DoctorLooksmax
IPDcel
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- Jul 17, 2019
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Background I have mild SFS.
Have a very vertically short chin- only 34mm.
My midface isnt actually vertically short but it looks it in pictures, probably because of my above average bizygomatic width.
My face looks decent when resting, but when im talking, laughing or smiling, it has that typical SFS 'scrunched up' look I would describe it as.
First consult with ramieri - after seeing my CBCT he reccomended a CW rotation BSSO with a vertical genio and no Lefort 1. He said id need 10 months of braces to decompensate by bite beforehand to give him room to move my lower jaw forward in the BSSO, he described my dental compensation as 'severe'. He didnt reccomend a lefort 1 for me, from this im going to assume he didnt think my midface was excessively short - he didnt say I couldnt have one if i 100% wanted it the vibe I got was mroe than the movement wouldnt be significant so it wasnt really wroth it in my case. Plus from what ive heard upper jaw +lower jaw surgery recovery is a lot worse than lower only. He seemed pretty dead set on his plan for how to fix my face, he even said 'after looking at your scan, there's only 1 way were gonna be able to do this'
Second consult with birbe. I told him the same thing to start off with, that I had a vertically short face, lower third in particular, to which he agreed. His attitude towards my face was more along the lines of 'it depends how big of a change you want'. He said we could go genio only, bimax, or bimax and genio. He told me that I was an ideal surgery first candidate - which is odd since ramieri reccomended 10 months of braces beforehand, but i dont think ramieri does SFA at all. He said I could come to spain and for a fee when can knock up some 3D simulations- after this I can decide how much movement I wanted or what surgery based on the simulations. He seemed like he takes patient input a lot more in terms of what exactly they want doing- which im not sure is a good thing or bad thing, I feel like the surgeon is the expert and in this case its maybe better to jsut trust them to get a good result than let the patient decide, especially sicne its so hard to look at your own face objectively. He also said you cant do just CW roation of the jsut one jaw which completley contradicts what rameiri said bu this might be down to the fact he does SFA vs non SFA.
Overall- it appeals to me that with Birbe I could do SFA rather than wait and procrastinate this for even longer and I like how I can see simulations mocking up different surgeries before I make a final decision, whereas with ramieri I dont get a 3D plan until im nearer surgery time and by that point its too late to decide if i only wnated a genio rather than bimax. On the other hand, Birbe might only be reccomending SFAm because he doesnt have a UK ortho hes in contact with so it makes it logistically easier, I feel like Ramieri has better attention to detail and consistently produces good results so it might be better jsut to trust him to do a good job and not cut corners than decide my own movements etc
Have a very vertically short chin- only 34mm.
My midface isnt actually vertically short but it looks it in pictures, probably because of my above average bizygomatic width.
My face looks decent when resting, but when im talking, laughing or smiling, it has that typical SFS 'scrunched up' look I would describe it as.
First consult with ramieri - after seeing my CBCT he reccomended a CW rotation BSSO with a vertical genio and no Lefort 1. He said id need 10 months of braces to decompensate by bite beforehand to give him room to move my lower jaw forward in the BSSO, he described my dental compensation as 'severe'. He didnt reccomend a lefort 1 for me, from this im going to assume he didnt think my midface was excessively short - he didnt say I couldnt have one if i 100% wanted it the vibe I got was mroe than the movement wouldnt be significant so it wasnt really wroth it in my case. Plus from what ive heard upper jaw +lower jaw surgery recovery is a lot worse than lower only. He seemed pretty dead set on his plan for how to fix my face, he even said 'after looking at your scan, there's only 1 way were gonna be able to do this'
Second consult with birbe. I told him the same thing to start off with, that I had a vertically short face, lower third in particular, to which he agreed. His attitude towards my face was more along the lines of 'it depends how big of a change you want'. He said we could go genio only, bimax, or bimax and genio. He told me that I was an ideal surgery first candidate - which is odd since ramieri reccomended 10 months of braces beforehand, but i dont think ramieri does SFA at all. He said I could come to spain and for a fee when can knock up some 3D simulations- after this I can decide how much movement I wanted or what surgery based on the simulations. He seemed like he takes patient input a lot more in terms of what exactly they want doing- which im not sure is a good thing or bad thing, I feel like the surgeon is the expert and in this case its maybe better to jsut trust them to get a good result than let the patient decide, especially sicne its so hard to look at your own face objectively. He also said you cant do just CW roation of the jsut one jaw which completley contradicts what rameiri said bu this might be down to the fact he does SFA vs non SFA.
Overall- it appeals to me that with Birbe I could do SFA rather than wait and procrastinate this for even longer and I like how I can see simulations mocking up different surgeries before I make a final decision, whereas with ramieri I dont get a 3D plan until im nearer surgery time and by that point its too late to decide if i only wnated a genio rather than bimax. On the other hand, Birbe might only be reccomending SFAm because he doesnt have a UK ortho hes in contact with so it makes it logistically easier, I feel like Ramieri has better attention to detail and consistently produces good results so it might be better jsut to trust him to do a good job and not cut corners than decide my own movements etc
