Matt's CCW MMA Thread

[Matt]

Hey, guys. Sorry for another post, but I'm hoping for some surgeon advice, if anyone can help.

As I mentioned in my last post, I may try going to an out-of-network surgeon now, but if I do their rates must be around the ballpark of what my insurance provider considers "customary / reasonable". Upon further research, that's looking like the $20,000 - $30,000 range.

So, with those numbers in mind, do you guys have any recommendations for surgeons that can perform large CCW rotations? I may need posterior downgrafting of my maxilla (in addition to the anterior impaction of my gummy smile) so finding a surgeon that can do this combination will be the goal.

Obviously Dr. Gunson and Dr. Wolford are not in the $20,000 - $30,000 price range. What about Dr. Posnick, though? I found one thread stating that he did double jaw, genio, septo, etc. all for $24,000 (although it seemed to be an old post) and then shortly after I found another post saying he was in the $50,000 range just like Arnett, Gunson, Wolford, etc.

How about Dr. Sinn or Dr. Kasey Li? Are they any more affordable? Molestrip sent me an e-mail recommending Dr. Terry Taylor in Houston, TX. Apparently he does 200 surgeries a year and is in-network with my insurance provider (BCBS) which would bring the cost down a lot ($4,000 total - the cost of my out of pocket maximum and that's it).

Finally, I'm still going to push for Dr. Richard Joseph here in Florida. Maybe I can get him to budge and take me on as a patient, despite living just outside of his radius. If so, I'd be looking at $9,000 - $12,000 out of pocket (which I'm happy to pay for someone like Dr. Joseph). I just want to find a surgeon who can offer the amount of rotation I need, and for a "customary / reasonable" price.

[swsee]

What surgeon's have you spoken with? I consulted with 8 different surgeons, and every single one suggested rather significant posterior downgrafting to achieve CCW rotation and flatten my occlusal plane to ~8 degrees. I don't know why everyone on this forum acts like there's only like 3 surgeons in the world that do such a thing. I know this doesn't really answer your question, but I think if ask around you will find it is not as uncommon as you may think.

[Matt]

What surgeon's have you spoken with? I consulted with 8 different surgeons, and every single one suggested rather significant posterior downgrafting to achieve CCW rotation and flatten my occlusal plane to ~8 degrees. I don't know why everyone on this forum acts like there's only like 3 surgeons in the world that do such a thing. I know this doesn't really answer your question, but I think if ask around you will find it is not as uncommon as you may think.

Thanks for the response, swsee. I don't want to post my current surgeon's name on here just yet, because as of right now I'm technically still working with him. However, I will say that he was a somewhat local option that was in-network for me (I live in Palm Beach Gardens, FL and drive two hours up to Orlando, FL to see him). Apparently he does surgeries every Monday (so I'm guessing around 50 a year?) and he seems to be one of the more senior surgeons at the practice. With that said, though... I'm not sure if his plan is right for me. He's only planning anterior intrusion (impaction) for my CCW rotation, and never mentioned posterior downgrafting to me (verbally or in his written plan). I've reattached the drawing of his surgical work-up below (what do you think of it?). To me, I feel like I need more rotational advancement than I do straight advancement - and I'm worried that the anterior intrusion alone is not enough (considering how steep my jaws are, wouldn't you think combination anterior impaction / posterior downgrafting is necessary?).

Since I'm feeling a bit uneasy about this, I'll be getting a second opinion from Dr. Stephen Rimer down in Boca Raton, FL (an out-of-network surgeon that my orthodontist had originally recommended to me). I'm hoping he'll suggest more rotation to me when we meet next week. If not, I don't know who to consult with next. Any suggestions, given my case and pricing requirements?

[Matt]

Hi, everyone. It's been a while! I wanted to update my thread one last time, as I'm actually having surgery this coming Tuesday (April 18th) with an entirely new surgeon. I was given the measurements today (all done with virtual surgical planning) and I wanted to run them by the forum one last time before heading into surgery on Tuesday. So, as of now, my movements will be:

- 2-piece upper jaw (originally he thought it'd be a 3-piece, but after virtual planning said that 2-piece was the way to go). I've actually never heard of a 2-piece, usually just single or 3, but he felt this was best for me and he'd be widening my upper jaw at the back towards the molars to better place my upper teeth over my lower teeth.

- 4mm upper jaw impaction. He said this was on the conservative side for me, but he really doesn't want to over-impact and he feels that having a little extra gum show is aesthetic and youthful.

- 6mm upper jaw advancement.

- BSSO moving my lower jaw 12mm, tip to tip.

- Occlusal plane will lower by about 8-9 degrees, from about 14/15 degrees now to 6/7 degrees after surgery.

- No genioplasty. He feels my chin is good as it is, and in his words "doing anything to your chin will... make it look like something was done to your chin". Haha. (I know this was something we spoke about previously in this thread. He seemed to plan my case with the higher level goal of trying to get enough rotation that we could avoid the genioplasty for me.)

- Septoplasty while he's in there.

That's about everything! He said he'll let me look at the virtual stuff before going into surgery, and iron out any final questions that I might still have. In his words, he felt everything was looking very "artistic" and he was happy about it.

What do you guys think of these measurements? I really trust my new surgeon, but some final opinions / reassurance (hopefully!) would be nice before surgery. I'll repost some old photos and x-rays just for reference again, in case that helps at all.

[Matt]

Bump! Any last words on the surgical plan before I head into surgery? Two days left!

[kjohnt]

Sounds like a good plan to me man, best of luck!

[XXRyanXXL]

Matt
You havn't posted your surgery results yet.
Let us know how it went!
Guys, keep bumping this thread to the top!

[mike888miller]

is there anyone that can enlighten me about the scenrios of downgrafting?

also, my doc today mentioned that he might use a higher cut line for me bsso, as it would allow him to lengthen my ramus, even thought it is less stable and he will need to get filling material out of my hip.

[ditterbo]

Aaaand he's long gone.