Jaw surgery before implants? (need serious help)

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Calling all experts here, I really need your help. My problem: a weak, narrow, and slightly recessed jaw. I had braces as a kid, so my teeth are aligned, but my jaw is not aesthetic. I've talked to various doctors about what can be done, and the big decision is jaw surgery + implants or just implants. However, everyone gives me a different answer.

I first talked to Eppley. Of course he suggested I was a good candidate for implants. But he also said my jaw was recessed and I would benefit from jaw surgery first. He said it's better to fix structural problems first and recommended I find a jaw surgion before getting implants with him.
Then I talked to several jaw surgeons in Korea (closer for me). First of all, Koreans basically only do jaw reduction, whereas I want to make my jaw more prominent. So right off the bat it's not their specialty. They pretty much all said the same thing: they could only advance around 5mm and it wouldn't make much of a visual difference. They did not seem confident in their ability to help me.

After that I talked to Ramieri in Italy. I told him about the Korean doctors. He said they're right, but there's another option. I can have two pre-molars removed, get braces for a year, and then do surgery. With this option he can do significant advancement and give me the visual difference I wanted. Sounds great, but braces and a years wait is a real pain.

Finally, I talked to Yaremchuk. He basically told me jaw surgery was a waste of time and money. He said it wouldn't help in my primary goal of making the jaw wider (this is true, all surgeons admitted this) and would only affect the recession. He suggested I skip jaw surgery and go straight to implants.
So unless I talk to even more surgeons, I think my two options are to do jaw surgery with Ramieri and then implants at a later date, or directly go for implants with Eppley or Yaremchuk.

Which option is better?
Should I seek more opinions?
Will implants alone look natural? (there seems to be a lot of debate about this).

Yes, I'm a curry but I don't give a shit. I only care about getting the best surgery I can, so don't bother with the negativity.

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Xrays:
 
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your chin is very far behind your lower lip, how will implants change that?
 
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your chin is very far behind your lower lip, how will implants change that?
True, but that could be solved by genio or a chin implant. Do I really need bimax?
 
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True, but that could be solved by genio or a chin implant. Do I really need bimax?
Chin implant would look terrible. Look at that deep mentolabial fold. If you do genio there would also have to be significant vertical movement so the fold doesnt get accentuated. Do you have an overbite?
 
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your chin is very far behind your lower lip, how will implants change that?
How does someone have such a prominent fold with that level of recession? Confused
 
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Chin implant would look terrible. Look at that deep mentolabial fold. If you do genio there would also have to be significant vertical movement so the fold doesnt get accentuated. Do you have an overbite?
I had an overbite, but got braces as a teen. My bite is now aligned, but obviously jaw is still recessed. Hence why Remieri suggested I would need to remove two teeth and get braces again (to put me back into an overbite?) before jaw surgery. Do you think what he said is the best option?
 
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I don’t get why your chin looks that recessed even tho your bite and skull seem normal. Is soft tissue a factor here?

I guess it really is just mm of bone
 
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I don’t get why your chin looks that recessed even tho your bite and skull seem normal. Is soft tissue a factor here?

I guess it really is just mm of bone
I don't know either. I have soft tissue issues (double chin and nasolabial folds) that I assumed were due to the recession. Already got submentoplasty, so I had an even worse double chin before. I would assume that bringing the jaw forward would stretch out the chin tissue and reduce this problem.
 
True, but that could be solved by genio or a chin implant. Do I really need bimax?
Yes, bimax with CCW likely also extractions before surgery and another extensive braces treatment
I don’t get why your chin looks that recessed even tho your bite and skull seem normal. Is soft tissue a factor here?

I guess it really is just mm of bone
Bite is not normal teeth are inclined significantly.
 
Yes, bimax with CCW likely also extractions before surgery and another extensive braces treatment

Bite is not normal teeth are inclined significantly.
Can you elaborate? I've always felt my bite was not aligned, but every jaw surgeon and ortho has denied it.
 
Interesting case. As someone who's had both bimax and jaw implants, I'd say just go for a wraparound jaw implant. Your bite already came together nicely, and if you messed with it with something like bimax, you'll likely be underwhelmed. Plus the end result can be somewhat unpredictable and introduce new problems, shift your gonial angles around, etc. No one's going to be paying attention to the inclination of your teeth if you have a nice jaw anyway.
 
just do jaw surgery and then implants

not rocket science
 
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I had an overbite, but got braces as a teen. My bite is now aligned, but obviously jaw is still recessed. Hence why Remieri suggested I would need to remove two teeth and get braces again (to put me back into an overbite?) before jaw surgery. Do you think what he said is the best option?
This is 100% the best option for the best aesthetic outcome. You wore braces when you were young so now you will need to decompensate your bite for surgery which will allow for a larger movement (aka larger ascesion). Then after get jaw implants if you feel you are still dissatisfied with your jaw.
 
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Can you elaborate? I've always felt my bite was not aligned, but every jaw surgeon and ortho has denied it.
your bite is "fine" (class 0), it is fixed with camouflage orthodontics. your incisors are not at a 90 degree angle to the occlusal plane, this is not possible in your case, likely due to teeth crowding. if you had mroe space (extractions) you could put your tooth at a proper 90 degree angle to the occlusal plane and then level your plane to a horizontal occlusion with jaw surgery. i hope that makes sense.
 
What scans did you get done?
 
Calling all experts here, I really need your help. My problem: a weak, narrow, and slightly recessed jaw. I had braces as a kid, so my teeth are aligned, but my jaw is not aesthetic. I've talked to various doctors about what can be done, and the big decision is jaw surgery + implants or just implants. However, everyone gives me a different answer.

I first talked to Eppley. Of course he suggested I was a good candidate for implants. But he also said my jaw was recessed and I would benefit from jaw surgery first. He said it's better to fix structural problems first and recommended I find a jaw surgion before getting implants with him.
Then I talked to several jaw surgeons in Korea (closer for me). First of all, Koreans basically only do jaw reduction, whereas I want to make my jaw more prominent. So right off the bat it's not their specialty. They pretty much all said the same thing: they could only advance around 5mm and it wouldn't make much of a visual difference. They did not seem confident in their ability to help me.

After that I talked to Ramieri in Italy. I told him about the Korean doctors. He said they're right, but there's another option. I can have two pre-molars removed, get braces for a year, and then do surgery. With this option he can do significant advancement and give me the visual difference I wanted. Sounds great, but braces and a years wait is a real pain.

Finally, I talked to Yaremchuk. He basically told me jaw surgery was a waste of time and money. He said it wouldn't help in my primary goal of making the jaw wider (this is true, all surgeons admitted this) and would only affect the recession. He suggested I skip jaw surgery and go straight to implants.
So unless I talk to even more surgeons, I think my two options are to do jaw surgery with Ramieri and then implants at a later date, or directly go for implants with Eppley or Yaremchuk.

Which option is better?
Should I seek more opinions?
Will implants alone look natural? (there seems to be a lot of debate about this).

Yes, I'm a curry but I don't give a shit. I only care about getting the best surgery I can, so don't bother with the negativity.

a4iWKPj.jpg
6DWDlcp.jpg


Xrays:

bimax can make the jaw wider. It was a key part of my bimax design with Dr Ramieri, you cant do as extreme as you could with implants where there is no real limit, but you can do a lot (I think mine was 4-5mm each side)

Im looking at you and thinking, if you do jaw implants first and arent 100% happy, you will kick yourself for not fixing the underlying structure first, then if you change your mind you would have to go and have them removed to do bimax

1683536293267
1683536307590
 
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bimax can make the jaw wider. It was a key part of my bimax design with Dr Ramieri, you cant do as extreme as you could with implants where there is no real limit, but you can do a lot (I think mine was 4-5mm each side)

Im looking at you and thinking, if you do jaw implants first and arent 100% happy, you will kick yourself for not fixing the underlying structure first, then if you change your mind you would have to go and have them removed to do bimax

View attachment 2190610View attachment 2190611
How do you make them wider? Every doctor I've spoken to so far has said you can't make the jaw wider with bone surgery.

What scans did you get done?
Front/side/panoramic xray and CT scan apparently. I only have the xray images.
 
bimax can make the jaw wider. It was a key part of my bimax design with Dr Ramieri, you cant do as extreme as you could with implants where there is no real limit, but you can do a lot (I think mine was 4-5mm each side)

Im looking at you and thinking, if you do jaw implants first and arent 100% happy, you will kick yourself for not fixing the underlying structure first, then if you change your mind you would have to go and have them removed to do bimax

View attachment 2190610View attachment 2190611

Interesting if legit.

I thought the point of bimax being a sliding osteomy is that the bone can easily fuse back together, with a 5mm gap how does that work? Is recovery just that much longer? Rib graft?
 
How do you make them wider? Every doctor I've spoken to so far has said you can't make the jaw wider with bone surgery.


Front/side/panoramic xray and CT scan apparently. I only have the xray images.
1) you leave a small gap of a few mm between the splits on the mandible
2) you torque (twist) the condiles so that the gonions flare out a bit
You need a bone graft to fill the gap

Coceancig is the surgeon who is known for doing this, but others will do it





 

@feelgood @VenatorLuparius Saw your comments on this thread. Do you think I'm recessed enough for bimax? Still can't decide between bimax or genio + implants
 
You definitely need bimax + genio. Otherwise attempting to get that much change with implants alone will make u end up looking like shit 100%
 
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I first talked to Eppley. Of course he suggested I was a good candidate for implants. But he also said my jaw was recessed and I would benefit from jaw surgery first. He said it's better to fix structural problems first and recommended I find a jaw surgion before getting implants with him.
When you talked to Eppley, were you reviewing your x-rays together? Or were you just describing your symptoms to him, and getting his opinion on that?
 
When you talked to Eppley, were you reviewing your x-rays together? Or were you just describing your symptoms to him, and getting his opinion on that?
Yes, he saw my xrays. He immediately claimed to know I had an overbite and braces when younger. Tbh I didn't get the feeling that I could really trust Eppley, but he was right about the overbite.
 
Yes, he saw my xrays. He immediately claimed to know I had an overbite and braces when younger. Tbh I didn't get the feeling that I could really trust Eppley, but he was right about the overbite.
It sounds strange to me that Eppley was the guy who encouraged you to get a jaw surgery, and Yaremchuk told you to do implants only to mask it. That goes against the stereotypes of those two men. I guess I prefer Ramieri's response out of all of them, but the idea of getting extractions out of what already looks like a small jaw would make me nervous.
 
He said they're right, but there's another option. I can have two pre-molars removed, get braces for a year, and then do surgery.
He told me the exact same thing. I'm in the same boat as you - had Class II as a kid that was fixed with orthodontics. But to me it sounded like he didn't think the extraction + braces option was a good idea, like he was using the hassle of it to try and dissuade me from getting bimax.
 
How many millimeters does the lower jaw need to be advanced for a significant improvement in aesthetics anyway? (Regarding bimax)
 
you need bimax + genio to have a nice result. what eppley told you is correct. you can get implants after. this is a common procedure. implants will also make your midface look better and make your mandible wider.
What Ramieri tells you is stupid. Getting 4 teeth removed collapses your maxilla and then doing an advancement is really contra-productive. Idk where you are from but maybe you can try Conceancig in Australia. He is expensive but probably the best in your area. Alternatively go to Pagnoni or Raffaini. Probably not Raffaini cuz people been saying he can b racist.
 
I got numbers and a simulation from Pagnoni.

The movements are:
Widening: 10mm (5cm each side)
Maxilla: 3.4cm
Mandible: 5cm
Geno advancement: 1.8cm
Genio lowering: 3.7cm
Overall chin advancement: 10.3mm

This is less advancement than Ramieri promised, but also doesn't require braces. Plus I don't think I'm super recessed, so maybe this is better than risking dogmaxxing. My concern is that it won't be a significant enough change. Thoughts?



@anticel @lopo12 @FinasterideAt17 @politically correct @SOS-Sonic @RecessedChinCel

My other Pagnoni thread:
 
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I got numbers and a simulation from Pagnoni.

The movements are:
Widening: 10mm (5cm each side)
Maxilla: 3.4cm
Mandible: 5cm
Geno advancement: 1.8cm
Genio lowering: 3.7cm
Overall chin advancement: 10.3mm

This is less advancement than Ramieri promised, but also doesn't require braces. Plus I don't think I'm super recessed, so maybe this is better than risking dogmaxxing. My concern is that it won't be a significant enough change. Thoughts?



@anticel @lopo12 @FinasterideAt17 @politically correct @SOS-Sonic @RecessedChinCel

My other Pagnoni thread:

Mm/cm difference buddy

Looks like a good plan but won't fix your harmony
 
I got numbers and a simulation from Pagnoni.

The movements are:
Widening: 10mm (5cm each side)
Maxilla: 3.4cm
Mandible: 5cm
Geno advancement: 1.8cm
Genio lowering: 3.7cm
Overall chin advancement: 10.3mm

This is less advancement than Ramieri promised, but also doesn't require braces. Plus I don't think I'm super recessed, so maybe this is better than risking dogmaxxing. My concern is that it won't be a significant enough change. Thoughts?



@anticel @lopo12 @FinasterideAt17 @politically correct @SOS-Sonic @RecessedChinCel

My other Pagnoni thread:

Dr Ramieri will probably never dogmax you. My plan was super assertive, i wasnt recessed at al and we did 14mm not including genio and a 4mm genio on top with 3mm downgraft. I was worried about being dogmaxed as my design was way past the line that alfaro typically uses for example, but Dr Ramieri assured me he was super confident because he's good t judging the overall balance of the face and hes never dogmaxxed anyone

he was right, I love my result, and if i had opted to do less i probably wouldve been underwhelmed

would help if we could see the designs incl front and side profile without soft tissue blocking everything

also, just personally ive never seen any super impressive pagnoni bimax results, he's good for implants and im not saying he's a bad bimax surgeon but he's not got the track record of raffaini or ramieri

im not a surgeon or an expert and ultimately you should trust qualified surgeons not me, but i think that 5mm mandible and 1.8mm genio sounds super conservative
 
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Dr Ramieri will probably never dogmax you. My plan was super assertive, i wasnt recessed at al and we did 14mm not including genio and a 4mm genio on top with 3mm downgraft.
How could you not be recessed at all but have room for 14mm of advancement? And did you have to have extractions?
 
How could you not be recessed at all but have room for 14mm of advancement? And did you have to have extractions?
honestly I have no idea how it works, I think basically by doing a large rotation, and because I asked for a hyper anteface type design

this is what i mean about trusting elite surgeons rather than people on forums, people on here dont really understand how this stuff works, me included

i had no extractions
 
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honestly I have no idea how it works, I think basically by doing a large rotation, and because I asked for a hyper anteface type design

this is what i mean about trusting elite surgeons rather than people on forums, people on here dont really understand how this stuff works, me included

i had no extractions
you‘re right. this forum probably cannot help you, maybe @RealSurgerymax. I still would recommend doing both jaw surgery and implants, but you should really listen to your surgeons on this one.
 
Me too. I don't know if subtle movements are worth the massive cost and recovery. I've heard that the jaw widening is subtle as well.
 

@feelgood @VenatorLuparius Saw your comments on this thread. Do you think I'm recessed enough for bimax? Still can't decide between bimax or genio + implants

The profile of the guy in that thread has NOTHING to do with yours. It will NOT work in your case. Check your labiomental fold.
 
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Dr Ramieri will probably never dogmax you. My plan was super assertive, i wasnt recessed at al and we did 14mm not including genio and a 4mm genio on top with 3mm downgraft. I was worried about being dogmaxed as my design was way past the line that alfaro typically uses for example, but Dr Ramieri assured me he was super confident because he's good t judging the overall balance of the face and hes never dogmaxxed anyone

he was right, I love my result, and if i had opted to do less i probably wouldve been underwhelmed

would help if we could see the designs incl front and side profile without soft tissue blocking everything

also, just personally ive never seen any super impressive pagnoni bimax results, he's good for implants and im not saying he's a bad bimax surgeon but he's not got the track record of raffaini or ramieri

im not a surgeon or an expert and ultimately you should trust qualified surgeons not me, but i think that 5mm mandible and 1.8mm genio sounds super conservative
Are you sure you weren't super recessed? Even @Gaia262 only got 8mm mandible + 5mm genio.
 
I got numbers and a simulation from Pagnoni.

The movements are:
Widening: 10mm (5cm each side)
Maxilla: 3.4cm
Mandible: 5cm
Geno advancement: 1.8cm
Genio lowering: 3.7cm
Overall chin advancement: 10.3mm

This is less advancement than Ramieri promised, but also doesn't require braces. Plus I don't think I'm super recessed, so maybe this is better than risking dogmaxxing. My concern is that it won't be a significant enough change. Thoughts?



@anticel @lopo12 @FinasterideAt17 @politically correct @SOS-Sonic @RecessedChinCel

My other Pagnoni thread:

@RealSurgerymax I sent you scans, could really use your input. I need to know if I need more significant advancement.
 
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Me too. I don't know if subtle movements are worth the massive cost and recovery. I've heard that the jaw widening is subtle as well.
im inclined to agree with this
 
I had an overbite, but got braces as a teen. My bite is now aligned, but obviously jaw is still recessed. Hence why Remieri suggested I would need to remove two teeth and get braces again (to put me back into an overbite?) before jaw surgery. Do you think what he said is the best option?
Are you sure this is even true? I'm wary of all the "camo orthodontics" talk that goes on in forums like these. I'm pretty sure dental elastics just bring your mandible forward and maxilla back. I don't see how dentists can align your dental arches without moving the jaws themselves. Sounds like you just have a small chin and maybe big lips/protruding mouth which makes it appear even smaller.
 
I got numbers and a simulation from Pagnoni.

The movements are:
Widening: 10mm (5cm each side)
Maxilla: 3.4cm
Mandible: 5cm
Geno advancement: 1.8cm
Genio lowering: 3.7cm
Overall chin advancement: 10.3mm

This is less advancement than Ramieri promised, but also doesn't require braces. Plus I don't think I'm super recessed, so maybe this is better than risking dogmaxxing. My concern is that it won't be a significant enough change. Thoughts?



@anticel @lopo12 @FinasterideAt17 @politically correct @SOS-Sonic @RecessedChinCel

My other Pagnoni thread:

We need to see Ramieri's plan as well.

The genio is good, but the bimac doesn't address a huge issue, which is your short face. You need more downgrafting on the maxilla. Like 3mm more than what you have currently. Just ask him for the biggest downgraft he can give.

And Ramieri will never dogmax you unless you push for aggresive movements. I would get the 3Dplan from Ramieri as well and then compare.
 
We need to see Ramieri's plan as well.

The genio is good, but the bimac doesn't address a huge issue, which is your short face. You need more downgrafting on the maxilla. Like 3mm more than what you have currently. Just ask him for the biggest downgraft he can give.

And Ramieri will never dogmax you unless you push for aggresive movements. I would get the 3Dplan from Ramieri as well and then compare.
I don’t think I have a short face lol. If anything it looks long. What I lack is width. Although my overall skull size is small.

Ramieir estimated about:
Premolar extractions
1 year braces
Mandible: 10mm
Total advancement: 13mm

I can ask him for a 3D plan, but I don’t know if a year of braces and looking worse is worth it. Already an oldcel…
 
Any updates?
 

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