Thank you for such a detailed response. It rivals that of the surgeon I saw today!
I forgot to mention in my previous post that I also had a consultation with an oral/maxiofacial surgeon over at Boston Medical. Her diagnosis was the same as yours (mild class II malocclusion with slight jaw misalignment). That said, she said it was "up to me" whether I wanted to do the surgery and I could pretty much go either way.
I do have TMJ issues (clicking on the right side when I open my mouth) but it doesn't interfere with my bite or cause sleep issues and is mostly just an annoyance for the people around me who have to put up with my clicking! Also, she told me there is no guarantee that my TMJ would be resolved and it could actually get worse, so NOT to do it for that reason alone. If I wanted it done for bite/jaw alignment, then thats a different story. I really just dont want to do the 6 months of braces before and after to be honest, which she said was needed.
To be frank, I'm really considering surgery for cosmetic purposes only, to add more balance to the lower part of my face. Yaremchuk did say though he elects to do chin implant rather sliding genioplasty along with jaw implant since he said they go hand and hand (he said if I were ONLY to do the chin implant, while adding more prominence, it could actually made the jaw seem narrower. Highyl advised doing both the same time in my case)....
Your welcome!
FaceNit - While I can understand why you are pushing for him to see a maxillofacial doc to treat his dentofacial issues and like I said, I too will usually strongly suggest that because for optimal aesthetics outcome and functional/long-term stability. You're exaggerating about an isolated genioplasty being necessarily wrong in this particular case.
Clicking in joints and natural jawline asymmetry by itself is not the slightest sufficient to predict his joints will deteriorate or lead to other skeletal issues. He doesn't mention pain (correct me if you do OP), no interference with bite or mastication and no breathing issues. All good. He is also doesn't have an open/cross bite. Also very good.
Drawing on my personal experience, I had joint clicking and symmetry before surgery and I still have it after successful double jaw surgery. Dr. Gunson told me that even without surgery my joints would be fine. I even had a small airway (I had mild sleep apnea).
Of course there's individual variation and everyone's developmental trajectory won't be the same. Good thing we aren't all basing our opinions off personal outcomes. OP, has you jaw unevenness of your visibly worsened over time? Or the clicking?
OP I would do three things:
1. Avoid any kind of TMJ treatments for now. Maybe forever. Unless your currently benign symptoms worsen.
2: Avoid jaw implants, I'll agree with Facenit on this point. Not that jaw implants can't give a good result for some people. And while I don't know Dr. Y's history, plenty of doctors will operate on a person even though it's contra-indicated, either out of genuine ignorance or because they just don't care.
3. If you do not want to go the jaw surgery route, go have at least several consultations with competent, experienced surgeons with good reputations about having a sliding genioplasty.
Then re-asses 6 months to a year down the line, both how you look and your functioning. Be prepared to have some residual partial numbness on your chin and lower lip that may be permanent. This happens in many cases even when the doc does everything right.
And finally a sliding genio, while not an insignificant surgery, will have no affect of potential future jaw surgery if needed. Other positives is that it's your own bone and it's a very stable procedure that will not negatively affect your bite or joints.
