Hi all,
I have had a consultation with two surgeons. The first dropped me as a patient because (as the second surgeon supposed), I was asking too many questions. The second is a more senior surgeon in Melbourne, Australia but he has not taken any measurements or scans. Presumably, he already had the measurements from the first surgeon, but he is also very much of the opinion, "I am not going to do anything until your teeth have moved" - fair enough I think.
I am actually a few months into orthodontic treatment, although the pics are before I began. It makes me anxious not knowing whether my concerns can be addressed. Both surgeons said that I am definitely a candidate for LJS, but I know that only DJS has the potential to fix my issues (or those that can be fixed...) My current surgeon says he'll wait for the teeth to move before making further decisions.
I actually "like" how the left side of my face looks. Sure, there are imperfections, my jaw isn't straight etc. But I get caught up on how the right side of my face looks. Now, sure, I might have some body dysmorphia and am booked in to see a psych (at my surgeons request.) However, I know what I can see, and I don't like how it looks. The right side of my face looks relatively flat and depressed. I feel like my face lacks much anterior projection and I have always hated my smile. My face is asymmetrical. According to my surgeon, my maxilla has grown downwards to compensate for my recessed mandible and thus my teeth point inwards - which I dislike.
The issue I am having, is that I feel like my case is less optimistic than most. Sure, some people have terrible malocclusion, but they can be surgically fixed. In my case, I know there is nothing that I can do to correct my orbital asymmetry. Now, if my cant is corrected by, in part, lowering the right side of my jaw relatively, then it is going to increase the vertical height between my lips and my right eye, which is already "higher" and more "recessed" than my left eye. I have just been struggling to put this all aside and wait for my orthodontics to be completed. Because until then, I don't really know what can be fixed.
My surgeon advised that he could perform a malar osteotomy pioneered by Maurice Y.Mommaerts to help with some mid face projection and under eye support. If I was told that, "your jaws will be brought forward to align your teeth correctly and in doing so, in addition to some malar augmentation, your asymmetry can be decently addressed by improving the harmony of your facial elements", then I would probably be okay. But as it stands, I am completely in the dark about what can and can't be fixed.
TBH, I also can't articulate what I dislike about my face properly. I don't have the medical training to be able to do so. That's why I'd like a CBCT scan to at least be able to see, unbiasedly, without lighting artifacts and interactively, what my face looks like. However, my surgeon also said that he would not refer me to the imaging clinic until my teeth have moved, claiming that "I will be a different person after orthodontics". Sure, I get that logically, I need to get my front teeth projecting, create an overjet etc. before any surgical analysis is relevant. But I find the waiting part difficult. I don't want to look like a supermodel, but I'd like each side of my face to look more the same and be confident with my smile.
From a functional POV:
- I have never been able to bite on both sides of my molars simultaneously
- I don't feel like I have a natural resting position for my jaws
- Occasional jaw aches
Below is a series of images and scans prior to orthodontics. I noticed that I have pretty bad forward head posture in these images, and when I hold my head properly, my jaw recession becomes far more evident. When holding proper posture, my ears do top above my eyes. The two skull x-rays are from when I was about 12 lol because I got concussed at school, but they might help show the asymmetry.
https://imgur.com/a/EqtBUudAny advice on surgery, questions to ask my surgeon and coping with getting through the "orthodontics stage" would be greatly appreciated.
Cheers