What do I need? (Pics, Ceph+)

[PloskoPlus]

Just look at the pics, she had bad hair, acne, crap lighting and so on on the before pic. I'd also give her less advancement but my point is that it still doesn't look that bad, it looks better at least.

She had some ccw rotation maybe which flared up her gonial angle,

Jaw angle implants.

[ditterbo]

I was told my nerve damage is like 1 out of 50 or 100.  Anyway, you need surgery.  Don't take it the wrong way, but you will hardly look any worse after it.  You probably need CCW.  Ask how much posterior maxillary downdraft you need and how stable it is.  What will happen if it relapses.  Ask all the hard questions.

Are you just agreeing with me that jaw surgery isn't, by itself, going to help me look much 'better' in my case? 

I'm really pretty green regarding these technical maneuvers.. a big part of me just wants serious confirmation that this is worth it from a medical standpoint.  I've had wisdom teeth pulled, an ill fitting, malpositioned chin implant that I need revised, a rhinoplasty that left me with a septal bone spur & consequential deviated septum, permanent light bleeding, worse breathing... I don't have a lot left in me for more majorly invasive surgery to my face and more surprise complications, but I'm also somewhat unhappy with my looks (a bit less so since the rhinoplasty and chin implant, even with its complications). 

I agree, having also spoken a little about my case with Posnick, that I need CCW rotation.  I wish I got a more specific evaluation from him for my $175 consultation fee.  No ceph analysis, diagnostics, movement plan, etc., just a lot of describing how one's jaw position affects their appearance.  My jaws seem small in all directions, but so too appears the rest of my facial features. 

I'm also really not keen on losing my two lower bicuspids, but I see Lazlo posting that at least some max facs have found ways (unknown to me) to avoid extractions.  Kind of hoping to see him weigh in on my case. 

[PloskoPlus]

If done properly, you will definitely look better. Just be realistic. You won't be a model after this.  The only people coming out of these looking like models are those who looked like models with a dentofacial deformity before surgery.

[Tezcatli]

Are you just agreeing with me that jaw surgery isn't, by itself, going to help me look much 'better' in my case? 

I'm really pretty green regarding these technical maneuvers.. a big part of me just wants serious confirmation that this is worth it from a medical standpoint.  I've had wisdom teeth pulled, an ill fitting, malpositioned chin implant that I need revised, a rhinoplasty that left me with a septal bone spur & consequential deviated septum, permanent light bleeding, worse breathing... I don't have a lot left in me for more majorly invasive surgery to my face and more surprise complications, but I'm also somewhat unhappy with my looks (a bit less so since the rhinoplasty and chin implant, even with its complications). 

I agree, having also spoken a little about my case with Posnick, that I need CCW rotation.  I wish I got a more specific evaluation from him for my $175 consultation fee.  No ceph analysis, diagnostics, movement plan, etc., just a lot of describing how one's jaw position affects their appearance.  My jaws seem small in all directions, but so appears the rest of my facial features. 

I'm also really not keen on losing my two lower bicuspids, but I see Lazlo posting that at least some max facs have found ways (unknown to me) to avoid extractions.  Kind of hoping to see him weigh in on my case. 

From what I've read Posnick is against extractions in most cases, so if he recommends it for you, you must really need it. Extractions will make it possible to advance your lower jaw a lot more and let's agree it is pretty small.

I don't see how jaw surgery cannot be beneficial in your situation, you will make your small mandible bigger, more ccw rotated, you will get a septoplasty too, it will improve your looks and breathing.

[SJay]

Hey, looks like the rhino was an improvement. It's a complicated surgery, can I ask who your surgeon was? However, I think the jaw was the real issue, and that made your nose look worse. I think men can carry off lower tips and higher bridges, anyway jaw surgery will be a definite aesthetic improvement.

I'd definitely speak with Dr Gunson, they'll do a VERY thorough analysis and identify any imperfections you have (some of which you may not have even noticed). You can even do a paper consultation, if you can send them x-rays, intra-oral photos and models of your teeth, then they can do a preliminary analysis before you fly out to them. That's what I did, then I flew out and they'll do everything again in person before surgery. I'm actually scheduled for surgery tomorrow, but everyone at the office is very professional, they even made a 3D model to identify where my nerves are, they've spent a lot of time planning and I feel confident in them. I'd definitely speak to them and get their opinion.

[ditterbo]

Thanks for sharing your thoughts on this, SJ.  PMing you my op doc but honestly I don't think he does good tip work.  I want to get my now retracted alar rims and hanging columella fixed in the future.

Gunson has everything except the teeth models, I think, to do a preliminary analysis.  Was the prelim analysis any help though before seeing him in person? Do you know if they provide a morph of the surgery outcome at the consult? I really wish I could visualize how I would look coming out of this surgery.

What's really making it hard for me is how my side profile, pre plastic surgery, looks like a textbook jaw surgery case. Yet I am somewhat(?) lacking an OSA, teeth, or TMJ reason to go down this route.  I really need insurance to at least pay the hospital fees.

I'm in the US (DC), and so I just can't fathom spending 30-50k for surgery + orthodontics, as well as potential future surgeries out of pocket. Insurance doesn't pay for complications stemming from what they deem as cosmetic procedures.

I think you all have pushed me to at least try for a positive predetermination from my insurance company.  If they don't accept it, then I am probably relegated to camouflage treatment.  I'm actually about a week away from possibly scheduling revision chin implant surgery with Dr. Harrison Lee. Just debating now if I should get a custom implant, anatomic vs wings, etc..  Should I save the SG option for the future, when I'm absolutely sure whether or not I'm getting jaw surgery?

[ditterbo]

What if I just did a chin wing, slid forward?  The hardest part would be finding a doctor to do the chin wing. I had a very mild class 2 post orthodontics (though they did have the retainer do some work post braces that I don't have pictures of), and relapsed maybe 1-2mm into a slightly more moderate class 2 now since I neglected to wear my retainer for a stretch. 

Chin wing is probably not performed anywhere on the US east coast, right?

[SJay]

Yeah, the alar rims can scar inwards and upwards, leaving retracted nostrils and asymmetry... this was an issue after my primary. Be careful who you go to, some docs can fix this and some very reputable surgeons cannot.

The paper consultation was very useful, they'll do a full analysis of your face and give you a report telling you which areas you are deficient in, jaws, teeh, cheek bones, the lot. Then you can skype with them to talk it over. My treatment plan didn't change, the analysis from the paper consult was virtually the same as the in person. Dr Gunson will provide morphs, if you ask.

If I was you, I wouldn't bother with more implants. I don't think they're the long term answer and I suspect you still won't be happy after having them. I know it's frustrating and you just want to 'fix things now', but I'd save the money and put it towards a permanent fix... whatever that may be.

Chin wings are done in Europe, Germany and Switzerland, perhaps some other countries.

[thinkingme]

Ur problem is similar to mine. Good bite with no functional issues http://imgim.com/sefoelet.jpg . Speak with 3 ortho and all said u dont need surgery. Speak online onemaxfac surgeon and he said i need mandibular advancement if i push my mandibula forward long face and underbite coming. Its weird i want surgery but orthos say no u dont need. Ill speak with 2-3 ortho and 2-3 surgeons more next year. and I start feel depressed because i cant fix my problem. Hope u can find somethind because i cant find.

The only i find good molar relationship before surgery like me http://ovortho.com/jaw-surgery/ with extraction 4 biscupid and and without extraction http://imgur.com/gallery/gru8D arnett gunson

[Lazlo]

You definitely double jaw with CCW, plus maybe after a chin-wing. I going to make some observations and if you want further advice from me please answer to each comment specifically.

1) you had an open rhino, the scar is evident. Who was the surgeon: name please. While you had a run-of-the-mill job, it was done by my standards and those of what I'm going to call the "new school" of thought in rhinoplasty surgery --incompetently. Your bridge was lowered way too down in an effort to balance your still retruded jaws. I can see your scar which was not hidden well and ALSO you have severe "alar retraction" you can see far too into your nose in the profile view. It's not terrible, but it's not a really well done rhino according to the Cochrane, Toriumi etc. school of thought which is to build up the nose more.

2) what did you have done to your teeth? Did you have your fillings taken out? Bridges? Or implants? Where did all your fillings go and what materials were used to replace them?

3) The terino implant should be taken out. Posnick's plan sounds good. If you go with Gunson you'll probably want to ask them to do a more aggressive genioplasty of the chin than they usually do, I find Gunson/Arnett's genios to be too conservative but that may be a matter of taste. For all health, sleep etc. purposes a CCW will be beneficial. Aesthetically it will help, certainly better than the terino implant (motherf**king cosmetic surgeons don't know s**t and implants are f**king horrible --the whole field is run by retards).

Okay, that will give you a game plan. If you had the money I'd have that rhino re-done by Cochrane or Toriumi or someone really trained in revisions and will apply caudal struts, a septum strut etc.

[SJay]

btw, does anyone know what happened to that girls ear... the sailer patient. It looks like a chunk is missing.

[thinkingme]

to the op Our profiles are very similar i said it. I speak with 3 ortho only one said and he say'' ask a surgeon but i think he didnt accept surgery'' My chin to neck so close and im not fat maybe vertical jaw growth with small ramus.and im 5'10 and 155 lbs. Im gettin depressed more everyday. When no consultation i was thinking one day i can fix this then when i speak with doctors and searchin internet my case i have good bite and cant get surgery probably. This got me more depressed. I just want to ask have u have this mental problems too or im so weak? I cant stop thinking that. I just want to sleep everyday and dreaming be normal.

[Lurker25]

Jaw angle implants.

That's correct: http://www.sailerclinic.com/en/specialist-fields/aesthetic-surgery/jaw-line-enhancement-double-chin-reduction/

[ditterbo]

You definitely double jaw with CCW, plus maybe after a chin-wing. I going to make some observations and if you want further advice from me please answer to each comment specifically.

1) you had an open rhino, the scar is evident. Who was the surgeon: name please. While you had a run-of-the-mill job, it was done by my standards and those of what I'm going to call the "new school" of thought in rhinoplasty surgery --incompetently. Your bridge was lowered way too down in an effort to balance your still retruded jaws. I can see your scar which was not hidden well and ALSO you have severe "alar retraction" you can see far too into your nose in the profile view. It's not terrible, but it's not a really well done rhino according to the Cochrane, Toriumi etc. school of thought which is to build up the nose more.   

2) what did you have done to your teeth? Did you have your fillings taken out? Bridges? Or implants? Where did all your fillings go and what materials were used to replace them?

3) The terino implant should be taken out. Posnick's plan sounds good. If you go with Gunson you'll probably want to ask them to do a more aggressive genioplasty of the chin than they usually do, I find Gunson/Arnett's genios to be too conservative but that may be a matter of taste. For all health, sleep etc. purposes a CCW will be beneficial. Aesthetically it will help, certainly better than the terino implant (motherf**king cosmetic surgeons don't know s**t and implants are f**king horrible --the whole field is run by retards).

Okay, that will give you a game plan. If you had the money I'd have that rhino re-done by Cochrane or Toriumi or someone really trained in revisions and will apply caudal struts, a septum strut etc.

To your points:
1) Messaging you the op doc.  Correct, it was an open rhino. If I'm looking at jaw surgery though, should I even be thinking about correcting anything now with my nose?  BTW this guy installed a columellar strut graft, bilateral spreader graft, dorsal septum struts, and bilateral lateral crural struts.  Per operating notes, I was left with a "generous 6 to 7mm dorsal and caudal strut for support".  So seems like he tore my nose down, did some reconstruction and reinforced the foundation, so to speak? But YES, I really dislike how the tip came out. 

2)  The silver amalgam fillings were all replaced with composite resin. 

3) Cosmetically, I can't imagine the change but it sounds like bimax+sg, and a chin wing is the correction for retrognathia and microgenia.  I'm replacing the terino implant on April 13th to hopefully get some relief from the smile and cheek distortions, and pain. Otherwise I risk an ~8mm void from a 1.5 y/o implant. Also, how do you suggest I get around the $30-50k cost barrier to picking a trustworthy doctor? That's like almost my life savings.  With a mild amount of OSA, treatable by CPAP, I don't think I have an insurance case.  My airway looks almost normal, I think.  I've been told I'll need 15mm+ in jaw advancement, and apparently not many surgeons do that.  Ideally, I wouldn't do any more cosmetic surgery after bimax.

[Tezcatli]

To your points:
1) Messaging you the op doc.  Correct, it was an open rhino. If I'm looking at jaw surgery though, should I even be thinking about correcting anything now with my nose?  BTW this guy installed a columellar strut graft, bilateral spreader graft, dorsal septum struts, and bilateral lateral crural struts.  Per operating notes, I was left with a "generous 6 to 7mm dorsal and caudal strut for support". 

2)  The silver amalgam fillings were all replaced with composite resin. 

3) Cosmetically, I can't imagine the change but it sounds like bimax+sg, and a chin wing is the correction for retrognathia and microgenia.  I'm replacing the terino implant on April 13th to hopefully get some relief from the smile and cheek distortions, and pain. Otherwise I risk an ~8mm void from a 1.5 y/o implant. Also, how do you suggest I get around the $30-50k cost barrier to picking a trustworthy doctor? That's like almost my life savings.  With a mild amount of OSA, treatable by CPAP, I don't think I have an insurance case.  My airway looks almost normal, I think.  I've been told I'll need 15mm+ in jaw advancement, and apparently not many surgeons do that.  Ideally, I wouldn't do any more cosmetic surgery after bimax.

Why did you change your nose so much? I just had a closed rhino where he shaved down the bone to make it straight. I don't think your nose had any problems except the dorsal hump