not being altered."
So, with that, he's basically PREDICTING that his photoshop change of what the PRIOR doctor did (correct his bite) reflects his outcome from ANOTHER doctor who told him he could do a surgery without changing his bite and without braces. Too hard to unbelieve that FOR someone. But his belief that his morph somehow predicted his outcome with an entirely different doctor (who told him he could do a surgery with no braces) was a faulty premise. Although the other doctor might be able to do a surgery that does not change his bite or require braces, the faulty premise is the expectation that altering one doctor's morph/plan is how the other doctor is going to make him look just because the other doctor told him he could do without braces. Like he's contending that in the total absence of a plan from the other doctor, running with it and butting horns with GJ where 'suddenly' after a period not to long ago of knowing little to nothing, he now knows enough to be countering GJ.
So, with that, we leave them to their own devices and thinking process when it just looks like it's going to be too hard to UNDO it or UNTHINK it FOR them which is what it's looking like with his interaction with GJ.
That said, GJ and I shall wait until the next doctor actually confirms that trandom's morph made from the prior doctor reflects what the next doctor can do without changing his bite and WITHOUT braces afterwards.
Surgery first is when the surgeon does the surgery and leaves it up to the ORTHO to decide what ortho work needs to be done after that and/or for the ortho to decide if they are candidate for surgery first. It's based on the teeth moving FASTER when the braces are put on right after a surgery where as when you put them on before a surgery, the braces take longer to position the teeth to where they want them to prepare for the surgery.
-
Surgery first is when the surgeon does the surgery and leaves it up to the ORTHO to decide what ortho work needs to be done after that and/or for the ortho to decide if they are candidate for surgery first. It's based on the teeth moving FASTER when the braces are put on right after a surgery where as when you put them on before a surgery, the braces take longer to position the teeth to where they want them to prepare for the surgery.
Yeah, and that can be done if you have braces on prior to surgery, too. I'd argue it's a bit dangerous to move teeth fast, even with the increased blood flow to the area. They still have to move through bone and thus root resorption is a real risk if/when they try to do that. I think they like to do it because it's less "chair time"...orthos are obsessed with chair time.
VME patients, and to a degree Class III patients, can potentially get away with surgery first because their teeth generally fit properly in their arches (i.e. less compensation). This doesn't mean it's a great idea, but at least it makes some sense. Class 2, crowding, etc that is not the case at all. The only justification for surgery first, IMO, is if someone has sleep apnea and is at risk to die. Then you do the surgery and figure out the teeth later.
-
Yeah, and that can be done if you have braces on prior to surgery, too. I'd argue it's a bit dangerous to move teeth fast, even with the increased blood flow to the area. They still have to move through bone and thus root resorption is a real risk if/when they try to do that. I think they like to do it because it's less "chair time"...orthos are obsessed with chair time.
VME patients, and to a degree Class III patients, can potentially get away with surgery first because their teeth generally fit properly in their arches (i.e. less compensation). This doesn't mean it's a great idea, but at least it makes some sense. Class 2, crowding, etc that is not the case at all. The only justification for surgery first, IMO, is if someone has sleep apnea and is at risk to die. Then you do the surgery and figure out the teeth later.
The OP looks to have Class 2 Division 2 DEEP BITE and basically claiming that because he can have surgery first with no change in bite, he therefore won't need braces afterwards and with that he's assuming his morph changing one doctor's plan reflects the next doctor's plan. When that's behind the thinking process and you tried to make your point with him and it didn't get through, the BALL IS IN HIS COURT to go where his own 'beliefs' take him and come back and show us that the next doctor's plan is going to look like his morph prediction of it and this plan involves NO braces afterwards.
I have no issue with what you wanted to convey to him and the reasoning behind it.
-
The OP looks to have Class 2 Division 2 DEEP BITE and basically claiming that because he can have surgery first with no change in bite, he therefore won't need braces afterwards and with that he's assuming his morph changing one doctor's plan reflects the next doctor's plan. When that's behind the thinking process and you tried to make your point with him and it didn't get through, the BALL IS IN HIS COURT to go where his own 'beliefs' take him and come back and show us that the next doctor's plan is going to look like his morph prediction of it and this plan involves NO braces afterwards.
I have no issue with what you wanted to convey to him and the reasoning behind it.
Yes, agree, just wanted to clarify my thoughts on that for anyone who comes across this info in the future.
-
Are you are asking this question to GJ based on anything the OP (trandom) conveyed to you or GJ?
more like a general question
i just wonder when surgery without braces is so dangerous then why many patients who get jaw surgery for sleep apnea related issues dont get braces at all or only after jaw surgery? wouldnt that be irresponsible
and are european surgeons really that irresponsible compared to usa surgeons for following the surgery first approach? i think thats a very harsh claim especially when literature and studies are not clear on the topic as far as i know?
-
I want to clarify a few points.
Are you are asking this question to GJ based on anything the OP (trandom) conveyed to you or GJ?
If so, trandom has reached the point where he is beyond help by the mods here. Posters reach the point where they are beyond help when they become over confident that that their thinking process is grounded on the right premise when the premise it's grounded on is actually faulty.
Note how GJ is having a hard time getting through to him about the need for braces. That's what happens when you get sucked into someones erroneous thinking process and let's face it, some people on this board would need a brain transplant to overcome the confusion they generate for themselves. From my perspective it's a futile endeavor if I see that type of pattern going on and being used to contend things based on belief systems that have nothing to do with how things work.
Trandom's premise here is that he actually BELIEVES he can take the visual proposal of one doctor and CHANGE it to apply to what A DIFFERENT doctor TOLD him. https://imgur.com/a/2lnbao7
"Right: 1st proposed plan
Left: I edited the photo in photoshop so that the bite stays the same, it's basically a simulation of how the plan is going to look if the bite is not being altered."
So, with that, he's basically PREDICTING that his photoshop change of what the PRIOR doctor did (correct his bite) reflects his outcome from ANOTHER doctor who told him he could do a surgery without changing his bite and without braces. Too hard to unbelieve that FOR someone. But his belief that his morph somehow predicted his outcome with an entirely different doctor (who told him he could do a surgery with no braces) was a faulty premise. Although the other doctor might be able to do a surgery that does not change his bite or require braces, the faulty premise is the expectation that altering one doctor's morph/plan is how the other doctor is going to make him look just because the other doctor told him he could do without braces. Like he's contending that in the total absence of a plan from the other doctor, running with it and butting horns with GJ where 'suddenly' after a period not to long ago of knowing little to nothing, he now knows enough to be countering GJ.
So, with that, we leave them to their own devices and thinking process when it just looks like it's going to be too hard to UNDO it or UNTHINK it FOR them which is what it's looking like with his interaction with GJ.
That said, GJ and I shall wait until the next doctor actually confirms that trandom's morph made from the prior doctor reflects what the next doctor can do without changing his bite and WITHOUT braces afterwards.
Surgery first is when the surgeon does the surgery and leaves it up to the ORTHO to decide what ortho work needs to be done after that and/or for the ortho to decide if they are candidate for surgery first. It's based on the teeth moving FASTER when the braces are put on right after a surgery where as when you put them on before a surgery, the braces take longer to position the teeth to where they want them to prepare for the surgery.
Photo edit - The edit of the photo was done to represent the change between what A first told me, and then what he told me a week later, both simulations are around his plan, I did not mix between 2 doctors plans / simulations. These simulations are not a very precise representation anyways, especially for someone like me with thick soft tissue in the chin area, projection in real life would be a few mm less.
I decided pretty early in the process to go forward with A, so everything I present here is around his plan and advice.
Braces - I will clarify on what A told me regarding this subject:
1. Post-op orthodontics might, or might not be needed.
2. If it is needed, my ortho can choose whether to do it with braces or Invisalign.
3. If it's needed and he chooses to do it with braces - they will have to be put on before the treatment.
Tomorrow I meet with A, will update on progress, I will arise some of the concerns to him.
-
I want to clarify a few points.
Photo edit - The edit of the photo was done to represent the change between what A first told me, and then what he told me a week later, both simulations are around his plan, I did not mix between 2 doctors plans / simulations. These simulations are not a very precise representation anyways, especially for someone like me with thick soft tissue in the chin area, projection in real life would be a few mm less.
I decided pretty early in the process to go forward with A, so everything I present here is around his plan and advice.
Braces - I will clarify on what A told me regarding this subject:
1. Post-op orthodontics might, or might not be needed.
2. If it is needed, my ortho can choose whether to do it with braces or Invisalign.
3. If it's needed and he chooses to do it with braces - they will have to be put on before the treatment.
Tomorrow I meet with A, will update on progress, I will arise some of the concerns to him.
Then your presentation was confusing as f**k because you failed to clarify it was Alfaro's initial proposal even when you were asked on this string (by CCW and Lefort3000) who's proposal it was. Even if it was same doctor's (Alfaro's), it's still a 'no no' to assume changes you, yourself make to it are going to reflect what he says to you.
Well OF COURSE, Alfaro actually told you or would tell you what you NOW disclose he actually told you which was not an absolute confirmation from him that you would not need braces. Clearly statements #1, #2 and #3 from him don't tell you for SURE no braces at any time would be needed. Yet you kept on doubling down on the claim you would't need them.
-
more like a general question
i just wonder when surgery without braces is so dangerous then why many patients who get jaw surgery for sleep apnea related issues dont get braces at all or only after jaw surgery? wouldnt that be irresponsible
and are european surgeons really that irresponsible compared to usa surgeons for following the surgery first approach? i think thats a very harsh claim especially when literature and studies are not clear on the topic as far as i know?
For sleep apnea surgery, when the bite is OK, it's often linear advancement where both jaws are advanced the same amount when they are not using braces to move the teeth to prepare for the surgery and/or they might put them on after the max/mand advancment (MMA). So, no pre surgery brace prepping and/or some post surgery brace refinements is associated with LINEAR ADVANCEMENT where both jaws are advanced by same amount and usually when their bite is 'OK'.
With more advanced practioners (in USA) who also treat sleep apnea and use CCW to balance face, airway and bite, there is brace preparation for that because they are focused on both FORM and FUNCTION. There could be post op ortho appliances with that too.
Surgery first puts a lot of the responsibility in the ORTHO's hands to be the ones to approve for surgery first and also do all the teeth adjustments for the bite to be right afterwards. Like the ortho is the one to make the PREDICTION that they will be able to make the bite right in accordance to how the surgeon wants to displace the jaws.
In the situation of USA doctors, let's take Gunson as example. He would want to FIRST see that the ortho put the teeth where he wanted them to be to carry out his surgical plan and if during the pre-surgery 'inspection', if he sees that the ortho has NOT done that, he can call off the surgery.
So, I guess you could say the difference is that the American surgeon wants to FIRST see IF the ortho's prediction of moving the teeth in right place pans out as true and that will take a LONG TIME in braces to wait and see, whereas the Euro surgeon places a lot of confidence in the ortho that their prediction that they will get the bite right AFTER the surgery WILL pan out later down the line and will pan out in LESS TIME than it would take for a pre surgical 'wait and see' period. (It takes less time to move teeth after a surgery.)
As to whether or not Euro doctors are 'behind' USA ones, I could be wrong one to ask that because by nature, I would be considered a 'Europhile' as in someone who considers European cultural history of advancement, especially in medicine a very salient thing to acknowledge. Consider the university of Padua in Italy where medical principles first taught in the 1200's . Then you have your early surgeons teaching at Cordoba in Spain in early 900s making a lot of medical discoveries and instruments. Just 2 examples but there are many more. Add Galen, Hippocrates Leonardo, Lois Pasteur...etc.
-
maybe the usa is just a bit behind:
Introduction: Compared to the conventional approach to orthognathic surgery, "surgery first" protocols could be advantageous in terms of shortened treatment times and immediate esthetic improvement. However, consensus regarding patient selection, technical protocol, and stability is still lacking.
Methods: A systematic review of the scientific literature on surgery-first treatment (January 2000 to January 2015) was performed. The PubMED and Cochrane Library databases were accessed. Patient selection criteria, specific surgical-orthodontic protocol, treatment duration, patient and orthodontist satisfaction, and stability of results were compared with a similar population treated conventionally.
Results: The search yielded 179 publications. The application of strict selection criteria gave the final group of 11 articles. In total, 295 patients were managed with a surgery-first approach. A Class III malocclusion was the most prevalent underlying malocclusion (84.7%). Total treatment duration was shorter in surgery-first patients than in those treated conventionally. There was substantial heterogeneity among articles and high reporting bias regarding the inclusion and exclusion criteria, the orthodontic and surgical protocols, and the stability of results. A meta-analysis of combined data was not possible.
Conclusions: The surgery-first approach is a new treatment paradigm for the management of dentomaxillofacial deformity. Studies have reported satisfactory outcomes and high acceptance. However, the results should be interpreted with caution because of the wide varieties of study designs and outcome variables, reporting biases, and lack of prospective long-term follow-ups.
https://pubmed.ncbi.nlm.nih.gov/27021449/
Lot's of articles on surgery first. Here's one that tells you what they look at. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4314839/
They mention, many examples are for class 3 types but can be done on class 2 types, limitations as to when to use surgery first. It's not for everybody, takes a lot of coordination, a minor surgical error could compromise occlusion, prediction of final occlusion is the greatest challenge etc.
-
very interesting replies, i think i see it a bit more clearee now.
sorry for hijacking the thread though
-
So I have done the surgery with Alfaro exactly a week ago.
The plan included CCW through posterior downgraft only, and a lot of movement of both the maxilla and mandible, while keeping my bite the same as it was already good.
Maxilla moved forward around 8mm, mandible 18mm, and POG 23mm.
Maybe someone will be able to shed some light on this:
I was always afraid of under projection, the clinic sent me a picture from exactly after the OP and it looked exactly how I wanted it in terms of projection, but when I take pictures myself it seems like I don't have the same projection as I had before swelling kicked in, I know that the swelling might create an illusion for that, but it looks like it actually went back, not just an illusion.
I also understand that the bones couldn't move between the photos, so I can't really explain what's happening.
Here are the photos:
https://imgur.com/a/TM6iDXQ
-
You will have to sit tight and wait to see how that swelling plays out. There's no way to know based on what you posted.
-
You will have to sit tight and wait to see how that swelling plays out. There's no way to know based on what you posted.
Thank you GJ, makes perfect sense, I'll update once swelling will go down, it must be the reason.
-
Sorry, I can't twist my head around your communication style because your statements and presentations are not logical.
Your IMGUR presentation says; 'pre op, exactly post op and 7 days post op'. There are 3 photos. The first 2 are pre-ops and the last one is exactly post op (because it's taken in the surgical room). There are no '7 days post op' photos presented AS IT SAYS IN THE TITLE. Jesus christ, if you can't even take the time to title your photo link correctly and/or are expecting feedback on how you look 7 days after when those photos are not included as your title reads, I'm out of here on this one as to further/future feedback.
-
Sorry, I can't twist my head around your communication style because your statements and presentations are not logical.
Your IMGUR presentation says; 'pre op, exactly post op and 7 days post op'. There are 3 photos. The first 2 are pre-ops and the last one is exactly post op (because it's taken in the surgical room). There are no '7 days post op' photos presented AS IT SAYS IN THE TITLE. Jesus christ, if you can't even take the time to title your photo link correctly and/or are expecting feedback on how you look 7 days after when those photos are not included as your title reads, I'm out of here on this one as to further/future feedback.
The first photo in the Imgur link is the 7-day post-op like it says in the description of the photo.
Edit: I know, the difference between the *exactly post-op* to the *7 days post-op* is super weird.
I was at his office today and have done the scans again and everything is in place, mandible is 16.5mm forward, POG 23mm.
-
The first photo in the Imgur link is the 7-day post-op like it says in the description of the photo.
Edit: I know, the difference between the *exactly post-op* to the *7 days post-op* is super weird.
I was at his office today and have done the scans again and everything is in place, mandible is 16.5mm forward, POG 23mm.
I must have missed that the first photo said '7 days post op'. It's like you could have TITLED the imgur link; '7 days post op', pre op and exactly after op in the order one sees the photos. OK so 'exactly after op' would be how it should look when all the swelling goes down. That's because the swelling does not set in when they take the photo in the operating room. It sets in and peaks afterwards.
-
I think you look great in the after photo, OP! Looks like A did a good job. How's your bite? Can you eat / swallow soft food? It's really important to keep up your calorie intake post op. Don't worry about the projection etc. - I had class 2 and for months after the surgery I used to think I wasn't advanced enough. Now the swelling is all gone, I can see it would look silly if they advanced my lower jaw more. I think you'll be very happy with your result eventually, especially if your bite is good too.
-
I think you look great in the after photo, OP! Looks like A did a good job. How's your bite? Can you eat / swallow soft food? It's really important to keep up your calorie intake post op. Don't worry about the projection etc. - I had class 2 and for months after the surgery I used to think I wasn't advanced enough. Now the swelling is all gone, I can see it would look silly if they advanced my lower jaw more. I think you'll be very happy with your result eventually, especially if your bite is good too.
Did you ever share your final result? I'd be curious to see it.
-
I think you look great in the after photo, OP! Looks like A did a good job. How's your bite? Can you eat / swallow soft food? It's really important to keep up your calorie intake post op. Don't worry about the projection etc. - I had class 2 and for months after the surgery I used to think I wasn't advanced enough. Now the swelling is all gone, I can see it would look silly if they advanced my lower jaw more. I think you'll be very happy with your result eventually, especially if your bite is good too.
The photo from the surgical room indeed look great and exactly how I want to look, I hope that when the swelling goes down it will look similar to this photo.
I can't tell yet how my bite is because I can't completely close my teeth but I think it's going to be perfect, and the Doctor says so as well.
Do you mind sharing photos from your swelling phase until the final result?
What Im worried about is that the swelling doesn't have much to do with the forehead / chin ratio that right now looks really off, but on the other hand, I also see no reason that I won't go back to look like I did right after the surgery.
Like, if the bones position is the same, and there's no swelling, I should look similar, probebly not 100% the same since muscles might adjust differently, but at least close.
-
The photo from the surgical room indeed look great and exactly how I want to look, I hope that when the swelling goes down it will look similar to this photo.
You will unless you had an immediate relapse. The surgeon should notice this and tell you if it happened.
-
You will unless you had an immediate relapse. The surgeon should notice this and tell you if it happened.
We re-took CT yesterday, everything remained in the exact same place, so I guess there shouldn’t be any problem....just some weird illusions caused by swelling.
-
We re-took CT yesterday, everything remained in the exact same place, so I guess there shouldn’t be any problem....just some weird illusions caused by swelling.
Then sit back and wait to be happy.
-
Did you ever share your final result? I'd be curious to see it.
I wouldn't like to share it on the forum, but could send it in a personal message, can't see an option for that though?
-
Update: 12 days post-op, seems like it was really a matter of swelling only.
https://imgur.com/a/JiQmHqF
-
Looks good.
-
looks very good
-
and everything without braces ya?
-
and everything without braces ya?
If you look on page 3, he said he was told he might or might not need braces after.
The original presentation that braces wouldn't be needed, as Kavan noted, was not accurate.
That said, we don't yet know if he needs them or not. OP, let us know.
-
If you look on page 3, he said he was told he might or might not need braces after.
The original presentation that braces wouldn't be needed, as Kavan noted, was not accurate.
That said, we don't yet know if he needs them or not. OP, let us know.
Hi,
I am going to use Invisalign to tweak the bite a little bit.
I got to choose wether I want to use braces (which would have to be put on pre op) or Invisalign (which I will only put on in 2-3 months)
-
Hi,
I am going to use Invisalign to tweak the bite a little bit.
I got to choose wether I want to use braces (which would have to be put on pre op) or Invisalign (which I will only put on in 2-3 months)
so basically you will be done with everything in 2-3 months? thats crazy fast no?
-
so basically you will be done with everything in 2-3 months? thats crazy fast no?
I will put on Invisalign in about 2-3 months but it's gonna take a year or so until I'm off of it.
-
crazy how the swelling makes the projection alot worse, eventho in theory the swelling should actually enhance the perceived projection
-
I will put on Invisalign in about 2-3 months but it's gonna take a year or so until I'm off of it.
so considering your bite was fine before surgery indeed affected your bite negatively right?
-
so considering your bite was fine before surgery indeed affected your bite negatively right?
I'm not sure if I'd classify it as negative.
I had a deep bite with a 2mm overbite, which is almost nothing, Dr said he would not touch the bite since he doesn’t want to ruin in.
Well, bite has changed and I now won't be able to chew until it is fixed, but once it will be fixed, the bite should actually be better
I didn't measure it or anything but I think that I now have maybe 1-1.5mm between my top teeth and the bottom ones, and once I finish ortho I won't have deep bite anymore.
I also assume that since my bite now is more open, I might benefit from that because I also had a shorter lower 3rd, so that coupled with the anterior downgraft lengthened it and I now look more balanced. But that's just how I imagine the effect of the bite change, not sure if it's true or not.
-
This is about what I'd expect.
If it's that minor, then he actually did a good job. My guess is they will tell you it can be fixed with Invisalign, but they gradually change your expectations and have you in braces by the end. Invisalign simply can't do the required movements needed for surgery (or post op). Start to watch for this shift in your expectations soon.
-
I really hope it won't end up like that, not having braces was the reason I decided to go for it, I'm not willing to put braces on again.
So far everything looks exactly like I wanted - https://imgur.com/a/ZVz5HjW
There's just one thing I'm a bit worried about, not sure if I even need to...but I think I've been chewing a little bit harder than I should have for the time being, is there any chance that I caused any damage?
On the good side, aesthetically nothing has changed, and my bite remained the same since surgery, does it mean that everything should be good? I'll definitely be more cautious, it's so stressful just to think about that.