How do you even pick a surgeon in a semi-informed way?

[FaceDay]

Asking for professional opinions seems worse than random selection, since orthos for example will just recommend the surgeon they have the best business relationship with. Online research will find the worst surgeons with the most tech savvy since most surgeons have terrible online presence to begin with, and the ones that advertise tend to be the ones that need to. Lastly, reviews and forums are a little help, but they are skewed by echo chamber effect and being a very very small and biased subset of people who get surgery.

So, is there actually any intelligent way to select a surgeon? Is it all just down to luck and location?

[Gregor Samsa]

If anyone here knew that then we wouldn't be here. 

The best option, although much more expensive, is to consult with as many surgeons and possible so you get a good idea of what is possible. I think the surgical ability is pretty similar when it comes to most surgeons so if you can get a surgeon who has a good surgery plan for you then you should be okay. Determining what makes a good or bad surgery plan is not easy though but you definitely decrease the risk of getting a bad one by consulting with as many different surgeons as possible and also by sharing the surgery plan on a forum like this one so that other people can give you their input.

[Nataliepryor]

I was super lucky....talking about requiring jaw surgery at my sons school yard and one if the mums had done journalism work with my surgeon and she thought he was brilliant. I made a cold call to meet with him, thought he was great.

I picked the closest orthodontist to my house and they advised they use two surgeons (one was mine!) quite a fluke that the whole thing fell together!!

Often there are only a selected number who perform certain surgeries and word of mouth travels fast.  My orthodontist also had a 'list' of ones they DONT recommend.

If you have a very highly  regarded  Ortho they will generally use highly regarded surgeons, as they need to work together to make your results work.

[Optimistic]

Asking for professional opinions seems worse than random selection, since orthos for example will just recommend the surgeon they have the best business relationship with. Online research will find the worst surgeons with the most tech savvy since most surgeons have terrible online presence to begin with, and the ones that advertise tend to be the ones that need to. Lastly, reviews and forums are a little help, but they are skewed by echo chamber effect and being a very very small and biased subset of people who get surgery.

So, is there actually any intelligent way to select a surgeon? Is it all just down to luck and location?

I would say it's about first of all determining what you are looking to achieve. Different surgeons are better at different things.

Look at their papers, what is published, the quality of said papers, quality of photos.

See what their reputation is amongst other surgeons. So when you consult surgeon X, ask what he thinks about surgeon Y. Most will give  a pretty honest opinion.

Find other online testimonials and results if possible.

At the end of the day you're always taking a chance and even the best surgeon doesn't have a 100% satisfaction rate. So with that in mind also find out about their attitude towards revisions. Some will do it for free, for cheaper, and others will become complete assholes.

Edit: I will also say that in a lot of ways things are made complicated by the fact that so few results of any surgeon are online. I guess because maxfac isn't too common a procedure and most are, as the person above says, referred to them by their ortho. They have the work done and never think about it again. On some level I think most surgeons will do a fine just as long as they demonstrate a willingness to achieve a good aesthetic result and aren't just solely focused on functionality.

[PloskoPlus]

It's very simple.  When I had my surgery consults I was given a http://www.aaoms.org brochure.  It explained underbite, overbite, gummy smile surgery.  Every before and after was the world of Richard Joseph.

http://drrichardjoseph.com/jaw-surgery/

[Mark32]

i suppose it’s down to a combination of research, going to at least a few consults and sharing those plans here, as Gregor said.

...Determining what makes a good or bad surgery plan is not easy though but you definitely decrease the risk of getting a bad one by consulting with as many different surgeons as possible and also by sharing the surgery plan on a forum like this one so that other people can give you their input.

Gregor, you were saying to me that Paul Johnson - the guy in Guildford, England - doesn’t do a surgery plan in the consult. is that common enough or is he an exception? also, with surgeons that do give you a surgery plan how detailed do they tend to be?

[Gregor Samsa]

See what their reputation is amongst other surgeons. So when you consult surgeon X, ask what he thinks about surgeon Y. Most will give  a pretty honest opinion.

I'm not sure how useful that is. There seem to be a rather large discrepancy between what surgeons think of each other and what the patients think. Take Mommaerts for example: He seemed to be highly regarded amongst other surgeons since he does a lot of research, speaks at conferences often and is even the president of various organizations. My orthodontist knew who he was and said that he had a great reputation. Meanwhile he is probably the most criticized surgeon when it comes to what his patients think. Similarly, some of the surgeons who are considered amongst patients or forum communities to be the best in the world are actually heavily criticized by other surgeons (I'm not going to go into detail on that one). Having a surgeon tell you that he has had to redo a lot of botched cases from a certain other surgeon is rather damning though.

[Mark32]

is there a clash between patients and surgeons because we tend to be more aesthetically minded whereas surgeons are more (too) focused on functional problems?

[Gregor Samsa]

Gregor, you were saying to me that Paul Johnson - the guy in Guildford, England - doesn’t do a surgery plan in the consult. is that common enough or is he an exception? also, with surgeons that do give you a surgery plan how detailed do they tend to be?

Paul Johnson was supposed to send me a surgery plan but instead I got a letter from him that informed me that he didn't recommend surgery since he didn't believe it was possible to achieve enough improvement. Other people on this forum have consulted with him without receiving a surgery plan but I can't say what his standard praxis is when it comes to this. Ultimately, I don't think the consultation with him was worth it since nothing came out of it and it was pretty expensive. I'd still go with him in a heartbeat if he offered me a surgery that makes sense though.

In general, I'd say most surgeons won't give you a detailed surgery plan after the first visit and they probably need to see study models of your teeth in order to come up with a proper plan. Say what you will about Arnett and Gunson but they will at least listen to you for several hours if needed and they do give you a detailed surgery plan from what I've read. Sandro Pelo is also like that but when you pay 300 euro (500 dollars for Arnett and Gunson) for a consultation I damn well expect something in return. A consultation with Triaca for example is 500 euro and I have no idea what you get for all that money. If he's like Schendel or Mommaerts who will listen to you for 5-15 min without barely giving you any feedback then it would be a complete waste of time and money IMO.

[Gregor Samsa]

is there a clash between patients and surgeons because we tend to be more aesthetically minded whereas surgeons are more (too) focused on functional problems?

The vast majority of surgeons only care about the functional aspect. This is probably the most important thing that sets the "top" surgeons apart from the surgeon at your local hospital. Very few surgeons will even consider surgery if your bite is functional even if the aesthetics are off by a large margin. I would even say that some orthdontist and surgeons will go so far that they'll even make you look worse just to improve the bite in the easiest way possible. There have been many stories on this forum about needless extractions at a young age that has led to disastrous results down the road.

[Mark32]

so, Paul Johnson must be one of the very best then. doing the surgery plan a bit further down the road when they've got models and done a bit more research makes sense. however, as you've started the process with them by that stage what happens if you don't like the plan they come up with. i know they can't force you to go any further but financially how much of the cost can you recoup if you back out? or do most surgeons take payments in installments?

what you're saying about Arnett and Gunson sounds ideal. i want time in a consultation to explain my concerns and not be hurried out the door.

it's shocking that surgeons don't give more regard to aesthetics when they're working on something as important as a person's face.

[Gregor Samsa]

You usually don't pay anything to the surgeon until you're close to the surgery but it could vary from surgeon to surgeon. The surgeon will instruct your orthodontist how to move the teeth though so if the surgery plan is not adequate then you could just be wasting your time and money on the orthodontic process or even worse, do something that is directly opposite of what you actually needed to have done in order to get the best result. I didn't know what the final surgery plan was until one week before the surgery and in some cases the surgeon will even change his mind once the surgery is underway (that actually happened to someone on this forum with a disastrous outcome).

[Optimistic]

Paul Johnson was supposed to send me a surgery plan but instead I got a letter from him that informed me that he didn't recommend surgery since he didn't believe it was possible to achieve enough improvement. Other people on this forum have consulted with him without receiving a surgery plan but I can't say what his standard praxis is when it comes to this. Ultimately, I don't think the consultation with him was worth it since nothing came out of it and it was pretty expensive. I'd still go with him in a heartbeat if he offered me a surgery that makes sense though.

In general, I'd say most surgeons won't give you a detailed surgery plan after the first visit and they probably need to see study models of your teeth in order to come up with a proper plan. Say what you will about Arnett and Gunson but they will at least listen to you for several hours if needed and they do give you a detailed surgery plan from what I've read. Sandro Pelo is also like that but when you pay 300 euro (500 dollars for Arnett and Gunson) for a consultation I damn well expect something in return. A consultation with Triaca for example is 500 euro and I have no idea what you get for all that money. If he's like Schendel or Mommaerts who will listen to you for 5-15 min without barely giving you any feedback then it would be a complete waste of time and money IMO.

I sent this in private but I might as well rehash it here for those who're interested. It's not my intention to be a surgeon shill.

I didn't have to pay for any of my consults with Dr Triaca oddly enough - though I could be the exception and not the rule. Who knows?

During my consult I was given a couple hours to have scans done, photos taken, occlusion looked at, and then discuss everything in great detail. He sat down with me and let me go ask all the questions I wanted, showed me things on models, and discussed some of my options in terms of an aesthetic outcome based on some simulations. He also took lots of notes and asked me to come back again to think everything over and go through a surgical plan one final time. It didn't feel at all rushed.

Truthfully I couldn't have asked for much more.

[Modigliani]

^ And he didn't charge you a penny?

[Optimistic]

^ And he didn't charge you a penny?

Nope 

Edit: Granted I had already deposited money for the operation, even if it wasn't 100% locked in. So it wouldn't have made much sense to charge me for the consult and work-up