Difficulty Finding Surgeon to Perform Revision Surgery

[peskywabbit]

Way back in 1999 I had lower jaw surgery at Kaiser in Oakland with Dr Felice O'Ryan. My teeth are nicely aligned, however, my chin has since looked lopsided and I've been very self conscious of it ever since. I've been unable to go back for revision all this time as life priorities tend to come first...education, children, business, etc. Anyway, I've decided now is finally a good time to seek that revision surgery. I'm back with Kaiser, but this time in Southern California. My first surgery was performed in Northern California Kaiser. The Maxillofacial Surgeon in San Marcos, (Dr Kim) was incredibly less than helpful. He said that this is considered a cosmetic procedure and I would have to seek a plastic surgeon to perform it, which means hefty bucks. He also implied that my concerns were insignificant, that I was magnifying the situation and that nobody is equal on both sides of the face. This last part, yes, I know. But, I didn't have this lopsided problem prior to the operation and I feel that Kaiser should be held accountable.
I've requested another doctor within Kaiser for a consult. This time it's Dr Robert Relle in Los Angeles. As far as I can tell, he has a great reputation. So I'm keeping my fingers crossed that all goes well, but am very worried about a similar outcome.

If anyone knows of any great revision docs, especially in the So California area, I'd be sooo appreciative.

Kind Regards to All, Peskywabbit

[treevernal]

Hey Peskywabbit!

So sorry to hear you have to go through this a second time. I highly recommend Arnett/Gunson in Santa Barbara for your redo. They are well-known around the world for doing complicated redo operations all the time. They are very expensive and out of network but so worth it for a redo. Just ask member "cvn"; she had to have a (gasp) 3rd surgery to fix the first procedure and the subsequent redo of that procedure.

If I were you I would definitely make sure you go to the very best since this is your second time around. You do not want to have to do this over and over again.

Think of it as an investment!

Good luck!
Dan

[peskywabbit]

Thank you, Dan

I have checked out Gunson/Arnett. And, yes, they do sound like amazing doctors. Have to admit, am a bit worried about the $35K-50K price tag. If I'm wrong about this, please let me know.
Thanks again, Jessica.

[treevernal]

You are correct about the price. However, you could get some coverage if a redo is medically necessary.

My thought is just, if you're going to go through this again, you want to go to someone with a lot of experience with redo surgery as the grafting and bone cuts will be much more complicated this time around and only someone with a lot of experience will know how to do it well.

I know the price is crazy but if you cut corners going to someone not as experienced you risk needing this done a third time (just ask cvn) which could make it cost just as much as / if not more than surgery with Arnett/Gunson this second time around. I also read in another post you wrote that aesthetics were important to you; well no one is better than Arnett/Gunson there as well.

I'm not trying to scare you, but talk to board member "cvn" and she'll give you great feedback.

[ceanna]

You say that your chin looks lopsided but your bite is fine? Did you have genioplasty along with lower jaw surgery? Maybe you actually don't need another lower jaw surgery but a shaving of the bone to make that side more even. A consult with the surgeon will tell you for sure. Let us know how it goes!

[peskywabbit]

Yep, it was a genioplasty. That's the lopsided part. Plus it sticks too far out. Just too manly. As I tend to be petite, it's just a wierd look. I think shaving is a great idea. I'll see if it can be done. thanks

[ceanna]

Peskywabbit - The same thing happened to me. I also had a genioplasty and after a year once the swelling went down and I could see the final result, I hated it because my chin was off-center and too far out. It also made it hard to close my mouth without chin wrinkling. As you said, it made it look manly. I was unhappy with it. I ended up having what's called a revision genioplasty which is basically the shaving of the bone. I had the bone shaved on the fuller side and in front. I think it looks so much better now, more even, and doesn't stick out the way it used to, and I can close my mouth now without the weird chin effect. I had always regretted getting the genioplasty with my first surgery and I'm glad that something could be done about it. So definitely ask if bone shaving is a possibility in your case. Good luck!

[peskywabbit]

oh Ceanna, thank you soooo much. You offer me a ray of hope. Was it considered cosmetic? Did insurance pay any part? Or did you pay cash? And if you don't mind, may I ask did you go to a plastic surgeon, your previous maxillo surgeon or another maxillo surgeon? Also wondering how much it might cost. I know that's a bit personal, but if you're comfortable you can e-mail me directly so I can get an idea of what to expect. Wow, I'm relieved to hear that you had a good outcome. Once again, thanks so much. Jessica

[ceanna]

Hi Jessica, I had it done with my original maxillo surgeon. It would be considered cosmetic since it doesn't have anything to do with any functional aspect (i.e. the bite is fine). I think any oral surgeon or plastic surgeon would be able to perform this procedure. I actually didn't have to pay for it because of another reason (I'll email you the details). If you have it done, it would probably cost less than an original genioplasty since it's less invasive and there is no bone cutting involved. The surgeon will most likely be removing the chin plates and screws while he's in there before doing the bone shaving. The plates and screws are no longer needed after the bones have healed from the original surgery. For me, this was a plus because my chin had a "shelf" like indentation where the plate was both in front and underneath the chin. When I lowered my head, it looked like I had a double chin. Once the plates were removed, I no longer had this problem. Very happy about that! But most of all, I'm just glad that my chin finally looks "normal" and suits me.

Genioplasty is not for everyone. Some people have great outcomes with it, especially if they hated their chin before or had a recessed chin. For me, I was never unhappy with my pre-surgery chin and I didn't have a recessed chin. But in my jaw surgery, my lower jaw was being set back and it was recommended that I have a genioplasty in order to compensate for the jaw being set back. Personally, I think my chin would still have looked okay even without the genioplasty. But I guess I'll never know. For anyone who is considering having a genioplasty with your jaw surgery and who is already happy with your chin now, please seriously think about it because you could end up hating it. And also realize that you won't see the final outcome until all of the swelling has gone down, which takes at least 6 months to a year.

[peskywabbit]

Ceanna, I'm having difficulty e-mailing you directly through the board. If you want you can email me directly at : peskywabbit@hotmail.com

I do have some pain on my right lower chin since the surgery. Kind of like a light toothache that sometimes zings up to my ear. Or maybe a swollen gland feel, but there is no infection. Must be a nerve prob. I get used to it and really it doesn't bother me as much as the funny looking chin. If it were just the dull ache that remained following the surgery, I probably wouldn't look into it, but because of the chin, I'm more compelled. So I would be interested in how you were able to convince the surgeon to perform the revision with the help of insurance. I'm worried the docs going to say it's just cosmetic and honestly I can't afford the 35K-50K that some people talk about (especially in regards to Gunson/Arnett).

Thanks so much for everything. So glad you're happy with your outcome. I think when all is said and done, I too, will come back and hopefully provide great advice for others such as you do.

[ceanna]

Thanks for the kind words! I emailed you.

[peskywabbit]

thank you treevernal and ceanna, I am seeing Dr Robert Relle tomorrow, but with the help you both have given me, I am definitely exploring my options.

[peskywabbit]

Saw Dr Robert Relle today. Wonderful man. Is gonna help me. Not shave it, but move it around a bit. Ok, so here we go. Round two, Aug. 22. Thanks all.

[Rizzie]

I'm so glad that you like your doctor! I felt bad that no one knew him and the other thread went unanswered. Good luck, and I hope you end up with a fabulous chin!

[Minerva]

Hello,

What happens at Gunson/Arnett's if there is some complication during/after surgery? Does the bill

blow up even more, or would that be included in the original price? Also, does one have to live in CA to have

them approved by insurance?

Thank you.