My Hopeless Situation

[treevernal]

It sounds like Arnett/Gunson would be worth considering. They specialize in aesthetics and will be able to pinpoint what your exact problems (functionally and aesthetically) and can provide a solution that addresses the source of the problem and cuts no corners.

Yes, they are expensive and since you live abroad will won't get insurance coverage here, but, even if you lived in the US, you might not get coverage either so take that for what it is. I am a US citizen but was denied coverage for Arnett but am still going with him as are other members on this board.

Anyway, it doesn't hurt to consult with them; I guarantee you it will be insightful and well worth your time. Their contact info is on their site "www.arnettcourses.com". All you have to do is give them a call, tell them your bite/profile issues, and they can get you scheduled (might not be for a few months though).

Good luck.

[treevernal]

The consult was $550.00 when I went and is probably still around that price. They will send you a detailed info packet in the mail where you can express to them all of your concerns about your bite/face. The consult is 3-4 hrs long and they do a Cat-scan/xray, soft-tissue examination, a digital prediction of results and will answer all of your questions. They will also address your TMJs and airway. You will need to send them molds of your teeth before hand which you can get from any dentist/ortho in your town to send to them.

I had a friend from Australia who consulted with them and I don't believe she needed anything special like a medical visa for her consult. She won't be going with them for surgery afterall though so I don't know if she would have needed anything special for the actual surgery.

You'll need braces for a time before surgery which is completely separate from their costs. You'll most-likely be able to use an orthodontist in your country and they might even be able to recommend someone close to you (they know orthos from all over; feel free to ask them at your consult).

Since I am paying entirely out of pocket, my surgical fees will be 49k. That price includes the materials fee and a discount for paying cash. That surgical fee is due 2 months before your surgical date. The week of surgery, you will also owe hospital (~10k/night) and anesthesia (~3k). Apparently they have a deal with the hospital for non-insurance patients which is pretty cool I must say. If you need to spend more than one night in the hospital (unusual), it is ~1500 for each additional night.

Yes, expensive. Worth it? Only you can decide and a consult is a great place to start.

[treevernal]

You'll see them 2x before surgery. The first time at your initial consult before even getting braces and then again a few days before surgery when you are orthodontically-ready and you've paid the surgical fees.

After surgery you'll prob need to stay in Santa Barbara for ~3-4 weeks before flying home (not sure about this though). Also, you'll need to do a few follow-up visits for a couple years after surgery to make sure eveything is stable and healing well. I don't know the exact number of visits/frequency at which you'll have to keep flying over here after surgery but they may have a system in place for international patients; they'll fill you in and if they don't, ask

[maxhammer]

The consult is still $550.

As far as your issues...have you looked into midface grafts? They can graft bone onto the zygomatic arch and other other facial bones that need it. Have any surgeons mentioned a Le Fort II to bring the entire midface out?

[ReoSity]

Since I am paying entirely out of pocket, my surgical fees will be 49k. That price includes the materials fee and a discount for paying cash. That surgical fee is due 2 months before your surgical date. The week of surgery, you will also owe hospital (~10k/night) and anesthesia (~3k). Apparently they have a deal with the hospital for non-insurance patients which is pretty cool I must say. If you need to spend more than one night in the hospital (unusual), it is ~1500 for each additional night.

You have to pay hospital fees in advance? Damn didn't know that. I'm also paying out of pocket and have enough for the surgical fees, anesthesia, etc so roughly 42k. Although my insurance (bc/bs) did approve me for surgery, they would only pay something like 1500 measly bucks but I wonder if they'd cover out of state hospital fees.

[treevernal]

The letter I received in the mail from A&G when my insurance denied me said that you owe the hospital fee upon admittance to the hospital. I think non-insurance people pay ahead of time as part of the deal between the hospital and A&G. They worked out this set price for the first night that will be the same for every non-insurance patient and I guess they bill you afterwards for any possible additional nights.

[maxhammer]

The consult is still $550.

As far as your issues...have you looked into midface grafts? They can graft bone onto the zygomatic arch and other other facial bones that need it. Have any surgeons mentioned a Le Fort II to bring the entire midface out?

I don't think procedures like that are available in my country (or in any country in Europe for that matter). The surgeon didn't mention what methods he considered, but he did make it clear that the midface deficiency would need to be addressed if the upper jaw was to be moved. The biggest challenge is to achieve a noticable change in my profile with limited movement of my jaws (my underbite is 3-5 mm at most AFTER the teeth are in the correct position).

If I could find a good surgeon within Europe then I could most likely get everything done for free, but I just don't think there are any surgeons here on the level of Arnett and Gunson.

In which country are you located?

[ReoSity]

The letter I received in the mail from A&G when my insurance denied me said that you owe the hospital fee upon admittance to the hospital. I think non-insurance people pay ahead of time as part of the deal between the hospital and A&G. They worked out this set price for the first night that will be the same for every non-insurance patient and I guess they bill you afterwards for any possible additional nights.

Ahh okay, I don't remember reading that in the letter I got after the first time my insurance denied me. Do you know how much the out of pocket discount is? I never got around to asking Natasha that.

[maxhammer]

The letter I received in the mail from A&G when my insurance denied me said that you owe the hospital fee upon admittance to the hospital. I think non-insurance people pay ahead of time as part of the deal between the hospital and A&G. They worked out this set price for the first night that will be the same for every non-insurance patient and I guess they bill you afterwards for any possible additional nights.

Ahh okay, I don't remember reading that in the letter I got after the first time my insurance denied me. Do you know how much the out of pocket discount is? I never got around to asking Natasha that.

15%.

I think it comes to 9k for the first night

[sarpevictim]

Wow, sorry to hear that you've been treated so poorly by specialists. (and by poorly, I mean that they didn't seem to put in effort into finding a proper solution for you)

As someone mentioned, if you have midface issues, you may want to look into one of two things: a zygomatic osteotomy (expanding your midface, if your deficiency is lateral, aka horizontal), or a Le Fort II (if your deficiency is in terms of how forward your face comes).

Both of these surgeries are for the more experienced oral surgeon.

Another option is cheek implants. Don't be turned off by the word implant...this is not something that's going to make you look like Madonna. Remember, cheek implants were originally intended for people with actual facial bone deformities. They have a ton of shapes and sizes to help you choose the right one for your face, and really good oral surgeons can tweak them to make them fit you even better.

Also, it's hard to tell because you didn't provide a picture, but the lower jaw can be retruded. So it is possible to move the upper jaw a little and move the lower jaw back so that you don't have to move the upper jaw so much forward.

[maxhammer]

Don't use silicone.

This guy in Australia does the HA, too.
http://www.bmendelson.com.au/permanent_cheek_fillers

I'm sure you can find someone in Europe if you research it more.

[maxhammer]

Try Giorgio Iannetti in Italy, too.

[Anastasia8]

Mommaerts in Belgium and Raffaini in Italy might be worth a look. Raffaini's website in particular have some amazing transformations.

[Anastasia8]

They're ridiculously slow, communication is not their forte.

[Anastasia8]

Done