My consult with Dr. Arnett

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#1 Post by **treevernal** » Fri Sep 11, 2009 5:40 pm

Hello. I have commented on here before but this is my first time creating my own post.

I had my orthognathic surgery consult with Dr. Arnett in Santa Barbara back in July and thought I'd share a bit about my consult for those that are interested.

I had braces as a teenager and while they did "straighten' my teeth, they did not correct my bite issues and actually made other problems worse. I went into this consult primarily for cosmetic issues regarding my retrognathic profile, but I came out knowing so much more about my underlying problems...

My issues are 5-fold:
- my face declined as a result of braces pushing backwards on my upper incisors to (unsuccessfully) correct my class II malocclusion.
- I have an open bite and a narrow palate that will both need to be corrected with a multi-segment Lefort I osteotomy.
- My TMJs are almost completely arthritic.
- I have grinded my teeth so much over the past 10 years when I sleep that I will need to get many of them bonded to their proper heights before I get braces again.
- My airway is only 3mm wide.

So...this consult was a complete eye opener to all that I have going on functionally.

Here is the proposed Cephalometric Treatment Plan (red is my post-treatment structure):

Dr. Arnett wants to do a 9.5mm multi-segment Lefort I advancement and a 20.3mm bilateral saggital split osteotomy (BSSO) advancement. While advancing my upper and lower jaws, he is also rotating them so that my "occlusal plane" becomes completely flat thereby putting less stress on my TMJs and creating chin projection without needing a genioplasty. My airway will also increase in diameter from 3mm to 13mm.

For pure cosmetics sake, he will also be doing hydroxyapatate cheekbone augmentations and an upper lip reconstruction to increase the vermilion height (red portion) of my upper lip.

I am extremely excited to go ahead with his plan, but the cost is astronomical and will have to wait a few years. I may stand a chance at some insurance coverage but even with all of my functional issues, Dr. Arnett is not a provider on any insurance plan so coverage will be minimal and this will most-likely be (almost entirely) out of pocket.

Anyway, I just wanted to vocalize my concerns and tell about my consult in case any of you were interested. I will keep everyone updated on my journey and feel free to ask me any questions at all!!

-Dan

#2 Post by **cvn** » Fri Sep 11, 2009 10:11 pm

I'm such a nerd. I went and got mine and compared, out of curiosity haha. They're probably not very comparable since mine is a redo of a redo, but interesting all the same!

I should be getting my surgery in spring, before my COBRA runs out and after my (hopefully) interviews for vet school. I'm using Arnett because this is my second redo, and he's one of the few surgeons who doesn't look at me and run screaming the other direction. Cost is insane, but should be worth it in the end. After two messes of surgery, this time it will be right and stay right.

Good luck with your treatment!

#3 Post by **chicago29** » Sat Sep 12, 2009 7:01 am

treevernal,

This is an interesting post. I too am one of those that like to look at all the "scientific" parts of these surgeries. Thanks for posting such detail.

It sounds like you definitely want to have surgery (and by the looks of things you are in the boat where the surgery is medical necessity), but the cost is an issue. While I understand Dr Arnett to be one of the best, do know that there are many other very qualified surgeons out there that are just as good and are much more affordable. The only difference is their name isn't "out there" and you have to go looking for them. I promise you they do exist, as many people on this board can attest to.

Of course, I'm not questioning Dr Arnett's skills or qualifications, but if you want to have the surgery done sooner as opposed to later, I would explore other options. You may even find in your case that you can find a very good surgeon that takes your insurance plan.

Best of luck, and please keep us posted as you go on your journey!

-Chicago29

#4 Post by **thenumber12** » Sat Sep 12, 2009 8:15 am

How much is the estimate for everything? and how much for just the surgery alone?

#5 Post by **Marisama** » Sat Sep 12, 2009 7:14 pm

I went to Dr. Arnett's office for a consult and they also wanted to do cheek implants. I actually saw Dr. Gunson. I've been to about 9 or 10 surgeons getting different opinions and they were the only office that recommended cheek implants. I've been told by other surgeons that they use that as just another way to make extra money, even if you don't need them. Get some other opinions. Dr. Reed Day in Phoenix is who I've chosen. He offers a payment plan at 0% for 12 months. That helps out tremendously!

#6 Post by **Marisama** » Sat Sep 12, 2009 7:15 pm

I went to Dr. Arnett's office for a consult and they also wanted to do cheek implants. I actually saw Dr. Gunson. I've been to about 9 or 10 surgeons getting different opinions and they were the only office that recommended cheek implants. I've been told by other surgeons that they use that as just another way to make extra money, even if you don't need them. Get some other opinions. Dr. Reed Day in Phoenix is who I've chosen. He offers a payment plan at 0% for 12 months. That helps out tremendously!

#7 Post by **treevernal** » Mon Sep 14, 2009 8:13 pm

Hey all, thank you for your responses and support!

cvn: Wow, this will really be your third go at surgery?? You are very brave. Is the scar tissue from previous surgeries not an issue? Did they discuss that with you at all? Anyway, nice to hear that you'll be getting some insurance coverage. If you have time to post it, I'd be very interested to see your Cephalometric Treatment Plan diagram as well! Best of luck with everything!

chicago29: Thanks for the well wishes! You are right, there are many good surgeons out there and i should definitely go on some more consults. While I am not in a rush to get this done, it would be nice not to drown out all of my savings on this one thing. I am actually going to be making a big move/career change soon so I'll have to wait until after I am settled with all of that to move forward with all of this.

thenumber12: The cost is broken down into sections, so sans insurance:
upper and lower jaw surgery: $35,750
cosmetic portion (upper lip + cheekbones): $5100
assistant surgeon (25% of the above): $10,212.50
surgical records: $1540
history and physical exam: $243
blood donation: $300-$800
anesthesia: $3075
hospital stay: $8700 for 1 night, but if you need to stay an additional night due to dehydration (rare), $1400 for each additional day

So at a minimum, I will have to pay $64,920.50 and that doesn't include braces or hotel stays (which Arnett's office has discounts for).

The good news is, if insurance approves this (likely), I won't have to pay for the hospital stay or anesthesia. However, it is the main chunk of the surgical fee that people have trouble getting decently covered. Their insurance coordinator told me that the most anyone has gotten covered there was $20,000. I do not know if that included that patient's hospital and anesthesia or not though.

I hope this information helps! (I also hope I didn't break any forum rules sharing all of that information with you!)

RYANvaughn: Thank you for the advice! That's fantastic that you've settled on a surgeon you like, congrats! As I told chicago29, going on a few more consults is definitely a great idea (0% interest for 12 months is amazing). I am actually someone who could use cheek implants and I knew they were too flat going into this. Are they necessary, no, but I figure if I'm gonna go through hell with this procedure, I might as well come out looking my best possible. I do appreciate your concern though, thanks! Best of luck with surgery and keep us in the loop!

Thanks guys, I will keep everyone updated. I was also considering starting a blog when I finally get the ball rolling. I picked a hell of a time to make a big change in my life, lol. 25 years old and still a rolling stone...

-Dan

#8 Post by **cvn** » Mon Sep 14, 2009 8:41 pm

Yeah my last two surgeries were pretty epic failures and I'm having a lot of trouble with losing condylar bone. Arnett is one of the few who is confident enough to do mine because I need pretty significant bone graphs and some out of the ordinary surgical techniques to give me normal function and balance while dealing with my scary joints. I don't really have too much trouble with scarring. I have some nerve loss in one quadrant and hyper sensitive teeth all around, but it's all manageable.

I'll find a scanner one of these days and copy it out for you. I really thought that machine he had was about the coolest.

Your cost is a good chunk less than mine, for what it's worth. You will probably get some flack from people (and I'm sure I will for saying it) for being willing to pay them such an amount of money when your insurance would probably cover it in network for a small co-pay. However, as someone with a wrecked jaw from staying in network, if you can afford it then do it. If I would have spent this money in the first place, I would probably have been done with this mess over 10 years ago.

#9 Post by **crazybeautiful** » Tue Sep 15, 2009 8:35 am

Can I just say first of all f***ing hell, that's a lot of money!

cvn- I understand your need to get it right this time around, so if you've got it, you might as well use your money to get a surgeon who is confident in sorting out your problems. Sadly ocean-ups happen, and sorry you've had to go through all this like you have. Well wishes for your next surgery

treevernal-
I'm not in the know about US insurance and health care so can't exactly pass comment on that (although I'm glad everything is covered by the NHS otherwise I'd never be able to afford braces, nevermind surgery), but I'm with chicago about shopping around to see if you can get a better deal. Being well-known doesn't necessarily equate with being the best, otherwise no other surgeons would even get any custom! If you're experienced in your job, you're experienced in your job, regardless.
Unless you have exceptional circumstances like cvn, then I think it's always best to try and get the best deal financially, and that will correct your problems all the same
Keep us posted

#10 Post by **treevernal** » Tue Sep 15, 2009 9:02 am

Thank you crazybeautiful, I do appreciate your concern. And yes, I will be going on more consults (which I stated to chicago29 in my last response).

LOL, cvn you were right about getting some flack about Arnett; it now begins. But, I do understand why they are doing it; they don't want me to be mis-informed and possibly throw all of my money away without knowing about more affordable (and possibly, equally reputable) options. For their advice I am much appreciative.

This is going to be a personal decision in the long run though, so no matter which surgeon I end up choosing I do hope I will find support on this site and not criticism. We all know how difficult this surgery can be so positive support is what is needed.

Thanks,
Dan

#11 Post by **treevernal** » Tue Sep 15, 2009 9:05 am

Thank you crazybeautiful, I do appreciate your concern. And yes, I will be going on more consults (which I stated to chicago29 in my last response).

LOL, cvn you were right about getting some flack about Arnett; it now begins. But, I do understand why they are doing it; they don't want me to be mis-informed and possibly throw all of my money away without knowing about more affordable (and possibly, equally reputable) options. For their advice I am much appreciative.

This is going to be a personal decision in the long run though, so no matter which surgeon I end up choosing I do hope I will find support on this site and not criticism. We all know how difficult this surgery can be so positive support is what is needed.

Thanks,
Dan

#12 Post by **crazybeautiful** » Tue Sep 15, 2009 9:56 am

I don't think me or chicago are giving you any flack. It's always best to get more than one opinion, and it's always best to get a price that's right for you, and your circumstances- be it a need to get surgery right this time around and know you're in very good hands, or whatever. Neither of us said anything more than that, to be fair

Everyone on this board is in the same boat, and I personally come here to give support and to be supported. But that means giving opinions sometimes

I'll say good luck to you both again in earnest, but I'll leave you to advise eachother.....

#13 Post by **treevernal** » Tue Sep 15, 2009 10:30 am

Perhaps you didn't see my humor when I made the "flack" comment. I know you guys aren't giving me flack, I was just joking around (hence the LOL in front of that sentence).

The only reason I made the last statement I did is that I've seen other posts get really out of hand with people arguing over whether or not a particular surgeon is worth it for them. I do welcome opinions and I wouldn't have posted my personal info on here if i didn't want them (if you look back, you'll see that I thank you for your opinion).

Please don't read so much into what I said

) I hope you'll continue to offer support and opinions.

Take care,
Dan

#14 Post by **brendan** » Fri Sep 18, 2009 11:22 am

good luck w everything buddy!

#15 Post by **treevernal** » Fri Sep 18, 2009 11:42 am

Thanks Brendan!

Yeah, I'll definitely keep everyone updated on everything. You're probably getting your braces off soon, huh? I think 6 months is usually the right time. That's awesome, post some post-braces pics if you can!

I hope your recovery is going well. Can you eat solid foods yet?

-Dan