jawsurgeryforums.com
General Category => Aesthetics => Topic started by: eglantine on April 27, 2021, 02:09:30 PM
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Hello everyone !
My name is Eglantine and I have been considering jaw surgery for years. But due to lack of time, I got my first appointment with a surgeon, dr Alfaro, only yesterday.
I saw that several participants here have acquired a lot of knowledge concerning jaw surgery and I would highly appreciate it if you could give me any advice or insight on my case.
I am also eager to get any information about Dr Alfaro and to be suggested other surgeons that I could consult (I am ready to travel all around the world).
- Alfaro told me that with his minimally invasive technique, there is zero risks for nerve damage. Have you any thought about that?
- When I asked him for his range of prices, he replied that he didn't know and that his secretary would get back to me to tell me. I was a bit surprised by this answer. Does anyone know what kind of prices he practices?
Considering my case, I thought I had prognathism but he told me that I have Maxillo-mandibular retrusion with a bad inclination of my front teeth that are too much horizontal. He advised me to first have their inclination fix (to get them more vertical) through orthodontic treatment, and then to have my upper and lower jaws move forward with surgery.
He said that this would make the tip of my nose higher, fix the sagging of my neck and give it a better definition, and more generally (if I understood correctly) lift the soft tissues of my face (that, without operation, would go down with aging).
Thank you very much to anyone who could help me !! It's a very hard choice to make and it is most valuable to have your insights :)
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The first thing I noticed is how proclined your teeth are, so he's correct on that. Do you have a tongue thrust? Usually that's a cause of this, and it would be worth fixing trust before any surgery.
Regarding your jaws, the record is taken at an angle where you head is pointed downward. This makes little sense, and I wonder why it was taken this - rarely good reasons. Your mandible tilts downward right around the midpoint of the body. There's a mild notch. Many times this is due to trauma (falling as a kid). Sometimes it's genetics. Some argue tongue thrust causes this, which brings me back to my first question, given your incisor flair.
All said, from what I can see, you look pretty good. I don't see any under neck sag, and everyone ages. Surgery won't prevent any of that. In theory, with more bony support in the lower jaw, you could "stretch" the skin and pick up slack. But slack and sag is mostly due to collagen production and skin quality.
I'd personally do nothing based on the records you provided. I'd have to see more and a justification for the surgery. Why do you want to do this? If you did get surgery, it looks to me like you have a straightforward CCW type case, but again, a record with your head in a more neutral position would help here.
PS. We don't discuss price on the forum since surgeons read this forum.
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It looks and sounds like he told you right. Although the ceph is a crappy one, sometimes they use the head tilt down posture (rotation of head in clockwise direction) when they are indeed entertaining CCW (counter clockwise rotation) for bimax advancement (of both jaws). Your front teeth are indeed bucked out a lot and you DON'T have prognathism. Quite the OPPOSITE of that like he told you. The bimax advancement, particularly the lower jaw would tend to give more soft tissue support as he said. It's just that the head tilt down posture (and I don't know if that was done by him) is often done when they are entertaining a significant/dramatic advancement. You should try to get a VISUAL proposal from him that estimates or gives you some idea what he has in mind. They can do that by using a photo taken in the office and using a computer program where the proposed movements of the bones/teeth are plugged in to give a basic visual of how the changes could look on you.
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Any surgeon claiming zero risk of nerve damage is a liar (unless he has a special definition of nerve damage like "permanent numbness is not nerve damage"). I know multiple people who have had surgery with him and ended up with permanent numbness.
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Any surgeon claiming zero risk of nerve damage is a liar (unless he has a special definition of nerve damage like "permanent numbness is not nerve damage"). I know multiple people who have had surgery with him and ended up with permanent numbness.
Yeah, to make any prediction is foolish. They should just say they'll do their best to avoid damage. I was told surgeons sometimes knowingly "sacrifice the nerves" to make a cut...did they tell the patient that? Likely not.
In general, piezosurgery does help a bit, so if he used that I'd say it gives better odds.
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piezosurgery is what he uses.
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Advantages of piezoelectric surgery.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4672167/#:~:text=Piezoelectric%20bone%20surgery%20is%20a%20technology%20based%20on%20the%20high,until%20the%20early%2021st%20century.
• Selective cutting of mineralized tissue
• Significant reduction of trauma to soft tissue
• Reduced hemorrhage (cavitation effect)
• Excellent visibility within the surgical field, due in part to minimal bleeding, to high luminosity LED lights and effective irrigation
• Precise cutting (limited vibration amplitude and specific design of osteotome tips)
• Curvilinear cutting
• No thermal damage
• Sterile irrigation – steam sterilization
--------------------------------
Excuse reference to veterinary maxfax surgery. Same concept as for humans. This article easier to read. Preserves neurological and vascular structures.
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The first thing I noticed is how proclined your teeth are, so he's correct on that. Do you have a tongue thrust? Usually that's a cause of this, and it would be worth fixing trust before any surgery.
Regarding your jaws, the record is taken at an angle where you head is pointed downward. This makes little sense, and I wonder why it was taken this - rarely good reasons. Your mandible tilts downward right around the midpoint of the body. There's a mild notch. Many times this is due to trauma (falling as a kid). Sometimes it's genetics. Some argue tongue thrust causes this, which brings me back to my first question, given your incisor flair.
All said, from what I can see, you look pretty good. I don't see any under neck sag, and everyone ages. Surgery won't prevent any of that. In theory, with more bony support in the lower jaw, you could "stretch" the skin and pick up slack. But slack and sag is mostly due to collagen production and skin quality.
I'd personally do nothing based on the records you provided. I'd have to see more and a justification for the surgery. Why do you want to do this? If you did get surgery, it looks to me like you have a straightforward CCW type case, but again, a record with your head in a more neutral position would help here.
PS. We don't discuss price on the forum since surgeons read this forum.
Thanks a lot for your reply !!
Noone had ever mentioned my tongue before you, but I am indeed worried that I have a very big tongue that might push forward my teeth (and that would possibly spoil the result of a surgery if I have one). Do you have any idea how to fix a tongue thrust ?
What you say about the notch is very interesting and I hadn't noticed it.
Why do you think CCW would be a good fit for me ?
"Why do you want to do this? "
I had been advised since I was a kid to do something for my jaws (or teeth) that are too much forward and when I was a teenager an orthodontist advised I should have jaw surgery (which was not possible at that time because my parents don't have the money). I've never stopped thinking about it since then because I do think that my face would be much more harmonious without this flaw...
Can I ask you what you think of Alfaro and if you know of any other surgeons that would be worth consulting ?
Thanks again very much for your reply ! It is very helpful
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@Kavan Thank you very much for your reply !and the information on the technique used by Alfaro. He claimed he had invented it (the minimal invasive technique): is that true ?
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Any surgeon claiming zero risk of nerve damage is a liar (unless he has a special definition of nerve damage like "permanent numbness is not nerve damage"). I know multiple people who have had surgery with him and ended up with permanent numbness.
You know of people who had bad experience with Alfaro? Thanks a lot for sharing it, that's a very precious information for me ! How many people do you know who ended up with permanent dumbness after an operation with him?
Actually, he not only said that there were zero risk of nerve damage when having an operation with him, but when I asked him about the risks in general, he enumerated a list of risks which he said were only "theoretical" but had never happened to his patients (he mentioned some felt a numbers but said that it weren't permanent).
May I ask you what you think of him as a surgeon ? And if maybe you know of some other surgeons that you could advise to visit ?
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One of my concern is that I have quite big teeth: I'm afraid they would look much too long if they were in a more vertical position...
I also would like to shorten my face... Alfaro said this would be possible but I have no idea how...
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Thanks a lot for your reply !!
Noone had ever mentioned my tongue before you, but I am indeed worried that I have a very big tongue that might push forward my teeth (and that would possibly spoil the result of a surgery if I have one). Do you have any idea how to fix a tongue thrust ?
What you say about the notch is very interesting and I hadn't noticed it.
Why do you think CCW would be a good fit for me ?
Can I ask you what you think of Alfaro and if you know of any other surgeons that would be worth consulting ?
I'm not sure how to fix a tongue thrust. You'd probably need to see someone who specializes in that, though I think YouTube has lessons on how to have better tongue posture. Look into that maybe.
I have no idea about Alfaro. No opinion either way.
The latest photos made me change my mind on CCW. It almost looks like you have an underbite in one, so I looked at the scan again, and it seems your incisors are almost edge to edge, and your lips are a bit protrusive in profile (have you had extractions, or did anyone recommend them ever?). I'd have to see more scans before solidifying an opinion here. Things look a bit different in every record.
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@Kavan Thank you very much for your reply !and the information on the technique used by Alfaro. He claimed he had invented it (the minimal invasive technique): is that true ?
Actually, I gave you information on the science and technology behind piezoelectric surgery. It is this type of technology that allows for selective cutting of bone without damage to soft tissue/nerves etc. It's something that certainly allows for a minimal invasive technique and would allow him to claim virtually no nerve damage. Piezoelectric science has been known for quite some time for many applications. Modern surgery is example of putting it to use for yet another application. I don't know if he 'invented' it. He may have designed a tool for it and he's very likely to be one of the first 'movers and shakers' to incorporate the technology into his practice. He's using a technology that by vibrational frequency can SELECTIVELY cut one type of tissue but not harm another type and thereby significantly reduces the risk of 'collateral damage' of other tissues.
Undoubtedly, he's braggadocious though.
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Literally every surgeon I've talked to claims they pioneered piezosurgery...
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[...]
Actually, he not only said that there were zero risk of nerve damage when having an operation with him, but when I asked him about the risks in general, he enumerated a list of risks which he said were only "theoretical" but had never happened to his patients (he mentioned some felt a numbers but said that it weren't permanent).
[...]
Surgeons like to say things in a way, what is strictly true, but not really true for somebody, who does not share the same definition of some words. For example nerve damage could mean anything. There is for sure a definition in medical books, what is a nerve damage and it could have a total other meaning, than what you understand as a nerve damage.
I can only advice for your further consultation to name specific your concerns. I mean, what is your real concern behind a nerve damage? To not move your muscles? To not have the same feeling afterward? .... and so on.
About the second part, that he is watering down some risks: I would inform yourself about the law in spain, so you can understand the attitude of the surgeons. For example in germany, there is a diferent between surgeries for medical reasons and for purely aesthetical reasons.
In germany surgeons are somehow allowed to water down some risks, if the surgery is for medical reasons. If it is a purely aesthetical surgery, than they aren't allow to do this and can really break their neck, if they don't follow this rule. BUT: Even if many patients undergo a jawsurgery for aesthetical reasons, it is NOT an aesthetical surgery in germany. So the surgeons are allowed to water down the risks like Alfaro did.Also there could be some nuance for example, who has to prove in a lawsuit certain things. In germany the surgeon has to prove, what he told in a consultation.
[...]
I also would like to shorten my face... Alfaro said this would be possible but I have no idea how...
You should ask him this more specific. It should be no problem to have a second consultation with him.
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Here's a great intro video where he shows the device can do surgery on an egg--cut through the shell without damaging the soft tissue of the egg. https://www.youtube.com/watch?v=ZRMAqi1xWu8&ab_channel=GBAesthetics
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Literally every surgeon I've talked to claims they pioneered piezosurgery...
There indeed can be a NUMBER of pioneers or INNOVATORS who come up with techniques used with a DEVICE.
I did some research on this to distinguish between the 'inventor' and the 'pioneers'/innovators.
There are MANY pioneers/innovators, Alfaro is indeed one of them. The inventor is the one who gets the PATENT on the device. Although the inventor would also be a pioneer. Alfaro isn't listed as the patent holder/inventor. Assignee: Piezosurgery, Inc.
Inventors: Tomaso Vercellotti, Fernando Bianchetti, Domenico Vercellotti
I referred to the following article: Piezosurgery in implant dentistry
https://www.dovepress.com/piezosurgery-in-implant-dentistry-peer-reviewed-fulltext-article-CCIDE#r_ref66 and looked for the KEY pieces of info within it.
" In 2001, the Piezosurgery® was introduced, a tool that combines the ultrasound and the piezo effect. 9" That tells me that 'Piesosurgery' is actually a TRADE MARK.
Then I go down to the credits in the bibliography and look for number 9. It lists:
9 Vercellotti T, Crovace A, Palermo A, Molfetta A. The piezoelectric osteotomy in orthopedics: clinical and histological evaluations (pilot study in animals). Mediterranean J Surg Med. 2001;9:89–95.
That tells me one of those names is likely to be the Inventor. Knowing that Piezosurgery® is a TRADEMARK and INVENTORS are usually assigned by a company to invent something, I find that it's owned by 'Piezosurgery INC' a corporation which is company owned by/associated with a company named 'mectron'.
After that, I find the PATENT on it and hence the INVENTORS:
Surgical device for bone surgery
Patent number: 8002783
Abstract: A surgical device (1) for bone surgery including a body (2) able to be gripped by the user and a tip (3) mounted at the head of the body and set in vibration at a modulated ultrasonic frequency to operate on bone tissue, the surgical device (1) being particularly suitable for oral surgical procedures such as bone sampling, excision of cysts, third molar extraction, preparation of alveolar sites, creation of an opening into the maxillary sinus (Caldwell Luc), elevation of the maxillary sinus by the crestal route and orthopedic and neurosurgical procedures such as osteoplasty, ostectomy and osteotomy.
Type: Grant
Filed: December 12, 2007
Date of Patent: August 23, 2011
Assignee: Piezosurgery, Inc.
Inventors: Tomaso Vercellotti, Fernando Bianchetti, Domenico Vercellotti
So, Alfaro isn't actually the 'inventor' of the device with TRADEMARK; Piezosurgery®
Perhaps he used the term loosely, something got lost in the translation or meant to say he was the INNOVATOR of a TECHNIQUE using the device. The article most certainly lists Alfaro as COMBINING it with an ENDOSCOPE:
"The piezosurgery technique can also be combined with endoscopic assistance for corticotomies. 66"
Looking at listing #66 in the bibliography:
66. Hernández-Alfaro F, Guijarro-Martínez R. Endoscopically assisted tunnel approach for minimally invasive corticotomies: a preliminary report. J Periodontol. 2012;83:574–580.
"CONCLUSIONS
The authors present a simple yet effective technique
to achieve rapid orthodontic tooth movement. A
tunnel approach through one to three buccal vertical
incisions per arch is used to minimize soft-tissue
debridement and periodontal risks. Endoscopic assistance is useful to design and perform the corticotomies
and to select the sites needing bone augmentation.
The preservation of root integrity is further maximized with the use of piezosurgical instruments.
Compared to traditional corticotomies, the procedure
has manifest advantages in surgical time, technical
complexity, patient morbidity, and periodontium
preservation."
So, Alfaro indeed is a PIONEER of a technique used with the device (and has TONS of journal articles) and an INNOVATOR using the device. The article CREDITS him in the bibliography. But the actual inventor/s of the TRADEMARK device he uses called Piezosurgery® are different people.
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Exactly. I used "innovator" specifically for that reason. None claim they invented it, but they all hint they sort of did...(innovator). Lol.
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Exactly. I used "innovator" specifically for that reason. None claim they invented it, but they all hint they sort of did...(innovator). Lol.
Indeed, the correct word would be 'innovator' for combining other modalities (endoscope) with the device for minimum invasive surgery. It's really an amazing technology to be put to use in surgery though because it acts on principle of specific frequency levels targeting selected tissue and not harming the surrounding tissue.
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Indeed, the correct word would be 'innovator' for combining other modalities (endoscope) with the device for minimum invasive surgery. It's really an amazing technology to be put to use in surgery though because it acts on principle of specific frequency levels targeting selected tissue and not harming the surrounding tissue.
Agree. I had it with my surgery, and I had next to zero nerve damage.
I think some of this, though, depends where the nerve is and where the cut is. Like I mentioned, Dr. G said some surgeons very knowingly "sacrifice the nerve" as in they look at it and have it in hand, and make the cut knowing it will result in damage. Their justification is that it has to be done to do the surgery as they want. I don't know...isn't the first principle "do no harm"?
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Agree. I had it with my surgery, and I had next to zero nerve damage.
I think some of this, though, depends where the nerve is and where the cut is. Like I mentioned, Dr. G said some surgeons very knowingly "sacrifice the nerve" as in they look at it and have it in hand, and make the cut knowing it will result in damage. Their justification is that it has to be done to do the surgery as they want. I don't know...isn't the first principle "do no harm"?
Then perhaps Dr. G is referring to surgeons using 'buzz saws' (medical equivalent of such) and other type tools that can sacrifice the nerves when needing to cut through an area. That is not the case when a selective frequency is specific to cutting bone but not the right frequency to cut through or damage other soft tissue. In fact, if they press on the piezo tool too much, the vibrations stop and they can't cut with it. Watch the video I linked to where the doctor does surgery on an EGG. It demonstrates the basic principle of using selective frequencies to cut through hard stuff but not damage the soft stuff in the process.
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@GJThanks a lot again for your replies !
"(have you had extractions, or did anyone recommend them ever?"
By extraction you mean the fact of extracting a tooth ? Alfaro mentioned it would be necessary but I never had one so far (except wisdom teeth).
Could you maybe recommend some surgeons that you believe to be good ones ? I've heard of Arnett Gunson Pelo...
I'm very shocked with what you said about surgeons cutting nerves voluntarily !
You said that yourself had "next to zero nerve damage": what light damage did you have ?
Thanks a lot again for your help !!
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@Kagan Thank you very much for all the informations you give me and for your time !!
I've read the links and your posts on Piezosurgery. It makes things much clearer and it is very interesting for me to learn more about these technique.
And it is very reassuring as my biggest fear is nerve damage.
Can I ask you if you have any opinion on Alfaro and if maybe you could suggest surgeons that are known for their good results ? As I said in another post I've noted the names of Gunson, Arnett, Pelo...
Again thanks a lot for your help !
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You said that yourself had "next to zero nerve damage": what light damage did you have ?
I don't think I had any damage, but my chin feels a slightly weird so maybe some very light damage there. I can't even tell for sure.
In my instance, that was not a big deal. But it is for many people. They say 10%, but I would say the odds of damage are higher. Piezosurgery does seem to help.
Be careful with extractions. Run any final plan by the forum.
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@Gadwins Thank you very much for your reply =) !
I didn't think of that (that nerve damage could have different definitions for different people) and it certainly does make sense. I will ask questions more specifically in the future as you advice...
I didn't know anything about the law in Germany or in Spain. It sure makes a difference knowing these contexts...
Alfaro said I could ask him more questions by email which I have (but I haven't received any reply yet). I think I'll stick to that instead of scheduling another consultation. I would rather have a consultation with another surgeon to have a second medical opinion on my case. If you have any surgeon that you could recommend, it would be very helpful !
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I don't think I had any damage, but my chin feels a slightly weird so maybe some very light damage there. I can't even tell for sure.
In my instance, that was not a big deal. But it is for many people. They say 10%, but I would say the odds of damage are higher. Piezosurgery does seem to help.
Be careful with extractions. Run any final plan by the forum.
10% is indeed a lot ! I'm glad it's not a big deal for you !
Why should I be careful with extrations ? Thanks for the warning anyways !
I'm sorry my English is quite bad and I don't understand this sentence "Run any final plan by the forum."
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@Kagan Thank you very much for all the informations you give me and for your time !!
I've read the links and your posts on Piezosurgery. It makes things much clearer and it is very interesting for me to learn more about these technique.
And it is very reassuring as my biggest fear is nerve damage.
Can I ask you if you have any opinion on Alfaro and if maybe you could suggest surgeons that are known for their good results ? As I said in another post I've noted the names of Gunson, Arnett, Pelo...
Again thanks a lot for your help !
Well, I think that my participation as it relates to opinions is best when I can give focus to basic scientific principles and aesthetic relationships. Being a graduate of one of the best scientific institutions in the world and also having studied art/aesthetic theory at another renowned university, my academic inclination is more in the venue of shedding light on that kind of topic matter. I mean I'm happy to confirm that Alfaro is using an advanced technology where he does have some 'bragging rights' as to his use and success with it since your questions revolved around that in part. So, my 'opinion' as to Alfaro was to buttress factual relationships having to do with the technology he was using and also the differentiation between 'Inventor' and 'Innovator'. So, I guess I can say my opinion on Alfaro is that he likes to 'toot his horn'. But then again, he CAN and I'm in no position to hold his feet to the fire because he does.
I'll also say that another practice you named; Arnett/Gunson (Arnett is retired) is known for balancing aesthetics with scientific principles behind function. But I need to disclose and perhaps veer away from the appearance that I am recommending a doctor or conveying; 'This is the one for you' (or anyone else who might assume that) when I name doctors. So, the act of my naming surgeons can give appearance JSF is promoting them or be interpreted as conveying: 'Here's the one/s for you.' or that they are the 'right' ones for every person reading the mention of a name. Hence, personally, I veer away from suggesting surgeons although I have no issue with others doing so.
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@Kavan Thanks for giving some background :) The informations you gave me about the technique used by Alfaro was very interesting !
" balancing aesthetics with scientific principles behind function. "
my English is too bad and I don't understand the meaning... Does he privilege aesthetic at the detriment of function ?
" JSF is promoting them or be interpreted as conveying: '"
Of course, I would never take it like that ! I just believe that you have heard of many surgeons and that maybe you have an idea of the statistics of good experience reported for each one, and which surgeons seem to be the best... Of course, I am fully responsible of the surgeon I choose to meet. It just helps saving a lot of time to know that such one is reputated for doing a bad job or that this one has mostly good reviews from former patients...
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@Kavan Thanks for giving some background :) The informations you gave me about the technique used by Alfaro was very interesting !
" balancing aesthetics with scientific principles behind function. "
my English is too bad and I don't understand the meaning... Does he privilege aesthetic at the detriment of function ?
" JSF is promoting them or be interpreted as conveying: '"
Of course, I would never take it like that ! I just believe that you have heard of many surgeons and that maybe you have an idea of the statistics of good experience reported for each one, and which surgeons seem to be the best... Of course, I am fully responsible of the surgeon I choose to meet. It just helps saving a lot of time to know that such one is reputated for doing a bad job or that this one has mostly good reviews from former patients...
Your English is very good. Now the 'balancing aesthetics with scientific principles behind function' would have to do with what he calls 'FAB' which is 'Face, Airway and Bite'. So, your bite and airway are the functional things and the face is the Aesthetic thing and the goal is to BALANCE them.
Alfaro and Gunson are frequently mentioned on here. There is a section of the board called 'Surgeon Leads'. So, you might want to try that for more names than the 2 you've already found.
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Thanks a lot for all your help :) !
I'm going to look at this section !
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You might be tongue tied. Can you touch the roof of your mouth with your tongue and get behind your top back teeth with your tongue? You should be able to do both. A lot of times when the bottom front teeth are flared forward it's because your tongue is tethered to the bottom of your mouth and then you push your tongue forward when you sleep and move those teeth. It seems like a sagging chin is very often actually caused by a tongue tie because the whole tongue muscle is languishing at the bottom of your mouth instead of nicely stretched along the upper palate. I had a chin that sags more than yours and I completely corrected it by just having my tongue tie cut. I've noticed almost every person that has a sagging chin seems to have bad tongue posture. It might do more for that problem than jaw surgery. If you do have it at least in the US you can have a dentist remove it with a laser for like $500. You don't even need anesthesia. Such a simple thing that can dramatically improve your quality of life.
There is some controversy about whether tongue tie surgery is necessary and how to do it. I suspect a lot of the controversy arises in part because some doctors do it wrong. Some cut the tie with a scalpel and then stitch it back together. This is a huge mistake. I know because I made it. I had the surgery done and then went home and was dumbfounded that I couldn't even stick my tongue out as far as I could before the surgery. I immediately removed the stitches and there was an instant feeling of relief as I could stick my tongue out again and I ended up with a nice long tongue that rests naturally on the top of my mouth. I went back and looked at pictures and every person that does the surgery with suture and stitches ends up with a strange looking sausage like appendage and everyone that does a laser without sutures ends up with a nice beautiful long tongue. The tongue is a remarkable organ that remodels itself after being cut so if you stitch it in place you can't stretch it and remodel it the way it should be. So be careful if you do it. There is a lot of talk of needing "myofunctional therapy" to retrain your tongue after surgery too which is nonsense. You just need to cut the tie without suturing it and then stretch your tongue like crazy while it's healing.
I noticed too you mentioned having your chin shortened. Be very very careful with that. Your tongue is literally attached to your chin and pretty far down. I don't see how you can shave down the chin without compromising that attachment. You could end up with very bad sleep apnea by doing that. Or you might just notice you don't sleep as well as you used to and never quite feel like yourself again. Sleep apnea can completely ruin your life. I don't think shortening the chin is even worth it except in maybe the most extreme cases and then I would still say if you understood the anatomical benefit of the deformity you would choose to keep it. If you did it you would want to at least do a very large advancement of the lower jaw to compensate.
In regards thinking you have prognathism, you might just be noticing your lower lip is ahead of your upper lip. I think that is because your lower teeth are flared forward and the lower lip is resting on those teeth. I don't think it looks bad but if you wanted to correct it you might be able to do that with just braces on the lower teeth.
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OP, you look fine and normal, you have no functional issues, do you really want to have jaw surgery? This is major, risky surgery where bones are cut etc., lots of potential complications, and anybody that tells you the chance of nerve damage is zero is lying. You can get very lucky but the chances of no nerve damage / no lasting numbness at all are very low. I personally think people should only have jaw surgery if they feel that the potential benefits are worth the risk of nerve damage / numbness.
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@thedude I reply very late so I'm not sure you will read my answer but I wanted to thank you very much. I had never heard of tongue tie and it seems relevant to my case. If you can advise me with a good doctor who can do it, I'm very interested!
I'd be very careful of the functional consequences (like sleep apnea) of my intervention (i I decide to do it). (I don't plan to shorten my chin but maybe to change the angle of my lower jaw (I'm not sure if I'm very clear ;D)
Thanks a lot for all your advice and the information you gave on the jawsurgery itself also !!
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@InvisalignOnly Thanks for your reply and warnings. Actually I'm still hesitating... Do you have any idea of the probability to get damage and complications (when you chose a very good surgeon) ?
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@InvisalignOnly Thanks for your reply and warnings. Actually I'm still hesitating... Do you have any idea of the probability to get damage and complications (when you chose a very good surgeon) ?
Noone can give you probabilities really. I mean I would say of all the surgeons, alfaro's is the least traumatizing, but that doesn't guarantee anything. What I will say is that those of us who do have a dot or small area of the lip or chin which is a bit numb or has a different feeling --it's not a dealbreaker. I have a couple numb stops and I'd go through the surgery again. It's not a terrible tradeoff. Usually the numbness happens around the chin or lower jaw. I have no experience with upper jaw numbness but it's far rarer. Again, Alfaro is prob your safest bet.
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@Lazslo Thank you for your reply and sharing your experience !
I guess your surgeon was Alfaro ?
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@Lazslo Thank you for your reply and sharing your experience !
I guess your surgeon was Alfaro ?
No i Had surgery in the states. I like Alfaro's approach, but I don't know if his results are any good.
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@InvisalignOnly Thanks for your reply and warnings. Actually I'm still hesitating... Do you have any idea of the probability to get damage and complications (when you chose a very good surgeon) ?
There’s no point trying to quantify probabilities, especially because ‘damage and complications’ is so vague. This is major surgery that involves cutting bones and nerves etc. Of course there’s a possibility of different kinds of damage and complications, no matter how ‘good’ the surgeon is. Everyone has to decide individually if the risk is worth it for them.
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There’s no point trying to quantify probabilities, especially because ‘damage and complications’ is so vague. This is major surgery that involves cutting bones and nerves etc. Of course there’s a possibility of different kinds of damage and complications, no matter how ‘good’ the surgeon is. Everyone has to decide individually if the risk is worth it for them.
Go into the surgery assuming you will end up with some peripheral nerve changes. Would you feel okay if you had some numb spots on your lip and chin?
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Go into the surgery assuming you will end up with some peripheral nerve changes. Would you feel okay if you had some numb spots on your lip and chin?
People with some numb spots are lucky. There are people like me that don’t have any numbness but altered sensation, it’s a permanent feeling that’s hard to describe. For me that’s okay because it’s not painful, very mild and overall I’m very happy with my surgery results, but I can well imagine that for many people this would not be worth it. Not to mention much bigger risks (not being able to eat or speak properly etc.).
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Thanks all of you for your replies !
Actually I don't really îcture what permanent dumbness would be like and what practical consequences it could have in everydaylife, so it's hard for me to know if I would be ok with it...
@Lazlo Can I ask who was your surgeon ?
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Hi,
I find it extremely difficult to communicate with dr Alfaro. I've sent an email more than 2 weeks ago and I still don't have any reply despite me reaching out several times (because I need a reply before my appointment with orthodonctist that is on Tuesday). I had already had the same problem earlier (very long times to get a reply).
I understand that his secretrary must be overbusy but that is really not reassuring. Why not employing more secretaries ? What would happen if once operated I need to ask something concerning my health... Has anyone had problems reaching Alfaro after being operated ?
Thanks