BIMAX or Chin Wing? My pre op choice is on the edge – I desperately need advice

[Problemjaw123]

Hey guys I’m new to this forum I’m 23 years old and male, I have a very strong face asymmetry - the jaw is around 3-4 cm right to the middle as you can see on the first picture attached.

Living in Switzerland I went to Dr. Brusco in Zurich which offered either a Chin Wing or BIMAX to resolve that problem.

Reading on forum quite scary stories about the BIMAX (one example on this forum is the story of tightchinlip in the thread “A legit bad outcome” about pain when talking years after the surgery or that some people feel constant burning or even trigeminal neuralgia) I don’t know if I maybe should do the lighter Chin Wing.

What would you guys say and how was your experience with a BIMAX if you had one?

Ps. Even with just Chin Wing Brusco has some quite awesome results (see his Instagram page for example attachment number 2)

On the side: As my insurance pays for it because I’m still young and the asymmetry is massive I can go to any surgeon that works in Switzerland, maybe you can recommend me the best one!

I also consulted Triaca, I know Triaca is more experienced but if you watch google reviews of patients they seem way more happy with Brusco (especially recently very negative reviews on google about Triaca)
 
But I’m open to reconsider my choice on that too if I gain new insights from someone that actually did the surgery or knows more about it (I literally don’t know anybody so I’m quite helpless)

[kavan]

Yes, you have asymmetry. They would have to explore (via ceph X rays) where it's coming from; maxilla, mandible or both and then determine how to correct..via bimax surgery, chin wing or combo of both. Most likely both (as opposed to 'either or').

Chin wing doctors usually prefer to do a 'high BSSO' which is higher than the type of BSSO usually done. Ching wing doctors usually prefer a high BSSO because the standard BSSO cut is perpendicular to the cut the chin wing doctors make for the chin wing.

Chin wing alone is unlikely to address all your asymmetry, especially part that could be coming from upper jaw to lopside the lips. So, which asymmetry is coming from WHERE, needs to be determined and if you want/need both, you probably should consider having the/a chin wing doctor perform the all of the surgery needed. Chin wing doctors are also maxfax surgeons

Extraneous to concern yourself with 'this or that' or 'such and such' a poster having problems with bimax surgery. Also, very common phenomena on message boards for people happy/satisfied with surgery to not stay on message boards

ETA: I know of 3 chin wing doctors; Triaca, Brusco and Zarrinbal in Deutschland.  Both B an Z trained with T.

[GJ]

You're an ideal candidate given the level of facial asymmetry. But asymmetry can be tricky to correct. You appear to have a cant (pitch) and a yaw. Maybe all three dimensions. Give this a look:

https://go.digitalsmiledesign.com/hubfs/DSD%20Articles/Articles%20by%20others/Pich,roll%20and%20yaw.pdf


I don't see chin wing addressing all of that, or even any of it. You should post x-rays, cephs, and images taken at an office when you get them. Did you tell me via email that you're having surgery soon? Which surgery? I wouldn't rush into anything.

[Problemjaw123]

Yes, you have asymmetry. They would have to explore (via ceph X rays) where it's coming from; maxilla, mandible or both and then determine how to correct..via bimax surgery, chin wing or combo of both. Most likely both (as opposed to 'either or').

Chin wing doctors usually prefer to do a 'high BSSO' which is higher than the type of BSSO usually done. Ching wing doctors usually prefer a high BSSO because the standard BSSO cut is perpendicular to the cut the chin wing doctors make for the chin wing.

Chin wing alone is unlikely to address all your asymmetry, especially part that could be coming from upper jaw to lopside the lips. So, which asymmetry is coming from WHERE, needs to be determined and if you want/need both, you probably should consider having the/a chin wing doctor perform the all of the surgery needed. Chin wing doctors are also maxfax surgeons

Extraneous to concern yourself with 'this or that' or 'such and such' a poster having problems with bimax surgery. Also, very common phenomena on message boards for people happy/satisfied with surgery to not stay on message boards

ETA: I know of 3 chin wing doctors; Triaca, Brusco and Zarrinbal in Deutschland.  Both B an Z trained with T.

Thank you a lot Kavan for your reply and the time analysing my picture!

I did X-ray even in 3D and Dr. B told me he would prefer to give me Bimax but still also just the Chin wing would improve my situation quite a lot! I will see him Thursday and then ask him to give me a copy so I can upload it here!

Okay I understand so you observed that happy people stay off forums, interesting!

So broadly speaking can I assume that those really bad side effects like chronic pain years after, problems with speaking that never go away again happen less than lets say 1 out of 1000 surgeries?

Because I thought those bad bad things happened quite often that’s why I maybe thought about the not so heavy Chin Wing even if my asymmetry wouldn’t be corrected as much as with other surgeries

[Problemjaw123]

You're an ideal candidate given the level of facial asymmetry. But asymmetry can be tricky to correct. You appear to have a cant (pitch) and a yaw. Maybe all three dimensions. Give this a look:

https://go.digitalsmiledesign.com/hubfs/DSD%20Articles/Articles%20by%20others/Pich,roll%20and%20yaw.pdf


I don't see chin wing addressing all of that, or even any of it. You should post x-rays, cephs, and images taken at an office when you get them. Did you tell me via email that you're having surgery soon? Which surgery? I wouldn't rush into anything.

Thank you for your answer GJ,

No I’m not rushing into it, no appointments for surgery fixed yet! I just have a second consultation with Dr. B this Thursday!

Thursday evening when i get back home i will upload the 3D X rays so you can see it way better than in a selfie (i saw them already at the first consultation) and also its quite cool to see a deformed skeleton in 3D haha

I just know I want to do something about my asymmetry and don’t want to wait many other years.

Prior I also had some consultations with Triaca and he proposed me: Le Fort 1 Osteotomie first and after Chin wing wherease Brusco told me that also just Bimax and no second Chin wing would be enough.

After those two opinions i thought this style of threatment would be right but obviously it could also be that they propose quite the same type of treatment because they have worked for long togheter.

Do you think I should consult someone other?

[kavan]

Thank you a lot Kavan for your reply and the time analysing my picture!

I did X-ray even in 3D and Dr. B told me he would prefer to give me Bimax but still also just the Chin wing would improve my situation quite a lot! I will see him Thursday and then ask him to give me a copy so I can upload it here!

Okay I understand so you observed that happy people stay off forums, interesting!

So broadly speaking can I assume that those really bad side effects like chronic pain years after, problems with speaking that never go away again happen less than lets say 1 out of 1000 surgeries?

Because I thought those bad bad things happened quite often that’s why I maybe thought about the not so heavy Chin Wing even if my asymmetry wouldn’t be corrected as much as with other surgeries

So, since Dr. B is chin wing doctor who prefers the bimax, ask him to do it with the high BSSO cut so you can get chin wing later.

Brusco's patient, you showed a photo of did NOT have all the asymmetry you have. So, if you are choosing doctors and single procedures they do (here just chin wing) based on photos of patients who DON'T have similar start points as you do, it's not too far of stretch to extrapolate you are finding posts by patients on here that have little in common with your situation. So, I should say, extraneous for ME to engage on that path other than to tell you not to assume what one patient has is a predictor for you. Besides, the doctor should be the one to tell you the risks.

You can show your X rays here but I'm getting away from interpreting stuff FOR doctors in situations where I think they should be sitting down with the patient and giving them more TIME to explain things. If he hasn't made clear one way or the other that your significant asymmetry would not all be corrected by a chin wing, then impel him to address which problems the chin wing alone WON'T address. That or consult with the other chin wing doctor. (Z)

[GJ]

So broadly speaking can I assume that those really bad side effects like chronic pain years after, problems with speaking that never go away again happen less than lets say 1 out of 1000 surgeries?

Because I thought those bad bad things happened quite often that’s why I maybe thought about the not so heavy Chin Wing even if my asymmetry wouldn’t be corrected as much as with other surgeries

I know a lot of people with bad results who don't post on forums because they're ashamed of the result and/or feel it's their fault. It's hard to deduct what's going on with opinions online.

[Problemjaw123]

So, since Dr. B is chin wing doctor who prefers the bimax, ask him to do it with the high BSSO cut so you can get chin wing later.

Brusco's patient, you showed a photo of did NOT have all the asymmetry you have. So, if you are choosing doctors and single procedures they do (here just chin wing) based on photos of patients who DON'T have similar start points as you do, it's not too far of stretch to extrapolate you are finding posts by patients on here that have little in common with your situation. So, I should say, extraneous for ME to engage on that path other than to tell you not to assume what one patient has is a predictor for you. Besides, the doctor should be the one to tell you the risks.

You can show your X rays here but I'm getting away from interpreting stuff FOR doctors in situations where I think they should be sitting down with the patient and giving them more TIME to explain things. If he hasn't made clear one way or the other that your significant asymmetry would not all be corrected by a chin wing, then impel him to address which problems the chin wing alone WON'T address. That or consult with the other chin wing doctor. (Z)

Yes you are right this picture isn’t equal at all to my situation maybe I was just dreaming about some perfect result.

But don’t take me as fool I know my situation at departure and that even just because of my nose I will never have perfect symmetrical features. I just think that from where I am now there is much improvement that could be made and this is what I look for/ would make me happy.

But I also don’t want to have severe health problems because of it. And related to that i know before surgery I will get full disclosure of what could go wrong but I still wanted to have insights as you (and other active members) have seen hundreds or even thousands of posts on this forum so how often really bad complications (like nerve damage that causes you chronic pain or doesn’t allow you to smile or speak like you did before surgery) occur.

And also yeah I’m really new to this so even if my questions may sound stupid and I don’t really know as much as many others here about the subject, advice and tips are very welcome for example I will for sure ask about the high BSSO cut at the appointment so thank you a lot!

[Problemjaw123]

I know a lot of people with bad results who don't post on forums because they're ashamed of the result and/or feel it's their fault. It's hard to deduct what's going on with opinions online.

Thanks GJ!

Before today i really didn't knew any of this I just heard the opinions of the two surgeons which obviously want to sell the advantages of their ''product'' and never directly talked to other people on the patients side, its really helping me a lot!

Not to sound disrespectful or wanting to get into someone’s privacy but also from people who did surgery with Dr. T or B?
And just to be on the same page I'm not referring to not aesthetically happy but severe consequences like nerve damage that causes you chronic pain or doesn’t allow you to smile or speak like you did before surgery, things like that.

[kavan]

Yes you are right this picture isn’t equal at all to my situation maybe I was just dreaming about some perfect result.

But don’t take me as fool I know my situation at departure and that even just because of my nose I will never have perfect symmetrical features. I just think that from where I am now there is much improvement that could be made and this is what I look for/ would make me happy.

But I also don’t want to have severe health problems because of it. And related to that i know before surgery I will get full disclosure of what could go wrong but I still wanted to have insights as you (and other active members) have seen hundreds or even thousands of posts on this forum so how often really bad complications (like nerve damage that causes you chronic pain or doesn’t allow you to smile or speak like you did before surgery) occur.

And also yeah I’m really new to this so even if my questions may sound stupid and I don’t really know as much as many others here about the subject, advice and tips are very welcome for example I will for sure ask about the high BSSO cut at the appointment so thank you a lot!

1rst improvement would be more jaw to jaw balance (even if nose area stays as is). That part in venue of maxfax. Next improvement would be chin wing to widen lower face as you see in the patient photo posted.

Asymmetry can often come from the UPPER JAW, especially when a straight horizont does not pass through the lips. Of the 2 consults you went on, I'd say Triaca's to do a lefort and later the chin wing was more on target with what you have or maybe I should say...my logistics.

First patient to get a CW on this board, years back, had the chin wing with Triaca. But, I don't think he had other stuff going on.

It is possible to do the chin wing first which could improve the lower 1/3rd of the facial border. But if the lip cant is coming from the upper jaw and later, you wish to address that with surgery to the upper jaw, the chin wing work could look asymmetrical if upper jaw fixed later which is why Triaca's proposal makes more sense to me than does Brusco's. However, if you are committed to no maxfax surgery now and never in the future, then that would justify doing chin wing as first and only thing.

If a surgeon get a 'vibe' that a patient has fear about one procedure over the other, it's not uncommon for some to offer you the procedure they know you are more likely to accept. Others will suggest more to improve more of the problem.

[GJ]

And just to be on the same page I'm not referring to not aesthetically happy but severe consequences like nerve damage that causes you chronic pain or doesn’t allow you to smile or speak like you did before surgery, things like that.

I've heard of both types of issues and seen more bad results than anyone here. Mainly because people send me private emails with their issues, but they don't post that info in public. I stand by the original statement and feel you can't conclude much. In general, people with great results will post about it to brag and get accolades. In general, people with bad results will be ashamed/embarrassed and not post their result. If anything, I feel the internet is skewed positive about jaw surgery because of the former - people like to brag if they get great aesthetic results.

I don't remember anyone with those specific surgeons, no.

[InvisalignOnly]

OP, if I were you, I would go for bimax surgery. You are right, there are risks of nerve pain etc. afterwards but with an experienced surgeon and for a young healthy patient like yourself, the risk is minimal and there is so much to gain. The quality of your life could be so much better for many years to come. I am way older than you and had bimax for an overbite 7 months ago. I have no complications at all except for some altered sensation on one side which is very minimal. I am very, very happy with my results and wish I got this done twenty years ago. It is quite rare for people to have permanent speech problems or pain after the surgery. Numbness etc. is common but it does not interfere with most people's day to day lives. I hope you will get the surgery with the result you would like and no complications.

[Problemjaw123]

OP, if I were you, I would go for bimax surgery. You are right, there are risks of nerve pain etc. afterwards but with an experienced surgeon and for a young healthy patient like yourself, the risk is minimal and there is so much to gain. The quality of your life could be so much better for many years to come. I am way older than you and had bimax for an overbite 7 months ago. I have no complications at all except for some altered sensation on one side which is very minimal. I am very, very happy with my results and wish I got this done twenty years ago. It is quite rare for people to have permanent speech problems or pain after the surgery. Numbness etc. is common but it does not interfere with most people's day to day lives. I hope you will get the surgery with the result you would like and no complications.

Thanks InvisalignOnly for sharing your Bimax story!

I also feel that with my strong asymmetry I would have much to gain and that this could improve my quality of life for many years to come.

But at the same time as I’m still young I don’t want to have severe health damages from it that I would carry on forever.

A bit of numbness and altered sensation on one side I definitely consider not severe and they wouldn’t bother me.

Also if I will go for the bimax I would opt for Invisalign as I would prefer to avoid one year of braces - Dr. Brusco already told me he works with an orthodontist that uses them.. so we might share the same path on that too!

[Problemjaw123]

I've heard of both types of issues and seen more bad results than anyone here. Mainly because people send me private emails with their issues, but they don't post that info in public. I stand by the original statement and feel you can't conclude much. In general, people with great results will post about it to brag and get accolades. In general, people with bad results will be ashamed/embarrassed and not post their result. If anything, I feel the internet is skewed positive about jaw surgery because of the former - people like to brag if they get great aesthetic results.

I don't remember anyone with those specific surgeons, no.

Thanks GJ I really appreciate the straight forward facts from you, so tomorrow at the appointment I can ask the Dr. Brusco about those eventualities. Especially I will ask him about those possible severe damages:

-   Irreversible problems with speaking that persist long after surgery
-   Chronic pain that persist long after surgery

From what you have heard by people emailing you or on the forum which other severe irreversible health damages could there be? so I can ask him tomorrow about those as well
 

[GJ]

From what you have heard by people emailing you or on the forum which other severe irreversible health damages could there be?

- Inability to open their mouth fully (i.e. poor range of motion). Very common.
- Crunchy joints (very common)
- Losing teeth if roots are hit during surgery (not common but happens)
- Bad bite after surgery (fairly common). This can be an open bite, crossbite, etc. Edge to edge seems to be the most common post-op bite problem.
- Entire death of upper jaw - this can happen if doing a 3 piece (happened once).
- Actual death - we only saw this once, and it was on the other jaw forum, but he died due to an artery being hit during surgery.

These last two are rare, so don't freak out.

The list isn't comprehensive. I'd have to go through emails and look. But that's my answer off the top of my head.

Then there are the mental issues. I've seen many dozens of people who can't cope with the new face, feel their lost their ethnicity, etc. Sometimes there's truth to their concerns, sometimes there isn't.