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Hello,
I would like to get some insight on my orthodontist's treatment plan. I have a class II bite and a hypo-divergent face growth pattern. The orthodontist suggested that I should perform a mandibular advancement surgery (BSSO) along with a genioplasty. I was not prepared to hear about the genioplasty, as most talks with other orthodontists in the past focused around the mandibular advancement only. I questioned its necessity and the doctor remained firm about it. I told him something along the lines that "I would like to fix the occlusal problem and I don't want my face to be changed too much" and he responded that the genioplasty would not change my face too much as it will be performed to move my chin where it was previously. I suppose this is because the mandibular advancement includes a clockwise rotation which would move my chin further back. His focus is to make the lower third of my face longer, as you will see in the plan.

In the past I've also been told that I have a prognathic maxilla, based on a measurement of 85 deg. SNA angle (my SNB angle is 80 deg) and proposed a treatment that involves maxillary distalization (with carriere motion). I told my current orthodontist about it, whether we should retract the maxilla a little bit (with elastics) and then follow with the mandibular advancement surgery, which he refused. "The teeth will not touch" he said. I thought that by retracting the maxilla a little we would also get some clockwise rotation (more height). I fear a little that if we advance the mandible so that I have a class I bite, both jaws will be slightly prognathic.

Below you can see my cephalometric x-ray and the treatment plan.

Thanks in advance

What was his argument to not refund you a 100%?

You can contact them and see if they are able to help you:
https://www.berner-aerzte.ch/de/informationen/fuer-patientinnen-und-patienten/ombudsstelle.html

Or call +41 31 359 12 10, maybe they are able to assist (medical professional association, Switzerland)

The link is in german but once you speak to someone they most likely are able to help you in English.

Edit: I am not assessing the situation, but in general, if you feel that you have been treated unfairly or that the doctor is in the wrong you should definitely do something against it. It doesn't cost you any money.

Approximately how old are you and did you ever have any tooth extractions in the past?

Are your teeth positioned in a V--shape rather than a round U shaped arch and do you have a high vaulted palate. I've attached an image that describes that I am referring to.

There are a lot of people with UARS and Sleep apnea who have benefited from a variety of orthodontic and surgery procedures. Treatments such as MARPE can help expand the upper palate and make space for the tongue but also expanded the nasal cavity internally resulting in improved breathing. MARPE is not indicated as a treatment for Sleep apnea but this is anecdotal opinions from a lot of people. Jaw surgery is used to treat sleep apnea, and both the upper and lower jaw forward creates more space for the tongue and the additional effect from moving the lower jaw forward is that it stretches the tissues that have started to sag with age (sleep apnea often develops with aging and becomes more common in your 40's and 50's) it alters the position of the tongue and soft tissues opening the airway. A segmental lefort may also have similar effects in traverse expansion again making space for the tongue. As you can see there are a few ways to skin a cat and there are resources online discussing this specific topic and the specialists who offer treatment. Certainly you want to find an airway orientated orthodontist (not that common unless you are in the US) and likewise surgeon.

In regards to temporary measures, there are mandibular advancement devices which can help reposition your jaw whilst sleeping as well as a myriad of other temporary devices you can dry as well as nasal dilators such as mute. MAD devices are usually available via orthodontists and custom made to fit your mouth.

Whilst I appreciate you may hate CPAP, do not give up on it until you have found alternative treatment, make no mistake untreated sleep apnea is deadly, I know this from personal experience. There are also a myriad of resources on how to optimize your cpap treatment, which different masks and also entering the clinician menu so you can customise and adjust your CPAP machine settings to make it more comfortable.  Often the default settings are poorly set with huge swings in pressure causing you to wake up. Some people also spend the cash to buy a bi-level machine privately which is a more advanced and can be configured to give a more comfortable experience. Depending on where you are, if you make a big song and dance about how much you hate CPAP, your provider will consider changing you to Bipap. These machines are more expensive so they always want to prescribe CPAP first and hope you will stick with that.

Disclaimer: This post is not intended to defame Dr Safi. I am simply sharing my experiences.

Original post (from different account): https://www.reddit.com/r/LegaladviceGerman/comments/1dh8zl7/surgeon_cancelled_surgery_refund/

So this post is a bit hard to write since I have to awaken some bad memories of all this ordeal, which I wanted to forget, but I want to share my experience of trying to get surgery overseas with everyone.

If you are looking for a surgeon, please read my post as I dont want anyone else to go through what I did.

So here is the backstory:

I went to Dr Safi in Swizterland for pre-surgical consult. In the meeting room, he immediately started going on quite an unprofessional rant about his past patients, evening mocking them. He started talking about how people "on the internet" accuse him for putting unplanned filler in his patients. Afterwards, he begins to defend himself in his monologue saying that he has partnered up with many institutes and that other professionals "love him", probably to defend his ego but I had no idea why he was venting to me.

Then he randomly starts talking about GiantImplants (a person a lot of incels follow for surgical advice) all of a sudden. Honestly the first 5mins felt surreal, I never expected a professional person to talk like this.

He then talks about how many of his past international patients were 'blackpillers' who came from a website called looksmax. A lot of them were completely mentally ill, one even shockingly committing suicide after surgery with Safi. Another sued him. I'm sure he was trying to see if I was one of them.

He started complimenting me saying he is surprised "I don't stink" (given his past experiences with patients) and "look like an athletic guy" and that "he likes that". I suppose these were green flags?

Anyways, he then starts talking about looksmax, saying that I should delete my account. Now I stupidly lied, saying that I don't have an account, and only browsed the site, hearing about Dr Safi from a post. He caught my lie as one of his employees had discovered my account. FYI I only used that website occasionally to learn about surgeons (I learnt about Safi from there) and never took part in any of the dark dialogue. I only lied because I didn't want him to think lowly of me as he spent the past 10mins bashing many patients from that website.

He then was pissed, saying that I was a "major red flag". He then asked me to wait outside the meeting room for 20mins as he thought about whether to cancel the surgery of not.

After 20mins, I get called back in and to my shock, he decides to cancel the surgery. I literally cried in front of him as a grown as man. And not because he cancelled the surgery but because he literally attacked my character, mockingly saying I should go back to the internet with my blackpill friends and start writing about him like they all do.

Honestly the change in character was astonishing since he was such as nice guy in the zoom meetings.

I then started to practically beg, asking what the refund policy. I told me I don't come from a rich family (I literally worked at a factory and part-time tutor to earn 65k). He said he couldn't give me an answer as he would have to talk to his accountants. He would tell me on Monday.

This all happened on Friday. I had to wait the entire weekend not knowing whether all my hard-earned money would be lost or not. It was one of the worst periods of my life (not kidding). That's when I asked reddit about my problem. It was funny that practically everyone on r/jawsurgery were on my side, saying I should sue Safi if I don't get 100% of all my money, whereas people from other subreddits were saying it was all my fault for lying and I should be happy with whatever I get.

After the weekend I call Safi and he tells me that since I broke the surgeon-patient trust, he doesn't need to refund a single dollar according to our contract (the contract didn't say anything about trust FYI), but that he is happy to give back 34.8k CHF out of total 39k CHF. He was obviously saying this to appear generous. In Australian dollars, I got around 58k back out of 65k.

So overall I lost 7k AUD + 3k for plane tickets and accomodation. Pretty s**t experience right. It took me 6 months of work whilst in uni to save all this back.

Overall, I feel neutral about this whole thing, since I can understand why Dr Safi would have cancelled the surgery as he doesn't want to risk himself, but I can also understand why I lied.

The main thing I am against is Safi's hypocrisy, since during our initial meetings, he was actively highlighting my facial flaws, saying I have 'weak chin', 'weak cheekbones', 'dark undereyes'. He even mentioned my wide nose which I didn't talk about at all. I got super insecure about myself after these meetings. He doesn't want overly insecure patients but he definitely made me more insecure about myself.

I want to share my story with everyone so that people are not swayed by online personas. Things can get dark when you meet a surgeon in person. Please research carefully and don't believe surgeons blindly if they point out flaws in your face.

Your face is their business!

TLDR: I, an Australian resident, flew to Swizterland in the hopes of getting with Dr Safi 5 months ago. Due to lying about an online account, the surgeon cancelled my surgery unilaterally in an in-person meeting. For a couple of days I was unsure of whether I would get the 65k AUD I paid for, causing great distress. The above linked post was posted by me during this uncertain time. Eventually, I only lost 7k AUD and got the rest back.

There is another technique you may want to investigate to see if relevant called SFOT (Surgically facilitated orthodontic therapy) it is also mentioned on the Jaw hacks channel you listed in your post. With SFOT it combines using a corticotomy and bone graft to build out the bone around the edge of the jaw and then shift the teeth outwards to "expand" the arch but its not actually expanding the mandible itself in the way MSDO does. I dont know whether this technique would provide the desired effect but its one to look into.

As pointed out previously MSDO is only expanding the mandible at the front not the back and from what I have read it seems to be a mixed bag of some people having no issues vs others having problems with their condyles. The same can be said for MSE with potential for serious asymettry issues and visual disturbances vs others who experience breathing improvements and aesthetic benefits.