Two Different JAW Surgery Plans – Need Opinions (CCW vs CW)

therocky

therocky

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I’ve consulted with two surgeons and got very different surgical plans:

Plan 1


  • Procedure: Double jaw surgery (DJS) with counter clockwise (CCW) rotation + segmental 3-piece Le Fort I + genioplasty
  • Rationale:
    • CCW rotation should improve airway/breathing.
    • Stronger jawline and chin projection.
    • Surgeon feels my bite is slightly steep (though this is tricky to judge from scans/photos, especially since my head may not have been in true natural position during CBCT, I assume he adjusted it when analyzing).
  • Cost: ~€26,000 (private).

Plan 2


  • Procedure: DJS with clockwise (CW) rotation + genioplasty.
  • Rationale:
    • Surgeon doesn’t see 3-piece Le Fort I as necessary, but says he could include it if I want. He made these recommendations after my first visit and shortly after seeing my old cbct + new xray (I assume he doesn't see the bite as steep because he hasn't adjusted the head inside the program yet).
  • Cost: Essentially free (covered by insurance).


At first glance, CW seems ok. But after analyzing it more, CCW makes more sense, especially with a 3-piece Le Fort I — because that allows each segment of the maxilla to be adjusted individually. From what I understand, the front (incisor) segment could rotate more, while the posterior segments are repositioned/impacted so the molars don’t end up too low.

  • Current profile photo: after orthodontics (I’ve gained some weight).
  • Older photos (before braces): I’m posturing my lower jaw slightly forward.
  • X-ray: after orthodontics, with molar turbos in place.
  • CBCT images: before orthodontics.


Which plan would you choose in my situation — DJS with CCW with 3-piece Le Fort + genio (private, 26k), or DJS with CW + genio (covered by insurance)?


Any feedback from people who’ve been through CCW vs CW would be really helpful.
 

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Plan 1
 
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Reactions: tunisianropemaxxer and therocky
Doesn’t look down grown to me. Option 2. Or even just no rotation.
 
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