Tips, Tricks, and Comments – From a guy who’s done double jaw surgery TWICE!

[tdc10]

Hi iamamused - thank you so much for this very helpful information, and for updating with details from your 10-mo. checkup. Glad to hear that you are pleased with the outcome. I am scheduled to have this surgery in a few months, and it is good to know how to mentally prepare. One follow up question - I am struck by how incredibly similar your surgeon sounds to mine. By any chance, if you don't mind sharing, did your surgery take place in New England?

[iamamused]

tdc10 - Tried PMing you, but it looks like you haven't been on long enough for private messages. My surgery was in the New England area.

[tdc10]

Thank you for your response iamamused, just sent you a PM. Just want to say on here that this thread has been one of the most informational/helpful ones I've seen on this board, so thank you again for posting it!

[iamamused]

Hi All - OP here - felt it good to come back and provide a whopping 4 year update! This topic was on my mind, and I wanted to come back and post to close this out. My last update (from 10 months after surgery - which is close to 3 years ago!), still resonates with me today. I continue to be satisfied with the cosmetic outcome of the revision. especially since the 1st surgery made my face look worse. The revision was absolutely needed for that alone and I will say, years out, cosmetically my face does look better than pre-all these surgeries.

However, nerve damage still remains, but thankfully it's much reduced over the years. My lower lip at 10 months was still very numb, today it's 95% normal. My upper lip at month 10 had the left half numb, today, unfortunately, it still is about the same. The left half of my upper lip and the corresponding gum line continue to have a reduced sensitivity and less mobility.

Thankfully my speech and mouth movements are fine, and on a side note I can say kissing is almost near normal and enjoyable again. Drool is gone, I can *usually* tell when I have food on my face (although that happens less as I have more control and feeling) and I bite my lower lip and inside left of my cheek with much less frequency.

These improvements happened (and hopefully are happening) at a glacial pace. Two years* after my 2nd surgery, I continued to have impactful numbness, consistent lip biting, and an overall discomfort that pushed me to review legal options. (*These have lessened at 4 years.)

In Jan of 2019, two years after the second surgery I decided to explore a claim and reached out to several law firms. First, let me say, I didn't arrive at this conclusion lightly. I work in commercial insurance. I know what fraudulent claims look like, and I know what an overly litigious nature the US is and what it's done to the insurance industry. I didn't want to be a "part of the problem", and so I waited to see how my outcome would resolve. I decided to pursue litigation due to the remaining nerve damage (greater at that time), as well as the cost and pain & suffering associated with the double surgery. Admittedly it nagged me that the 2nd surgery, an arguably more complex and difficult surgery, went so much more smoothly than the first. I remain convinced that either a resident student did my surgery (something I NEVER agreed to) or an egregious lack of care occurred to contribute to the first poor outcome. Don't get me wrong - I'm happy that the 2nd revision has gone as well as it did. But I don't think it had anything to do with my physiology and everything to do with the care taken to perform the work.

Unfortunately I waited too long. In my state the statue of limitations for medical malpractice is 2 years. There was also a question as to when the clock starts ticking. Was it after the 1st surgery in 03/2016 or the 2nd in 12/2016? If it was the 2nd I was right at the cusp - but even if I was well within the statue - I can tell you no lawyer wanted this case. The lawyers that deal in medical malpractice want the best bang for their buck (in this case their time). I suppose I don't blame them, that is capitalism after all. I was told time and again that I "looked fine". With no paralysis, or bone loss, or gross cosmetic deformity - they felt it wasn't worth pursuing. Not because my claim was meritless - but because the payday, and hence their cut, wouldn't be big enough.

In the end I let that issue lay. Although I did have one, particularly unscrupulous lawyer, string me a long for a couple grand to file "extensions" and perform research, only for him to decline pursuing for the same reasons the other lawyers all told me upfront and for free.

Still, I'm glad I at least looked into the matter. I wanted to attempt to pursue the issue, not for a large payout (I never thought my experience warranted that) but for at least a claim to be on the surgeon and the Hospital's license. For there to be a record for others to know this happened.

That's the entire reason I've written these lengthy posts and replies. I don't want anyone to go through what I did. All I can do is hope I've helped someone else avoid a poor outcome.

Again, in the end I do count my blessings. I have my health, my face back, and in many ways I am lucky.

[Emsrosie]

Hoping to find some support here for my 21 year old daughter, scheduled for double jaw surgery in 2 months. The surgeon is very well respected however he was almost flippant in response to her concerns over how she will look as well as concerns over numbness. She’s like to just go with him because it’s taken forever to get a surgery date, but given his attitude with her cosmetic and numbness concerns should she be looking elsewhere?

[iamamused]

Hoping to find some support here for my 21 year old daughter, scheduled for double jaw surgery in 2 months. The surgeon is very well respected however he was almost flippant in response to her concerns over how she will look as well as concerns over numbness. She’s like to just go with him because it’s taken forever to get a surgery date, but given his attitude with her cosmetic and numbness concerns should she be looking elsewhere?

Hi Emsrosie -
I still monitor this thread (after starting it close to 5 years ago). It's hard to make a determination based solely on the above. I've found that surgeons (in general) don't have the best bedside manner. Perhaps it's a required mindset, or one developed over years of experience, they are after all cutting open another human - there's a certain level of detachment required to do that.

That said, I've written a bit in this thread about researching surgeons (pulling licenses, looking for prior claims or lawsuits, asking for referrals, seeing who your ortho recommends, understanding experience, and speaking to more than one surgeon.) I'll also add, you should have a surgeon who takes your thoughts and concerns into account. This is after all your (well your daughter's) face. There should be some level of empathy.

It may not feel like it to your daughter, but (unless there's something up with insurance) she has plenty of time and shouldn't rush into this. This is a surgery that will alter her face for the rest of her life. It's not to be taken lightly. Make sure she's getting the surgery for the right reasons. (You can see my experiences earlier in this thread. My "right" reasons, in hindsight, weren't right enough to have this surgery.) I did a tremendous amount of research and still had issues.

Please don't think I'm looking to sway you one way or the other. There are people who truly need this surgery, and have lovely outcomes, both cosmetically and physically (no numbness, great teeth alignment). This surgery greatly improved their lives and their confidence. My point is to be well aware of the risks vs the rewards. Make sure this surgery is to correct major issues, because it is a major surgery. (By contrast, what I thought were "major" issues, were, upon reflection, minor. My - issues being a weak chin, jaw misalignment, and to be frank, a little bit of vanity. When taken against numbness I have to this day, 5 years later, and the fact that I had to have two surgeries, I would have sought other options - being stopping with braces, and maybe a genioplasty.)

Again, I've gotten quite verbose. But to summarize:
1. Understand why your daughter wants to make these changes to her face, and explore all options (including and beyond surgery) to achieve these changes
2. If surgery is the best option, understand the outcomes (both good and bad)
3. If you decide to move forward with surgery, do everything you can to feel comfortable (both research and interviewing) w/your surgeon
4. I've included tips in earlier posts on this thread on how to deal with surgery (both pre and post)

Lastly - one other tip. If you can avoid it - DO NOT HAVE YOUR SURGERY WITH A "TEACHING" PRACTICE. I'll never know for certain, but I am convinced that my first surgery was performed by a much less skilled hand. My belief is that it was the head resident that was being taught by my surgeon at the time. This was never supposed to happen, but I believe he (the head resident) was allowed to perform more than he should have. I was never supposed to be a teaching patient. There are other programs, and cheaper options, for patients to have this surgery performed by residents. I'm basing this on the fact that the person who did my revision was incredibly more skilled than the individual who did my first surgery (which should have been the same person).

Be aware, revisions are not the norm, neither is permanent large numbness, most have one surgery and a great outcome, with minimal or no permanent numbness: but it's not outside the realm of possibility.

Best of luck, any other questions, feel free to ask or PM.

[SpeakingUpJ]

Hi,

Im in desperate need of guidance.

Please help…my little sister underwent double jaw surgery for an overbite back in July 2021 (she was 16yrs old at the time) She is now 8 months in and is having serious problems with mastication, severe joint pain , and we are afraid the surgery might have caused TMJ. She was a Class II, but after the surgery her bite seemed too off, it looks like she is a class III. The immoral surgeon won’t admit it that he left her bite a Class III. The surgeon made us believe that everything would get fix with orthodontist and sent her back to ortho and now everything is a whole mess. We are so worried and freaking out, and just not sure what to do next

Please please give us some advice.

[iamamused]

I'm sorry to hear about your sister's situation. Having gone through this (and coming out the other side) I know how painful and frustrating it must be.

I've written at length in this thread about how I was able to get my surgeon to agree to a revision.

Here's what worked for me:
1. Work with facts, over feelings. Surgeons can be hard to convince of their mistakes. Once I started to "feel" that there were issues, as tough as it is (after all it's your face) try not to be emotional. I know this is easier said than done. I experienced some depression after the first surgery and keeping those emotions at bay while interacting with your surgeon can be difficult. After all, he's the guy who did this to you! But he's also heard it all, and likely will be closed minded to critiquing of his work - without facts! I put together a portfolio; prior pictures of myself, I put them on a grid and measured my midline. (This is why I stressed in my earlier posts, take pictures of yourself just before surgery. I had to use random photos I had, which were hard to find multiple angles.) I also enlisted the assistance of my Orthodontist, who took X-rays - and having another doctor back you up is helpful. Armed with these examples, my surgeon agreed to the mis-aligned midline. If this doesn't work, I would seek the review of another surgeon.

2. Don't be afraid to consider your options and let your surgeon know. BE TACTFUL THOUGH! Thankfully, my fact-based approach worked, but I did lay some groundwork and made my surgeon aware that I work in the Insurance industry, and that I was familiar with professional practice insurance as well as claims in those lines of business. In surgeries, especially those as complex as this, a "perfect" outcome is not what doctors are held to. Rather it's the standard of reasonable care. Would another doctor, in a similar situation, acting in good faith, with similar information - have the same outcome? I expressed concern that perhaps, the standard of reasonable care had not been met. I wondered if a student (my hospital was a teaching hospital) had performed work beyond what they should have. I also was exploring validating this theory by getting another expert's opinion. If a revision wasn't agreed to, I would have pursued engaging a law firm that specializes in malpractice.

3. Time is of the essence, be a pain in the butt. At 8 months out, your current outcome is likely the outcome you'll have permanently. The vast majority of swelling should have resolved, as well as nerves, and any joint issues. That's not to say there won't be improvements, but we're talking small increments, as most of the healing has already occurred. Pursue the above approaches (analysis, facts, 2nd opinions and if needed, legal) and do so, with tenacity and tact... bang on doors, force meeting, make phone calls! The longer you wait, the less opportunities you'll have (assistance with insurance, statutes of limitations, etc.).

I hope this helps. I truly wish you the best of luck. I know what it's like, but it will get better. Take action and be sure to advocate for yourself / your sister.

Hi,

Im in desperate need of guidance.

Please help…my little sister underwent double jaw surgery for an overbite back in July 2021 (she was 16yrs old at the time) She is now 8 months in and is having serious problems with mastication, severe joint pain , and we are afraid the surgery might have caused TMJ. She was a Class II, but after the surgery her bite seemed too off, it looks like she is a class III. The immoral surgeon won’t admit it that he left her bite a Class III. The surgeon made us believe that everything would get fix with orthodontist and sent her back to ortho and now everything is a whole mess. We are so worried and freaking out, and just not sure what to do next

Please please give us some advice.

[Lizzybae]

Hi. I’m going for a 2nd opinion on revision surgery and have lined up two different surgeons for consultation. Do you have any tips on what I should look for or what type of questions I should ask?

[iamamused]

Hi. I’m going for a 2nd opinion on revision surgery and have lined up two different surgeons for consultation. Do you have any tips on what I should look for or what type of questions I should ask?

In my prior posts I've listed guidelines for picking a surgeon in general (do they have claims, what's their bedside manner, how many surgeries, what technology used, etc.). I would argue those are quite important.

But here are a few extras I would ask a surgeon specific to a revision:

1. How many revisions have you performed? Have you revised your own work, or others?
2. Revisions can be more difficult due to the existing trauma introduced from the 1st surgery, how successful have your revisions been? And what have been the outcomes? Have they been simply improvements, or did they meet their goals for full correction?
3. Do you have any examples you can share? (References, pictures of prior patients, etc)
4. What would you recommend for waiting time between surgeries?

[BlueTears]

Hi,

I recently wrote you regarding my little sister. I had to create another account because somehow my password wasn’t going through.

Thank you for the advice. I went seeking answers, but came back more defeated then ever…I’m crying just writing this.

I made an appointment at the practice where the surgeon that left my sister a Class III worked, but he is no longer at that practice. So we scheduled with the main surgeon there. And although this other surgeon clearly saw my little sister’s misplaced bite, and the interior of her mouth and all that the other surgeon had done wrong. He just didn’t want to get involved (being that it was his colleague who caused this) or take on her case, so he was dismissive and just brushed it off. One of the things that this other surgeon said, that was so hurtful was, “yes surgeries can go wrong, but she’s still pretty” my sister is having functionality problems which is why we are seeking help, and this insensitive doctor talks about her looks (It was a very unkind and sexist remark…a man would never be told something like this if he was having problems chewing. My main concerns and questions were disregarded) I asked for a CT scan or MRI to look deeper into what’s causing the pain, but he said “you don’t have insurance right?” I said “we are working on getting her insurance” but he just cut things short. Honestly my mother and I are just regular working people, but we are willing to spend to the last penny to help her. The more we try to find a solution the harder it gets.

So sorry to sound like I’m rambling, but I’m unsure of what will happen in the future if my sister’s health doesn’t improve. I’m hoping that perhaps if I’m open about everything I can find answers, and I’m writing you because you’ve been in this same boat and understand the challenges.

I’ll just say it all:

Right after my little sister’s surgery she was left with her upper-jaw caved in and her bottom-jaw was protruding forward excessively (her top front incisors were aligned with her bottom molars) An open-space between her upper and lower jaw (exactly like a Class III patient) which cause her mouth to stay open…she cannot close it fully or comfortably. She forces her lips together to appear like her mouth is close, but it just shows she’s straining to keep her lips together. A lisp and other problems.

10 months have passed and the main issues still persist:

Severe pain in her tmj area, pain while chewing…headaches from this. Her mandible shifting from left to right (side to side) her jaw get tired from talking…she holds her jaw because it feels overworked from just speaking.

Right after surgery we knew something was wrong, but instead of sticking to our gut feeling, we asked the surgeon, and he knew exactly what to say to sound convincing and string us along and worsen things. Naively we believed that he was the doctor and he had all the knowledge.

After writing you for the first time and the info you gave me; I asked for all her medical records including all images, but we were giving partial paperwork and only 1 image was provided of an x-ray before the surgery (the important information is being withheld) and in the medical records the surgeon solely wrote things to make himself sound good on paper.

Now not only did the surgeon botched the surgery but all the orthodontic work that my sister had done for 4 years is now ruined also. After surgery she was sent back to orthodontics, and her orthodontist put spacers in her top teeth to expand her jaw and bring it forward to reach her bottom teeth. Now my sister upper part looks triangular, which gives a false illusion of her bite being ok, and this didn’t resolve her pain or mastication problems.

After analyzing everything with more clarity I can honestly say that that surgeon harmed my sister for profit. And it turned out that this man was more of a dental implant surgeon (he bragged about being the best in jaw surgery, but didn’t have the expertise…and lied about his capabilities) than an orthognathic surgeon. He was just looking for a big payday, because soon after the damage he caused my sister, he left the practice he worked at for 9 years, and opened up his own private practice. He didn’t care that my little sister would be in pain forever because of his greed.

My little sister’s world is upside down right now. I wish I could turn back time.

Thank you for hearing me out, and I’m sorry for getting overly emotional

[iamamused]

You certainly sound like a very caring person; your sister is lucky to have you. I know this is a tough situation for you and your family. I'm sorry to hear that you and your sister are experiencing these issues and roadblocks.

If it's any conciliation, I know what it's like and I am hopefully for you and your family. A good surgeon should be able to correct what you've described. Unfortunately, you've hit a few roadblocks on that journey.

I think you've taken some good initial steps, but based on your note, it seems going back to your original surgeon / practice is at this point a dead end. Although I too needed to take some convincing of my original surgeon, your sister's surgeon appears to not have been all that qualified to begin with (specializing in implants, rather than jaw surgery). I know this may feel like a setback, but it's not. You've now analyzed that the original surgeon is not the one to perform the revision. Revisions are harder to correct, and your original is not up for this challenge, both in skillset, and (if I'm blunt) in being a decent human being.

Here would be some suggestions, that I hope will help your sister get the care she needs:

1. At this point, I think you should consider legal options. I don't typically advocate lawyering up immediate, usually it's best to take a tactful, fact-based approach, and work in good faith together. However, the original surgeon / practice does not seem interested in doing good by their patients. You also noted that the original surgery was July 2021. Most states allow for 1 year for malpractice action. The clock is winding down. I would begin immediately consulting with lawyers. You can file a reservation of rights (which basically says you are exploring a possible claim). A reservation will also (in most states) extend your window for bringing a suit. Starting this process, may even be enough to push the surgical practice into action to help you. (Although you'll really want to assess if their skills are good enough for a revision, maybe compensation to help for another surgery?).

Consultations are free and if the lawyer likes the case, they will typically take it on contingency (meaning no out of pocket expenses, unless you win, at which point they get an agreed % of the verdict). That said, I attempted this route, although AFTER I already had a good outcome from a revision, and was told that while I had a case, it wasn't big enough for them. You are in a different spot as your sister is still in pain. I would strongly suggest that you seek legal options. You may need to consult with several firms.

2. Begin to interview other surgeons for a revision. See if the orthodontists (or others on this board) can suggest a better surgeon in your area. The matter of no insurance may prove difficult. You'll want a highly regarded surgeon for a revision and they likely cost as high as their skillset. I'm hopeful you can get the matter of coverage resolved. As great as this country is, no insurance makes access to quality surgeons near impossible.

As a word of caution, if anyone suggests that a "teaching school" is a viable option, one that will save you money, and allow a revision w/o insurance - think long and hard before taking this. Again, a revision is more complex, and requires a competent surgeon to correct. A teaching school will likely not have this (even if a master surgeon is the one teaching), because they will encourage the students to participate in the surgery. If you've read my prior posts, I am near certain that this is what happened to me, even though I paid for the master surgeon (and not his students) to touch my face. If this is your only option, I'm not suggesting that you don't explore it, or rule it out completely, but I would strongly recommend that you consider it very carefully.

I sincerely hope things get better for your sister (and you). I'm saddened to hear that you have not yet found a path forward, but I am confident (especially based on the jaw placement you described) that this can be corrected. It will be a matter of continued banging on doors until you find the right surgeon.

Hi,

I recently wrote you regarding my little sister. I had to create another account because somehow my password wasn’t going through.

Thank you for the advice. I went seeking answers, but came back more defeated then ever…I’m crying just writing this.

I made an appointment at the practice where the surgeon that left my sister a Class III worked, but he is no longer at that practice. So we scheduled with the main surgeon there. And although this other surgeon clearly saw my little sister’s misplaced bite, and the interior of her mouth and all that the other surgeon had done wrong. He just didn’t want to get involved (being that it was his colleague who caused this) or take on her case, so he was dismissive and just brushed it off. One of the things that this other surgeon said, that was so hurtful was, “yes surgeries can go wrong, but she’s still pretty” my sister is having functionality problems which is why we are seeking help, and this insensitive doctor talks about her looks (It was a very unkind and sexist remark…a man would never be told something like this if he was having problems chewing. My main concerns and questions were disregarded) I asked for a CT scan or MRI to look deeper into what’s causing the pain, but he said “you don’t have insurance right?” I said “we are working on getting her insurance” but he just cut things short. Honestly my mother and I are just regular working people, but we are willing to spend to the last penny to help her. The more we try to find a solution the harder it gets.

So sorry to sound like I’m rambling, but I’m unsure of what will happen in the future if my sister’s health doesn’t improve. I’m hoping that perhaps if I’m open about everything I can find answers, and I’m writing you because you’ve been in this same boat and understand the challenges.

I’ll just say it all:

Right after my little sister’s surgery she was left with her upper-jaw caved in and her bottom-jaw was protruding forward excessively (her top front incisors were aligned with her bottom molars) An open-space between her upper and lower jaw (exactly like a Class III patient) which cause her mouth to stay open…she cannot close it fully or comfortably. She forces her lips together to appear like her mouth is close, but it just shows she’s straining to keep her lips together. A lisp and other problems.

10 months have passed and the main issues still persist:

Severe pain in her tmj area, pain while chewing…headaches from this. Her mandible shifting from left to right (side to side) her jaw get tired from talking…she holds her jaw because it feels overworked from just speaking.

Right after surgery we knew something was wrong, but instead of sticking to our gut feeling, we asked the surgeon, and he knew exactly what to say to sound convincing and string us along and worsen things. Naively we believed that he was the doctor and he had all the knowledge.

After writing you for the first time and the info you gave me; I asked for all her medical records including all images, but we were giving partial paperwork and only 1 image was provided of an x-ray before the surgery (the important information is being withheld) and in the medical records the surgeon solely wrote things to make himself sound good on paper.

Now not only did the surgeon botched the surgery but all the orthodontic work that my sister had done for 4 years is now ruined also. After surgery she was sent back to orthodontics, and her orthodontist put spacers in her top teeth to expand her jaw and bring it forward to reach her bottom teeth. Now my sister upper part looks triangular, which gives a false illusion of her bite being ok, and this didn’t resolve her pain or mastication problems.

After analyzing everything with more clarity I can honestly say that that surgeon harmed my sister for profit. And it turned out that this man was more of a dental implant surgeon (he bragged about being the best in jaw surgery, but didn’t have the expertise…and lied about his capabilities) than an orthognathic surgeon. He was just looking for a big payday, because soon after the damage he caused my sister, he left the practice he worked at for 9 years, and opened up his own private practice. He didn’t care that my little sister would be in pain forever because of his greed.

My little sister’s world is upside down right now. I wish I could turn back time.

Thank you for hearing me out, and I’m sorry for getting overly emotional

[Lizzybae]

Hello…So I met with a second surgeon to discuss revision and both of them stated “I don’t understand why your original surgeon touched your top jaw. We tried to avoid touching both jaws”. Which is worth mentioning that my original OS told me at 4 months post op “ if I could go back in time I wouldn’t have touched your top jaw”. I need to sue him.

This new OS explained that if he places my top jaw where it was originally and he has no way of telling unless he compares the x rays (original before surgery) on top of the new ones he may be able to measure how far back the original OS moved it. That my top jaw will never look the same bc original OS detached it from my skeletal.

I’m so defeated. He ruined my face. There was no medical or aesthetic reason for my OS to have touched my top jaw. I went only for my bottom. I can’t believe I let him talk me into touching my top jaw.

So his recommendation is doing the VSP (virtual planning) with a custom plate across my top jaw to ensure my midline is aligned. He said the method my original surgeon did which is considered traditional the new OS stopped performing it 10 years ago. He has done over 5,000 surgeries so he is a lot older. Which I need to factor his age when it comes to surgery.

What method did you do your revision? Did you have your lower jaw rotated? If so, why? My lover jaw seems off but I can’t tell if it’s because it’s misaligned or if it also needs to be rotated?

Are there other factors I need to bring up? Ie i never knew there was a chance of midline off centered bc my original surgeon never mentioned it to me.

[runnergirl36]

Hi @iamamused--any way you could send me the name of your surgeon?