Very confused on surgeon to select

[beautyislife]

I don't know requirements for surgery-first, or your case, but if you have skeletal disharmony your bite would not have been corrected via past orthodontics, it would have likey been camouflaged.

Did Gunson give you a copy of the post-ortho tracing? Was there much work to be done?

are you referencing this? https://imgur.com/a/irRO8jJ

[Lazlo]

sorry for posting too much. I am just so confused on which surgeon to pick.
I am mostly doing jaw surgery for cosmetic benefit, increased airway is another part that two surgeons mention

I don't want too much advancement, I'd like to have projected jaws + get rid of vertical lip + keep my smile line/gum show same + hopefully mitigate mid face worsening. So far I have consulted with:

Gunson: he would do CCW with HA paste. I believe 9-10mm lower jaw, 6mm upper jaw movements. problem is I don't like HA paste from reading I do and the wait time and cost is high.
.
Zarrinbal: he said bimax with very conservative cow, spina nasals osteotomy and chin wing. problem is he doesn't give any measurements, but cost and timeframe is good.

I am thinking to consult with Raffaini and Alfaro, but I am unsure if it is worth consulting with them. I do not know which surgeon to select. Any advice?

go with gunson it's a no-brainer. don't worry about HA he uses it differently than whatever you've read.

[april]

are you referencing this? https://imgur.com/a/irRO8jJ

He gave me 3 tracings, the 2 you have but also one showing the orthodontic movements (pre-surgery).

But looking at yours now, your bite doesn't seem to change much at all, so maybe you're right and you won't need further ortho. Looking at the numbers after surgery your overbite reduces by 2mm (from 4mm to 2mm) and overjet reduces by 1 (from 4mm to 3mm).

[jawsandsleep]

OP, I am planning to get CCW done and will consult with Gunson, Zarrinbal and Alfaro. I am hoping to cure my sleep apnea this way. I also find it really hard to make a decision.
Currently, I am asking myself how the down movement of the posterior maxilla is being performed: I know Gunson uses a graft to close the defect, but apparently, some docs don't. Are there any opinions on this topic?
Naturally, Gunson seems like the better choice due to his track record, but am hesitating due to cost as it would be completely out of pocket for me.

[PloskoPlus]

OP, I am planning to get CCW done and will consult with Gunson, Zarrinbal and Alfaro. I am hoping to cure my sleep apnea this way. I also find it really hard to make a decision.
Currently, I am asking myself how the down movement of the posterior maxilla is being performed: I know Gunson uses a graft to close the defect, but apparently, some docs don't. Are there any opinions on this topic?
Naturally, Gunson seems like the better choice due to his track record, but am hesitating due to cost as it would be completely out of pocket for me.

I've seen no evidence that zarrinbal can do ccw.

[jawsandsleep]

He has told me that he can. But I doubt that he will be doing large movements especially when it's posterior downgrafting. He seems more focused on esthetic alterations such as chin wing, etc.

Either way OP. since we're in the same boat, I would be happy to hear from your progress!

[PloskoPlus]

He has told me that he can. But I doubt that he will be doing large movements especially when it's posterior downgrafting. He seems more focused on esthetic alterations such as chin wing, etc.

Sounds like a cop-out. If you need ccw, but get linear advancement instead, you will end up with a chimp mouth. No chin wing can make up for poor lip aesthetics.

[beautyislife]

I've seen no evidence that zarrinbal can do ccw.

He told me also that he would do a small ccw

[jawsandsleep]

Agreed. I will probably end up with Gunson ... 

[CCW]

He has told me that he can. But I doubt that he will be doing large movements especially when it's posterior downgrafting. He seems more focused on esthetic alterations such as chin wing, etc.

Either way OP. since we're in the same boat, I would be happy to hear from your progress!

He told me also that he would do a small ccw

Zarrinbal does chin wing to simulate CCW, and his surgery is an aesthetic camouflage treatment. At most his "CCW" is an anterior impaction to fix a gummy smile, but not a real one where the OP is leveled with a posterior downgraft. I wouldn't have surgery with him if your aim is to cure sleep apnea because, as I said, his treatment is mostly an aesthetic fix. In fact, I wouldn't even consider him for legit jaw surgery work. The European surgeons I'd recommend are Alfaro and Raffani and Gunson and Relle in the US.

[beautyislife]

Zarrinbal does chin wing to simulate CCW, and his surgery is an aesthetic camouflage treatment. At most his "CCW" is an anterior impaction to fix a gummy smile, but not a real one where the OP is leveled with a posterior downgraft. I wouldn't have surgery with him if your aim is to cure sleep apnea because, as I said, his treatment is mostly an aesthetic fix. In fact, I wouldn't even consider him for legit jaw surgery work. The European surgeons I'd recommend are Alfaro and Raffani and Gunson and Relle in the US.

would z still be a decent option for cosmetic reasons? I don't have sleep apnea, but do have a smaller airway.

[jawsandsleep]

I know it's highly subjective, but I have consulted with Z before and this is my opinion.
He has a fantastic eye for aesthetics and great intuition in his surgery. He has some unbelievable results in this practice, the website ones don't really do justice. One of the main reasons is that he has a wide array of techniques to perform them, most prominent among them chin wing. His marketing isn't really communicating all this which is kind of confusing. He also does CCW with posterior downgraft, but isn't willing to make large movements due to instability.
Eventually, it all comes down to your starting point and your preference. If only want to alter the way your jaw/jawline works, Z is a great choice. If the airway is concerned (might develop into sleep apnea into some point), some advancement should be considered.

@CCW: this is a legit concern in noname surgeons. Lefort I anterior impaction in patients with no incisor show is terrible, but happens sadly. But once again, Z knows about lips.

[kavan]

would z still be a decent option for cosmetic reasons? I don't have sleep apnea, but do have a smaller airway.

Sure, if you can ISOLATE your 'cosmetic reasons' to ONLY a chin wing.

[beautyislife]

Sure, if you can ISOLATE your 'cosmetic reasons' to ONLY a chin wing.

I don't think I can. I want the upper lip curvature fixed, my nasolabial folds addressed, and a full projected look that only looks like you can get from upper jaw movement.

go with gunson it's a no-brainer. don't worry about HA he uses it differently than whatever you've read.

It still fuses with the bone and from a few searches on here it sounds like it compromises the bone underneath. Also, HA on the cheeks seems like it would make a ZSO down the road impossible


Few additional questions (sorry for being an idiot):
-is a chin wing possible after a bimax with someone like Dr Gunson?
-does the ramus get longer and gonial angle closer to 90 with bimax? I like that look.
-is a zso possible once HA paste is applied? I will ask dr z about this but he is fully against HA paste

[kavan]

I don't think I can. I want the upper lip curvature fixed, my nasolabial folds addressed, and a full projected look that only looks like you can get from upper jaw movement.


It still fuses with the bone and from a few searches on here it sounds like it compromises the bone underneath. Also, HA on the cheeks seems like it would make a ZSO down the road impossible


Few additional questions (sorry for being an idiot):
-is a chin wing possible after a bimax with someone like Dr Gunson?
-does the ramus get longer and gonial angle closer to 90 with bimax? I like that look.
-is a zso possible once HA paste is applied? I will ask dr z about this but he is fully against HA paste

I told you before, in another string, that Dr. G's plans which one can SEE are preferable to Dr. Z's plans (usually verbal communication to the patient) that you CAN'T see.

I believe it was also mentioned to you that HA to the upper midface is unlikely to be a contingency for surgery with G and more likely to be a suggestion to also address your complaints with recession to that area.

You were also given a link to a patient who recently had surgery with G where you could have found another one by that patient where the patient showed ceph contours of the LIP CONTOUR he got from Dr. Z.

Since you know little to nothing as to making a selection, others on here have given you 'no brainer' selections of either Dr. G or Dr. W. THAT, in ADDITION to them telling you the chin wings are camouflage for not enough CCW with the bi-max.


IMO, that's sufficient info for anyone with average intelligence to reconcile. Self proclaimed 'idiocy' doesn't justify any more dumbing down the info to accommodate.

Dr. Z's 'popularity' here is RESIDUAL meaning many of those attracted to him are here via a RESIDUAL 'buzz' (constant name dropping and accolades) from a SCAM ARTIST who corrupted this (and other boards) some time back. Not saying Z, himself is one. Saying the popularity got rolling here VIA one.

For that reason, those who appear they need 'spoon feeding' as to what can and can't be done with Dr. Z (and you do appear to need that) won't be getting that from here--well, not from me, at least. You have the option of asking him DIRECTLY on another site where he has capacity to answer directly. Here: https://www.portal-der-schoenheit.de/schoenheitschirurg/ueber-uns/berlin/dr-med-ramin-zarrinbal-1.html