Please, need help

[golden280]

Im 22 years old male. I met with a maxfac surgeon this past week twice to plan out what we might be doing this past year. Im a typical mouth breathing case (narrowish palate, recessed mandible, high gonial angle, sloping forehead etc) that was "fixed" with orthodontics when I was 13 (brought the lower teeth in a lot to make it seem I had a normal bite).

My surgeon was against 3d computer imaging as he thought it made him "dumber" and instead used drew out on pieces of paper what the before and after would essentially be. I thought it was impressive, although bear in mind the before might be exaggerated a little bit because my family didn't recognize that as my "completely" natural profile.

It would be a year and a half in braces, removing two premolars on the bottom, and then leaving me essentialy with a class 3 bite after 5mm bsso (and 5-6 mm genio).

Do you think this is a dangerous thing to do? Involving removing two teeth and leaving a bad bite afterwards? I don't like my profile at all, my mandible is messed up and genioplasty alone won't fix it (I'm willing to upload some photos of myself) so please, please any help would be great as id ideally like to start with the braces asap.

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[SGseeker]

Hi! Which surgeon was this ?

Thanks!

[golden280]

This was Dr. Jamali in NYC
I had heard many great reviews about him, especially for sliding genioplasty and he seemed very competent and knowledgeable in person.

[SGseeker]

That's what I thought. I am considering him for my sliding genioplasty. Where did you hear great reviews btw? I have found some on Make Me Heal and Real Self. Do you have friends that went with him??

Regarding your question - everything he suggested sounds normal to me for jaw surgery BUT i am not an expert. I am sure some of the members on here will help you out

[molestrip]

I prefer the computer models. Surgeons make measurement errors. But paper plans are ok I think, especially for a very experienced surgeon. The bigger issue is that he's given you a bad plan. The typical mouth breather needs a double jaw surgery with CCW rotation. It may or may not include a sliding genioplasty, depending on the surgeon and specific case. I myself have this choice and am unclear which way I want to go, will be consulting a plastic surgeon to see what his thoughts are. The issue is that we often have normal labiomental folds and wouldn't want to screw that up.

[golden280]

Molestrip

He mentioned something about how my maxilla is in pretty much decent condition based on his measurements relative to a point on the forehead so he wouldn't want to touch that, however the mandible had "moderate" recession and wanted to focus on only bsso+genio.

I don't know whether or not to go through with this, as theoretically my face could use some width as its narrow now so implants may balance out my features in a much less invasive and inexpensive way. I might also consider rhino + chin implant instead, however I'm also hesitant to do this as it might be like the orthodontics at 13 was (masking the underlying problem).

Very nervous about all of this, thanks for the replies, anything would help

[molestrip]

Your surgeon is wrong. SGseeker has the same problem with the same surgeon. You have a high arch, it needs to drop 2-4mm posterior. You likely have sleep apnea and will likely still have or will have it after that BSSO. Your Maxilla is also too short, you likely have a long soft palate. Your face might be in balance now but fixing your airway will require a compromise in that balance.

Dr Posnick would be the closest good option for you. Otherwise, do what everyone else here does and travel to Dr Gunson. There's a few other good options too, none close to you but send me a PM if you want the names.

[golden280]

Here are the pics of the profile

Dont mind the eyebrows, I messed them up pretty bad recently, they're normally much more full and long.
I dont snore at night but I suspect my breathing is not 100% and I might have some form of moderate sleep apnea as my mouth is hung open during sleep and i wake up from time to time, and am exhausted in the morning 

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[terry947]

IMO, your profile actually looks pretty good. I'd be happy with this. Maybe Jamali has a point in that having only bsso would make your profile look good but would your teeth function properly with all the cusps aligning. not sure. Also it looks like your maxilla is in a good position as well. So even if you did have upper and lower jaw surgery the upper jaw movements would be minimal.

[golden280]

interesting terry, thanks for the response

im not sure what I'm seeing i guess because when i look at those pics it looks like something is off/reccessed. so I'm willing to maybe think that I'm overanalyzing it a bit

you make a good point about teeth functioning properly afterwards, especially considering he would be creating a class 3 now after the surgery (without any maxilla movement) so i don't know if all this is worth the hassle.

[molestrip]

He looks pretty recessed to me. His nose is slightly upturned and relatively straight, which is unusual in these cases. I'd almost think his maxilla was overdeveloped except for the drawing. His nose looks huge but not because it's big, the rest of the face is just so backset. His forehead is very sloped so I'm thinking nose developed that way just because of the angle of the face. This is a really tough case. What's interesting is that Dr Jamali's drawing shows a different forehead. And chin for that matter.

I'd say he'd be a great candidate for Dr Gunson. Make a flat profile with the jaws, fix the sleep apnea/breathing issues, and build out some cheekbones. The forehead will just be but I think humans are pretty tolerant of one or two off features once the rest of the face is in balance. He wouldn't be hot but he would be moderately attractive.

[terry947]

Hmm I see. Post a ceph. It'd be easier to see what's going on

[golden280]

wow thats really in depth analysis molestrip.. terry i don't have the ceph but ill request it next week

dr gunson in california? wow thats quite the trip, but i guess it would be worth it if he's the best and I'm going all in. whats my next step a sleep study? does insurance cover that and do they conduct them in nyc?

plus purely hypothetically speaking, would a forehead implant (if they even exist) and a rhino essentially even out the face to almost the same degree? just wondering here, as it would probably be much less expensive and invasive. the max amount of money i would be willing to spend here is like 20 grand and even thats pushing it

[golden280]

That was a stupid question especially considering this is a jaw surgery forum. plus forehead implant? I must be out of my mind.. it just sucks that i will progressively lose hair though so it will keep getting worse.

I'm just really frustrated that my case has to be this complicated. And a potential fix could cost upwards of 25k. Im not even looking to be "hot" (sure it would be nice) but just generally attractive and not "recessed" anymore. Plus something that will work for me as I keep getting more and more bald. I WISH this was only a case of something implants can fix but I guess not. Thanks for the replies though, any help I get here is appreciated.

[sean89]

The surgical plan is good.

DOn't touch your upper jaw.