Hi all! Yet another prospective patient here with questions about surgeons and surgical plans before setting a surgery date. Would love to hear any feedback that you have!
Info:
- 38/m in US with sleep apnea (AHI 35), unable to tolerate CPAP
- Had BSSO+genio with Bloomquist in 2016 mainly to treat open bite, unaware of sleep apnea at the time. Recovered well, minimal paresthesia in chin area
- Planning MMA early next year, have consulted with: Walline, Gunson, Bobek, Kasey Li, Alfi, Alfaro
- All suggested DJS + CCW rotation; Li suggested doing an Inverted-L to avoid the screws from the previous BSSO, he doesn't do them though and nobody else suggested going this route.
Imaging:
- Ceph, pano, front/side photos:
https://imgur.com/a/99sbLUPTreatment plans:
- Walline and Gunson, see here:
https://imgur.com/a/5mRnwJ8- Gunson also suggested adding cheek augmentation to avoid a hollow look after advancement
- Bobek: ~10mm pog, 5-7°ccw
- Alfi: +10mm mx1, 3-5° ccw
- Li: +10-12mm pog, ~6°ccw
- Alfaro: +9.5mm mx1, +19mm pog, 12° ccw (not seriously considering — seems like it's way too much)
Thoughts:
- If I'm going through this again, I'd like to maximize the airway benefit but also achieve a harmonious and aesthetically pleasing outcome. I'm generally pleased with my current appearance and don't really want to look too drastically different or chimp-like
- Each surgeon suggested slightly different movements and this has made it hard to choose
- Leaning towards Walline/Lacoms, but the simulation seems a little weird to me (see below). The movements are in the ballpark of others, though, it's within my budget, and patients seem generally satisfied on groups/forums, for whatever that's worth.
Questions:
- Something about
Walline's projection is bothering me, it seems like I'm jutting out my chin... I know that's the point of the surgery, but maybe it's too far forward? Or perhaps the "after" image doesn't show horizontal changes to the base of the nasal area that may occur when the maxilla advances, making it seem deficient relative to the mandible? I know these morphs are notoriously inaccurate and maybe I'm being too critical. What do you think, does it look weird to you?
- I'm having a little trouble reading Gunson's plan from the inclinations, but it seems like it's very similar to Walline's. During the consult he mentioned 7°CCW, +8-9mm mx1. From the plans linked above, do you see any significant differences between his plan and Walline's?
- Alfi, like Alfaro, apparently performs the surgeries very quickly with a piezo and custom guides, which he says would minimize nerve damage and improve recovery vs other surgeons. Since this is a revision and I'm old(er), I am of course concerned about lasting nerve damage. What do you think, should this be a big consideration?
- Any other advice on picking from the surgeons and plans above? Is there more information that I should them for?