s**t BEST DOC IN CANADA SAYS I NEED RE-DO OF MY BIMAX --PLEASE VOTE ON MY OPTION

[Lazlo]

So I had bi-max and genio with Dr. SInn, advancement was only 6mm mostly just linear advancement with a bit of ccw maybe.

I still feel my jaws are very narrow and I still look like a f**king CLASS 2 with a weak lower jaw despite a 9mm genio.

Today I consulted with the top doc in Canada Dr. Marco Caminietti. He said I wasn't advanced enough and that my teeth look the same as they did before surgery. Moreover he said both my jaws are collapsed in on the transverse (width) access.

He said he can't fix all my problems but he CAN advance me significantly more. He said my lower jaw needs almost 1 cm of advancement still. And that it will involve both jaws and will be mostly a linear advancement. He said he might widen the upper a bit (maybe 5mm) and if absolutely necessary he would do a midline osteotomy to the mandible and widen that a bit too, but he was hesitant to do that since its a major operation etc.

I asked him about CCW and Wolford. Gunson etc. and he basically said it's highly unstable, I don't really need it, its mostly for sleep apnea issues and moreover it proclines the upper teeth which he said isn't good. He said he does CW or CCW depending on how the bite should fit not based on it as a principl
He also was very tight-lipped about what he would do. He said he wouldn't tell me the exact millimeters, he wouldn't guarantee anything, he could only promise that he would give me a stronger lower jaw in profile but not any promises about the transverse width being fixed. He wasn't as open to discussion etc. as most American docs I've seen.

SO WHAT SHOULD I DO? OPTIONS:

a) have re-do surgery with Dr. Marco Caminetti. This would be fully covered by Canadian Health Insurance as I am a Canadian, the overall cost would be 7 grand (how much the digital planning etc. costs). I think he's a straightforward, technically very competent doc who sees my issues clearly and clearly identified I need a much greater lower jaw advancement. It would be relatively cheap for me but and I think he would do an "okay" job at least. He said I need about 6-8 months in braces first to set me up and then do the surgery. He said there was definitely risk of further nerve damage (I already have an affected lower lip).

b) Get GUnson to look at me again, chief plus here being Gunson would be able to do futher cosmetic improvements maybe since he uses HA paste? Also, one would have to weigh in on whether CCW is indeed better. I don't think Gunson would attempt any lower jaw expansion cause I don't think he does the midline osteotomy/widening on the lower jaw. but I do think he does surgical widening of the upper jaw. I really don't know, Gunson is heralded as a top surgeon yet main drawback VERY, VERY EXPENSIVE and long wait time for surgery.

c) Wolford: Again does strong CCW, so is that what I really need?? I believe Wolford also does both lower jaw and upper jaw widening but I have not consulted with him, nor have I consulted with Gunson since AFTER my Sinn surgery. Wolford would also be less expansive than Gunson but still mega-expensive compared to Caminetti.

I have to get my result right this time. Caminetti I've had some relapse but he couldn't tell whether it was the maxilla that moved back or the mandible that moved forward. Caminetti said he's done a lot of re-dos of all the top american surgeons like Sinn, and Gunson and Arnett but I don't know if he was just boasting. He also said, they've probably done a bunch of revisions of his work as well.

So I really don't know what to do. I want to get a revision but I don't know who to go with. I guess the next option is to just visit Gunson and Wolford again. That is just gonna waste so much money again on travel and hotels and s**t and maybe they won't tell me anything better than Camenetti. The only reason to go to Wolford or Gunson is if I believe CCW philosophy is truly the way to go. Also, I would have to make a decision between Gunson and Wolford. How do I choose between them? The only thing I know is that Gunson/Arnett do a lot more cosmetic stuff and would have a lot more frills like all the HA paste and after care etc. But I don't want to have to waste more precious time putting my life on hold in braces and all this s**t. I dunno, what would you guys think? What would you do?

[Lazlo]

I should add, just based on before/afters I like Wolford's strong, predictably good looking results where the lower jaw is indeed brought forward a fair bit.

But I think overall Gunson's results look more aesthetic. That may be because of the much better lighting and whatnot his photographs are presented with, so who knows, but he seems to achieve a more aesthetic result with the face more balanced and whatnot.

A f**k, now I have to make this decision. I'm basically having the surgery for free if I trust Caminetti that his 9-1cm milimeter linear advancement will do the trick. But what if I'm still f**ked up? And what if it still doesn't get me to the class 1 goal. He did say that he could definitely give me a stronger lower jaw.

[Lazlo]

And I don't even know if Dr. Zarrinibal is a good option. I feel like I should see him cause he's really into doing DO to expand the lower arch and stuff like that apparently. What do you people think? I really need help and the collective intelligence of this forum to make a decision.

[Post bimax]

How bad is your class 2? I’m worried about how large your upper jaw movement will have to be if your bite is basically okay.

[PloskoPlus]

What did he mean by unstable? What kind of a&g issues did he revise?

[ditterbo]

You're asking for opinions with no ceph, c'mon dude you know better than that lol.

[Lazlo]

How bad is your class 2? I’m worried about how large your upper jaw movement will have to be if your bite is basically okay.

yeah so, in that case CCW would be better cause its less upper jaw movement. He wanted to move my jaw down and out like 9 mm upper jaw movement and like a cm lower jaw. Though he was like I'm not going to tell you the exact movements. He pulled this whole "patients like you are very particular," and I can't possibly manage to satisfy all your concerns. I didn't even get into my concerns, I was more like just told him about the tongue space issue and let him do the analysis.

[Lazlo]

You're asking for opinions with no ceph, c'mon dude you know better than that lol.

yeah you're right, I'll post a ceph bro.

[Lazlo]

What did he mean by unstable? What kind of a&g issues did he revise?

He didn't go into it. He wasn't particularly into discussing anything in depth. I think he's very weary of the type of patients that come into his office and isn't into guaranteeing patient satisfaction. He just said I could give you a stronger looking lower jaw, didn't mention how it would affect the upper jaw or anything. He did say there was transverse "collapse" but I have no idea what that means!? Was that caused by the orthodontist or was that caused by the jaw surgery!!?? I mean he said your bite is fine, your teeth are straight. So I mean that being the case, the bite being fine, I only "look" class II, I'm not actually class 2 because that is a bit issue isn't it??? I mean you can have a class I bite but still look class 2, right?

And yeah, in my case he would probably do a big maxilla forward movement with a big mandible linear movement.

I doubt he'll go into a discuss about what A and G cases he's revised. He's a very high volume surgeon, had a resident there observing and watching what he was doing. I felt like he was impatient with my questions and rushing me. But does that mean he won't do a good job? I don't know. Sinn was very very patient and answered every question carefully. that's why I really liked him. But apparently he never advanced me even close to as much as I should have been.

This caminetti guy was like "patients like you who know to the mm what movements they've had are hard to satisfy," I wanted to be like f**k you motherf**ker --wouldn't you only expect patients to want to know what movements they've had so they can feel some sense of control and responsibility over a massive operation where their f**king heads are being reconstructed!?

It's not that I disliked him. He maybe an amazing surgeon. But discussion-wise he just wasn't interested in giving me detailed answers to my questions.

[Dogmatix]

You say "Get Gunson to look at me again".
Have you had Gunson look at you at your current state? If so, what was his opinion?
25mm total advancement from your starting point is a significant advancement, I've seen one other post on this forum that had this suggested. Do you know how the additional advancement will be distributed, even more genio, or only by bsso cut?

[Post bimax]

yeah so, in that case CCW would be better cause its less upper jaw movement. He wanted to move my jaw down and out like 9 mm upper jaw movement and like a cm lower jaw. Though he was like I'm not going to tell you the exact movements. He pulled this whole "patients like you are very particular," and I can't possibly manage to satisfy all your concerns. I didn't even get into my concerns, I was more like just told him about the tongue space issue and let him do the analysis.

I think you’re at very high risk of ‘chimp lip’ with that degree of advancement. You’ll end up with a longer mandible, but your lower jaw may still end up looking weak relative to your face because everything is being advanced together. The chimp look compounds this.

It could help your tongue issues though

[kavan]

As to the lower jaw advancement, it depends how the UPPER jaw advancement would look on you to to get it.

If he's not doing CCW, then he would have to advance upper jaw more in order to get the lower jaw advancement he wants.

He doesn't have to tell you the exact mm advancement. But given he told you the APPROXIMATE lower jaw advancement, I'm surprised he didn't tell you the approximate upper jaw advancement.

The things he doesn't like about the type of CCW Gunson does, for example proclining the front teeth, are the things that help MITIGATE unfavorable nose base changes.

I guess the most salient question to ask him is whether or not the advancement to upper jaw will give unfavorable changes  in particular the 'chimp lip'.

[april]

yeah so, in that case CCW would be better cause its less upper jaw movement. He wanted to move my jaw down and out like 9 mm upper jaw movement and like a cm lower jaw. Though he was like I'm not going to tell you the exact movements. He pulled this whole "patients like you are very particular," and I can't possibly manage to satisfy all your concerns. I didn't even get into my concerns, I was more like just told him about the tongue space issue and let him do the analysis.

I hate how they act like wanting to know details means you must be some difficult patient. These days most patients get a print out of their movements from the VSP down to like a 0.1 of mm anyway. So what's the big deal. If you can afford Gunson I would just go see him.

[JourneyToSerenity]

IIRC Prior to your first surgery, you were deciding between Dr.Sinn and Dr.Gunson after a consultation with both. What stopped you going through with, Dr.Gunson?

Personally, I would be extremely hesistant to go through surgery for a second time if you have no functional problems, the amount of financial, emotional and physical cost associated with JS just isn't worth it.

As for mandible expansion, I would be extremely reluctant to believe what the Dr. says, until he gives you firsthand evidence of the number he performs a year, the previous patients who have had it done, as well as possibly being given their contact details to connect with them and ask them about the surgery. From what I've heard even Stanford surgeons who are experts in sleep medicine are extremely unlikely to recommend or proceed with mandible widening osteotomy as it's not 'stable'.

Dr.Gunson definitely does segmental lefort to widen the maxilla, don't know the movements he can get, but from the various post by people who have undergone surgery with him, none have complained about 'stability' issues. Due to the vast amount of people who post online, who have undergone surgery with him compared to other surgeons, I think we would have heard about it by now had their been 'stability' issues.

I would consult with Dr.Gunson, again. Raise your concerns with him and then take it from there, as you had a consultation with him they probably still have your record, giving you a breakdown of your pre and post movements of your first surgery, and what can be achieved.

As for expense, I wouldn't think twice about if it's affordable, this surgery will most definitely cost me an arm and a leg, but it's worth it for the peace of mind knowing I put my face and well being in the most reputable of hands. I don't want to be a revision case and it's worth paying the extra to hopefully get it right the first time.

Gunson is heralded as a top surgeon yet main drawback...long wait time for surgery.

Oh, God. How 'long' are we talking? His consultation waiting list has already made me wait over half a year. Then comes the likely 6-8 month wait for orthodontist to get the bite right for surgery.

[april]

I mean he said your bite is fine, your teeth are straight. So I mean that being the case, the bite being fine, I only "look" class II, I'm not actually class 2 because that is a bit issue isn't it??? I mean you can have a class I bite but still look class 2, right?

I think you can have a dental class 1 bite (where the molars, canines etc are all fitting together in their correct spots) while still having a class 2 skeleton

I think Wolford is a good option too btw (not just Gunson). But you know the warning, if he wants to replace your joints - run.