What type of Bimax should I go for and is it even worth it at almost 26?

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NoaA99

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Talked to different (bluepilled of course) surgeons.
I have a moderate medical class 3 skeletal underbite with severe TMJ on the left side primarily. This was due to early tooth loss and stunted jaw growth in consequence.
My mandible bone is also very narrow despite my dad having a huge jaw and chin.
It was suggested I needed 6-7mm advancement for my occlusion to be corrected. At the moment I have a compromised bite, that induces a mid-line discrepancy. So the chin is off Center basically.
Did MSE beforehand and still in the middle of Invisalign.
Wished I never did it, as my face was already wide and compact and now it looks comical, as I am slightly less lean atm.
It also induced asymmetry (larger side expanded more)- my palate isn’t straight but canted, as is my maxilla now obviously.
This can only be corrected again by surgery, which was planned afterwards in the first place.
At least it did cure my nose breathing difficulties, which is actually pretty cool.

1) One surgeon suggested, that I have mild sfs and wanted to slightly set back the mandible, why doing cw maxillary rotation to lengthen the mid-Face and make the nose appear a bit longer and less bulbous at the tip.

2) Some other surgeon wants to actually do the opposite, although I believe it would look comical. So CCW rotation with only the maxilla advanced.

3) The third surgeon in question opted for a high cut lefort, as she mentioned, that my mid-face is relatively flat and that this will provide volume and make me look less tired.
Other than that, she opted to advance the mandible slightly ( as apparently it wants to move even more forward but is held back by the maxilla) and also advance the maxilla adequately in response.
She also said the cant would be eliminated, making the face more symmetrical.
Unfortunately she also mentioned, that the cartilage around my left TMJ is already damaged, so some pain will persist.
 

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LF3 + LF1 + BSSO + TMJ reconstruction with the bros in Turkey
 
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Did MSE beforehand and still in the middle of Invisalign.
Wished I never did it, as my face was already wide and compact and now it looks comical, as I am slightly less lean atm.
What age were you when you did MSE?
 
do you think it worked? My bite is fine now I just want a wider face.
Yeah it did work. It’s also really good if you have a narrow head/face shape. But my byzgomatic width was above 15cm before, so MSE was just overkill.
Funnily enough my palate was narrow, despite wide facial structure.

Also you need a plan for your mandible if there is no size discrepancy between the two
 
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How high a LeFort cut did she propose?

What's your current occlusal plane?
 
How high a LeFort cut did she propose?

What's your current occlusal plane?
She didn’t go into much detail. She just mentioned it would be beneficial to make the cut slightly higher for slightly more midfacial volume. Nothing major I suppose.
She mentioned my face is relatively flat with 181 degrees, if I remember correctly, which is indicative of the class 3 occlusion.

Would have to measure, she didn’t tell me.
Doesn’t appear particularly high though.
When smiling half of my teeth are not really visible, since the maxilla is deficient in every dimension apparently.
She actually said my mandible is really good but it does seem poor in real life.
 
How high a LeFort cut did she propose?

What's your current occlusal plane?
In real life it’s actually not that visible but it could be because of my poor posture.
I visited several different docs before realising, that the neck, jaw and head pain came from an skeletal underbite
 

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26 isn't over, don't let the teenagers on the forum make you think that.
 
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26 isn't over, don't let the teenagers on the forum make you think that.
Yes I know that. I plan to proceed with surgery primarily for medical reasons, but I want to ensure an aesthetically pleasing outcome as well. Surgeons have differing opinions on my case. A high-cut LeFort would be ideal if the risk of complications isn't significantly higher, but I'm unsure if clockwise rotation is necessary or if simple advancement is more reasonable. Everyone agrees on bimax surgery, but one surgeon suggested setting back the mandible, while another preferred slight advancement. After wearing a temporary splint I received from him for a few weeks, my mandible moved slightly forward once it was removed, indicating pressure to move forward.

I'm also unclear on the best approach to correct my canted maxilla. Any suggestions on how to proceed?
 
I'm also unclear on the best approach to correct my canted maxilla. Any suggestions on how to proceed?
It depends if youre willing to go private (spend 25-30K out of pocket) for the best aesthetic result or if youre staying with insurance where you get what you get.
 
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It depends if youre willing to go private (spend 25-30K out of pocket) for the best aesthetic result or if youre staying with insurance where you get what you get.
Have to go private and I am willing to pay that. My ortho declared, that insurance will never cover anything here in Germany unless your lower teeth are severely protruding relative to the upper ones. Or if you have severe sleep apnea, which I do not.
My body apparently compromised well for the skeletal discrepancy.
 
Have to go private and I am willing to pay that. My ortho declared, that insurance will never cover anything here in Germany unless your lower teeth are severely protruding relative to the upper ones. Or if you have severe sleep apnea, which I do not.
My body apparently compromised well for the skeletal discrepancy.
Well that's good news. First step is getting some CT scans.
 

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