Rate my surgeon's plan for my jaw ascension (part 2)

[blacksheep]

Hey, I posted another thread in May after I had my first consultation for a jaw surgery: earlier thread + more info on my anatomy

Last time I visited a surgeon my orthodontist recommended me. He was an alright guy, but I still wanted a second opinion by a surgeon that had been mentioned on the forum before (no crazy names jfl, just one in a public hospital in Western Europe).

His plan is basically the same as the previous surgeon: around 6 months of braces, virtual planning 3 weeks before surgery with custom splint, minimally invasive BSSO (lower jaw surgery) with screws and then 6 months of braces post-op. I did feel way more comfortable with the new surgeon. His explanation was more thorough, so was his plan. He made me come in with x-ray photos (that showed I had 2 upper wisdom teeth that were never detected on previous x-rays (??)). The wisdom teeth will be removed during the jaw surgery. The previous doctor just had me open my mouth in office but had no idea of the underlying bone structure or wisdom teeth, so that doesn't feel like he could've calculated his plan well. The new surgeon told me about a potential genioplasty too. Again something the other doctor didn't mention. Before-photos were taken, something the previous doc wasn't interested in.

Price wise both surgeons are pretty similar at first glance, with the only difference being that the second doctor works at a public hospital so health insurance should be giving me a lot more back + no hidden costs.

I'll book a consulatation with my orthodontist asap for the braces. Think she's on vacation now. So until that time, please tell me if this is a solid plan or if I'm overlooking something? Any tips are welcome

 

[shizuku11111]

how old r u bro? im dealing with class 2 malocclusion as well, how come braces didnt fix the problem? or they did but u need the surgery as well to push the mandible forward

 

[blacksheep]

how old r u bro? im dealing with class 2 malocclusion as well, how come braces didnt fix the problem? or they did but u need the surgery as well to push the mandible forward

Hey, briefly mentioned this in the previous post. I'm currently 19. I've had a complicated orthodontic journey age 10-15 with night retainers and braces. I'm currently still wearing fixed metal wire retainers on the inside of my teeth, so my teeth are perfectly straight. However my jaw shifted around 6mm since. This is very normal. The only way to make your jaw alignment permanent is with jaw surgery.

 

[cc_7373]

Lmao you couldve probably fixed your problems when young very easily orthos really fuck us up to make money

 

[blacksheep]

Lmao you couldve probably fixed your problems when young very easily orthos really fuck us up to make money

Agreed, really wish my ortho would've said the words "jaw surgery is the only permanent solution" way earlier, not when my jaw had already shifted again and I complained about it. Now I have to wear braces all pver again and spend another fortune

 

[cc_7373]

Agreed, really wish my ortho would've said the words "jaw surgery is the only permanent solution" way earlier, not when my jaw had already shifted again and I complained about it. Now I have to wear braces all pver again and spend another fortune

Nah i mean when you were 10 and wore braces you couldve fixed that shit soo easy without having to wear braces damaging your roots, having to wear a retainer and getting an overbite again orthos instead decide to fuck you up because they make money(no the solution isnt mewing that shits cope)

 

[blacksheep]

Nah i mean when you were 10 and wore braces you couldve fixed that shit soo easy without having to wear braces damaging your roots, having to wear a retainer and getting an overbite again orthos instead decide to fuck you up because they make money(no the solution isnt mewing that shits cope)

You are so right. I remember in that period age 10-15 I didn't even know what was happening. I'd come in every few months to her putting a whole other device in my mouth with no explanation what it was for. Like i had a night retainer to stop my jaws from growing in certain directions, than there were gaps that needed to be closed, then my teeth were crooked, 3 devices later night retainers again but different ones. Orthos completely benefit of the fact that parents just want the best for their children so they do whatever the expert says

 

[cc_7373]

You are so right. I remember in that period age 10-15 I didn't even know what was happening. I'd come in every few months to her putting a whole other device in my mouth with no explanation what it was for. Like i had a night retainer to stop my jaws from growing in certain directions, than there were gaps that needed to be closed, then my teeth were crooked, 3 devices later night retainers again but different ones. Orthos completely benefit of the fact that parents just want the best for their children so they do whatever the expert says

Literally couldve just given you some mastic gum to chew and you would've gotten way more results and wouldn't have to damage your teeth, also about the surgery now are you sure about removing the teeth, the wisdom teeth result in the least damage when extracted but its still not worth it when you can just expand the jaw also check your maxilla its probably downward rotated would be good if you also rotated ccw definitely check that out

 

[blacksheep]

Literally couldve just given you some mastic gum to chew and you would've gotten way more results and wouldn't have to damage your teeth, also about the surgery now are you sure about removing the teeth, the wisdom teeth result in the least damage when extracted but its still not worth it when you can just expand the jaw also check your maxilla its probably downward rotated would be good if you also rotated ccw definitely check that out

I mean I was pretty recessed as a kid, so I don't think mastic gum would've fixed that lmao. I luckily don't notice any damage to my teeth. I'm lucky with genetically extremely strong teeth, though making myself throw up for big part of my teen years.
My wisdom teeth are super high up which probably explains why they weren't even visible on my last x-ray. Surgeon said it would take another 3 to 4 years for them to come through which could fuck up the alignment of my other teeth. I don't think I wanna be recessed for another 3 years. But maybe you can convince me by telling me what the pros would be of keeping them and expanding the jaw instead.
Could you also send me some pictures of a downward rotated maxilla vs a proper one? So I can compare mine. Was thinking about mentioning ccw to my surgeon at the appointment but I felt too insecure about my skills of explaining what I wanted...

 

[cc_7373]

I mean I was pretty recessed as a kid, so I don't think mastic gum would've fixed that lmao. I luckily don't notice any damage to my teeth. I'm lucky with genetically extremely strong teeth, though making myself throw up for big part of my teen years.
My wisdom teeth are super high up which probably explains why they weren't even visible on my last x-ray. Surgeon said it would take another 3 to 4 years for them to come through which could fuck up the alignment of my other teeth. I don't think I wanna be recessed for another 3 years. But maybe you can convince me by telling me what the pros would be of keeping them and expanding the jaw instead.
Could you also send me some pictures of a downward rotated maxilla vs a proper one? So I can compare mine. Was thinking about mentioning ccw to my surgeon at the appointment but I felt too insecure about my skills of explaining what I wanted...

Lack of chewing is what causes reccesion mostly so yea it couldve fixed it as for the maxilla thing

This is a downward grown one caused by lack of chewing (little resistance on the maxilla so it rotated downwards) you can also notice this in starving children.
You can notice this by checking how your under eye support is(bad support= downward grown maxilla), a downward grown maxilla also gives the illusion of a sad facial expression, elongated midface or hooked nose

 

[blacksheep]

Wouldn't say my maxilla looks as bad as the picture. It doesn't curve downward, but it's also not really going forward by much. Just pretty flat actually. In most pictures of good maxilla the maxilla seems to be going almost parallel with the slope of the nose. This is not the case in my profile.
Just listing some things I can see in the picture vs pictures of myself:
- my posture is bad
- idk what they mean with the sloped forehead (every forehead is kinda sloped or more roundishly sloped)
- my palate isn't curved down (it goes up ever so slightly in my x-ray)
- my undereye support isn't great. it can make me look tired and create some hollowing
- i do look sad. idk if it's my maxilla or my will to rope
- my midface is elongated
- and no hooked nose. my nose slopes upwards

Where can I best ask the question whether I need work done on my maxilla? Would my orthodontist be informed about this?

Am I right in assuming you mean getting a bimax with ccw to potentially fix a downward maxilla? Because the surgery I was suggested is not a bimax, but a lower jaw osteotomy. As far as I'm concerned only a bimax can have ccw

 

[blacksheep]

Lack of chewing is what causes reccesion mostly so yea it couldve fixed it as for the maxilla thing
View attachment 3068208
This is a downward grown one caused by lack of chewing (little resistance on the maxilla so it rotated downwards) you can also notice this in starving children.
You can notice this by checking how your under eye support is(bad support= downward grown maxilla), a downward grown maxilla also gives the illusion of a sad facial expression, elongated midface or hooked nose

Hey, I asked my orthodontist and she said my lower maxilla is well-developed, however my upper maxilla is on the flatter side. Again, not like the dude in the picture. Just only slightly going forward. She told me it's not her domain so not sure what I can do about it

Just read in a post on the forum that upper maxillary projection is a European trait and uncommon among Congoids. The whole projected lower maxilla with flat upper maxilla issue I have is very typical for Congoids. Guess I just didn't win the gene-lottery for that part of my face (am mixed Congolese and Western European). luckily don't have chimp lips, as described in the same post

 

[NZb6Air]

it's not her domain so not sure what I can do about it

infras

flat upper maxilla issue I have is very typical for Congoids.

wrong

 

[blacksheep]

infras

wrong

why is it wrong? i saw some post on the forum explaining it pretty thoroughly

 

[blacksheep]

infras

wrong

don’t think i’d go with infras. seems highly invasive for something that i don’t think is making my looks absolutely horrific. might get some tear through filler to get a lil volume however

 

[NZb6Air]

why is it wrong? i saw some post on the forum explaining it pretty thoroughly

niggers don't have worse maxilla lol, they have worse periorbitals

don’t think i’d go with infras. seems highly invasive for something that i don’t think is making my looks absolutely horrific. might get some tear through filler to get a lil volume however

trying to fix a skeletal issue with soft tissue will be a looksmin at best and a botch most of the time, the only way to fix a negative orbital vector is with infras and it will massively enhance your attractiveness

 

[blacksheep]

niggers don't have worse maxilla lol, they have worse periorbitals

trying to fix a skeletal issue with soft tissue will be a looksmin at best and a botch most of the time, the only way to fix a negative orbital vector is with infras and it will massively enhance your attractiveness

i guess that post just worded it wrong. i think we are talking about the same part
honestly was just trying the filler thing cuz i don't feel like hardmaxxing extensively. the jaw surgery is mainly functional. i don't have the motivation nor money to be getting 5 surgeries

 

[NZb6Air]

i guess that post just worded it wrong. i think we are talking about the same part
honestly was just trying the filler thing cuz i don't feel like hardmaxxing extensively. the jaw surgery is mainly functional. i don't have the motivation nor money to be getting 5 surgeries

it's in the same surgery.. Even mainstream surgeons are aware of this, it's very common, they will couple the bimax with infras in the same surgery in cases where a "high" lefort 1 won't be enough to treat upper maxillary deficiency

Augmentation of the infraorbital rim in orthognathic surgery

Abstract Mid-face augmentation via a Le Fort I osteotomy is a commonly performed operation. Advancement of the upper jaw and associated structures (nose, lower cheek areas) can certainly improve fu…

pocketdentistry.com

 

[blacksheep]

it's in the same surgery.. Even mainstream surgeons are aware of this, it's very common, they will couple the bimax with infras in the same surgery in cases where a "high" lefort 1 won't be enough to treat upper maxillary deficiency

Augmentation of the infraorbital rim in orthognathic surgery

Abstract Mid-face augmentation via a Le Fort I osteotomy is a commonly performed operation. Advancement of the upper jaw and associated structures (nose, lower cheek areas) can certainly improve fu…

pocketdentistry.com

Not sure if my surgeon would do this. I have a surgeon in a public hospital. Will not be getting bimax, but lower jaw surgery instead, with a possible genioplasty. But i'll definitely discuss the infraorbital rim augmentation with my surgeon once we get to the digital planning of the surgery after the orthodontic preparation for the surgery. Thanks lad

 

[NZb6Air]

Not sure if my surgeon would do this. I have a surgeon in a public hospital. Will not be getting bimax, but lower jaw surgery instead, with a possible genioplasty. But i'll definitely discuss the infraorbital rim augmentation with my surgeon once we get to the digital planning of the surgery after the orthodontic preparation for the surgery. Thanks lad

even easier if i'ure just doing a bsso with no lefort since there will be no plate/screws from the lefort to mess up with the infras

 

[blacksheep]

even easier if i'ure just doing a bsso with no lefort since there will be no plate/screws from the lefort to mess up with the infras

yeah i don't think i'll need a lefort 1. my maxilla is well-developed. it's just the upper part (what i refered to as upper-maxilla, but apparently are the periorbitals)