New member, IVRO vs BSSO

[Kawininja]

Hi, I'm new here. Sorry for any repeat questions, but looks like most of the threads are multiple years old anyway, so figure I'd ask.

I'm 46. Class 3 malocclusion with maxillary hypoplasia and mandibular hyperplasia with steep plane angle. Severe tooth crowding and compensation.

I've always been told I needed surgery to correct it but never did. Now that I'm older my severely retroclined lower incisors have quite a bit of recession. I didn't know that would be an issue as I got older. So here I am on the road to try and save face before it gets worse. I'm now 1 year into braces and ready for DJS.

My surgeon had planned on a lefort 1 three piece and BSSO with setback and counterclockwise rotation. I currently have a negative overhead of about 1 cm. I have a pretty v shaped jaw. Does counterclockwise rotation make TMJ more stressed?

Of course doing all this reading on line I come across IVRO vs BSSO. my surgeon didn't mention IVRO. when I asked if it was an option in my case he said yes, but it was less predictable. He did agree its less likely to cause nerve damage or TMJ issues, but did warn of being wired 4 to 6 weeks and if it left you with an open bite there is still a chance BSSO might be needed anyway.

So wondering what I should do both from the practical side and also from the aesthetic side? I can deal with 6 weeks of being wired if the outcome is likely to be good in the end. I didn't want to push for something antiquated though if it's likely to not work. I'd rather not have long term issues if I can avoid it simply to save 6 weeks of annoyance.

[snapdresser]

Practically speaking, since you asked, at your age there are a few additional concerns. Normally this surgery is very difficult mentally. Looking at a new face in the mirror can take many years to get used to. You’ve gotten used to your current face for 46 years, and now likely consciously or subconsciously consider it “normal” for better or for worse. There is a good chance you will not like your new face. Given the natural loss in soft tissue elasticity, on top of the counter-clockwise movement, which generally includes some maxillary impaction, you are likely to look older afterwards. This is because of reduced tooth show on the top. You can discuss it with your surgeon but my understanding is calculating post-op tooth show is a bit of an art, and may conflict with what may otherwise be the best surgical plan. On top of that, your nerves will not heal up as well as a 17 year old’s. There is a good chance you will have some permanent numbness in at least your chin and/or lower lip with BSSO. If you decide to take the plunge, good luck! And please follow up with us here to let us know how it went!

[Kawininja]

Thanks for the reply.

My tooth show is almost non existent as is, so not sure it can look much worse lol.

I hear you on the rest. I'm scheduled for this January and meet with the surgeon in December, so I guess we will see what he says then. I already feel I look old so it's more functional than anything. Hopefully though, there is some improvements in esthetics. Wish I would have done this 20 years ago.

[snapdresser]

You may end up looking even older! But let us know what the surgeon says!