Metal Mouth Message Board

I am about to get orthognatic surgery for an underbite. Initially the plan was to advance my lower jaw and shave back my chin (its really strong already). On one of my visit the surgeon mentioned that I could also advance my upper jaw, this would be for esthetic reasons only, he didn't seem to think it would make a huge difference and thinks my bite can be fixed with just the lower.
My orthodontist however feels it would be significant and thinks Im going to regret not doing the upper jaw as well. When I expressed this to my surgeon, he said he really doesn't think I;ll regret it and that I could get veneers once the braces are off to make my teeth show more and have a similar result. (he also didnt seem too keen on having to do new records and change my surgery date since they need longer booking in OR)
Anyone has had the same dilemma? What did you decide?
Im less than a week from surgery and having serious last minute doubts...

Hi Izzy, yes I'm sort of in a similar situation. My bite can be fixed with lower surgery but the surgeon offered me upper surgery as well -- which he stressed would be for purely aesthetic reasons.

To be honest it wasn't that much of a dilemma for me. I'm going for lower only. My priority is function rather than aesthetics, and I wanted to keep any risk to the absolute minimum. My family already has to put up with my various other health issues, plus I suffered quite debilitating dizziness for some months after my SARPE, and basically I've had enough of all this, really!

I'm aware that I won't end up with the beautiful smile that lots of folks on this board achieve, and I'll probably have a few pangs of regret about that in the future, but I've had to weigh up all the other considerations and accept a compromise.

That's just me, though. You'll have your own set of circumstances influencing what you want/need most and what you're prepared to go through to get it. The only thing I would say is don't let your surgeon's scheduling arrangements be the deciding factor. If you need more information or time to think then ask for it! OK that could cause a lot of inconvenience, but better that than feeling rushed into a decision you later regret.

Sorry if that's not much help

I agree in that what ever you decide should be based on what you want not what fits in with other people this is a big descision not to be taken lightly.

I am not really in the same boat, the discussions we had didnt really involve a choice the surgeon basically said he wouldnt be happy doing just lower jaw he wanted to do both and he said to me i would have a better bite but also there is much much less likelihood of a relapse if i had both, maybe you could discuss relapse problems of having just lower incase your surgeon can comment.

I had the same decision to make but in a matter of minutes. Seeing the surgeon before the operation he enquired as to whether I felt I showed too much teeth/gum when I smiled, this is something I had never noticed before. My smile has always been one of my features so it seemed unnecessary to correct it especially as it would mean waiting 3 more months for surgery.

However after the lower jaw surgery (BSSO) my profile was not perfect as my chin did not come out quite far enough. This was caused by mentalis strain from where my lips stretched to meet so causing my chin to disappear. From here it dawned on me that the reason why I had my mouth open so often in life was not that I was too lazy to make a sufficient effort to close them. My lips were so far apart that to close my mouth my lips had to stretch 11mm instead of 3 to 0mm making it far harder to do constantly.

It also dawned on me that the upper jaw surgery that the surgeon was alluding to (Le Fort I) would help solve this problem! I sought a second opinion, which confirmed my inkling and this second opinion spoke to the initial surgeon who agreed to perform the upper jaw surgery!

9 months later I have now had both and without a shadow of a doubt it was the best decision to make for myself! Because my face lower face is now broadly the same length as my nose and forehead (rule of thirds) it has transformed my looks and self confidence. Please think long and hard before you turn down upper jaw surgery.

Bowater - so you were able to go back to do the upper jaw without redoing the lower jaw? My understanding is that it is a one time deal... if you mess with the upper after then you have to readjust the lower - am I wrong?

As it stands - I may have to reschedule last minute as it is - my insurance asked for new records last week since they had pre approved 2 yrs ago and I ended up needing braces longer, as of now I havent heard if they gave the ok or not and I'll know Monday. My pharmacy also messed up and didn't order my Roxicit so now it wont be there on time for post op... lots of fun!

I guess what I dislike about my face is the "sunken" appearance at the bottom of my face with then the large chin - looks a bit like a witch (to me, at least!). Initially the braces brought my upper teeth forward some but I fear that while doing the lower jaw/chin will decrease the witchy effect it still won't be what I want. And if Im going to eat through a syringe for 6 weeks it better be worth it!

Hey Izzy, well it is definitely not standard to do the two jaws separately and the result is probably not as good as doing them together. My bite was perfect after the first surgery but now my front lower teeth hit my upper teeth. The orthodontist can probably correct this but because the braces have come off it would mean having braces again to do so. For now I'll wait to see how it settles in.

My surgery was performed on the NHS (free public healthcare), your insurance company may decide it is a one time deal. In the UK the surgeon makes the final decision as to what surgery is performed and the NHS pays him.

However my best advice for you and anyone having surgery is to buy your surgeon a good bottle of champagne (French) after the operation. In addition try and develop a good repour throughout the treatment. You will stand out from the other patients and a bad result would be awkward to explain so chances are he will do his best. If things do need tweaking he will more keen to do so.

After both surgeries the only painkillers they gave me was paracetamol & ibuprofen and that was sufficient to keep the pain away remarkably. One ibuprofen, 3 times a day and I can find out the paracetamol dosage tomorrow (not at home right now).

Do you think the surgeon maybe discouraging you from having the upper jaw surgery for his convenience whereas the orthodontist is giving you his unbiased opinion?

He just keeps saying "it won't be a big difference, I think we can fix your bite with just lower" then my orthodontist seems to think it would be worth it. It is confusing. Of course if I can acheive the same results with veneers it is much less invasive but I doubt veneers can bring up your teeth 5mm forward?

I had kinda put it out of the questions with the additional cost but mostly the scared factor - cutting into your skull just seems a lot worse than your lower jaw. So I took his "not worth it" happily but the more I look at pictures of me and before/after of others the more I think the orthodontist is right

Now surgery is scheduled for Tuesday, which would mean cancelling on Monday which makes me feel bad, I almost hope my insurance doesn't go through so I have that excuse to revisit my decision!

Veneers are a bit of a scam, they correct your smile but they do nothing for your facial proportions. With the upper jaw surgery my smile did look better but by improving the proportions of my face it changed my whole appearance.

Here is how I look now:



Here is how I looked before:



Notice how the lower third of my face looked longer before (my chin and upper lip). Veneers over upper jaw surgery would not have achieved this. They treat one symptom... the smile but by not correcting the underlying cause it is a bit of a half hearted solution.

As it happens upper jaw surgery is far less risky than lower jaw surgery and as they say here "in for a penny in for pound." Roughly translates as you may as well go for the maximum improvement and not a compromise.

As for spending there is nothing else that you can spend that money on that will change your appearance for the better for life. In 10 years time you will still look more beautiful than no/less surgery but a holiday or a slightly bigger car would be long gone.

Bowater wrote:
... As it happens upper jaw surgery is far less risky than lower jaw surgery ...

Do you think you could explain more what that assertion is based on? It's a bit of a sweeping statement so more info would be useful.

It's a moot point here, though, since the OP needs lower surgery anyway. What's more relevant is whether double surgery carries more risk than lower alone.

Izzy, from what you've said here here it sounds to me like your surgeon is concentrating more on functional issues while your ortho is considering the aesthetics more. Is there any way all three of you can discuss things together, before the op?

sauerkraut wrote:Do you think you could explain more what that assertion is based on? It's a bit of a sweeping statement so more info would be useful.

It's a moot point here, though, since the OP needs lower surgery anyway. What's more relevant is whether double surgery carries more risk than lower alone.

Izzy, from what you've said here here it sounds to me like your surgeon is concentrating more on functional issues while your ortho is considering the aesthetics more. Is there any way all three of you can discuss things together, before the op?

Hey sauerkraut. There is a nerve that runs through the lower jaw that if damaged can lead to a partial or complete loss of sensation in the chin area. This is the worse risk attached to lower jaw surgery. Whereas in the top jaw there is no nerve that must be avoided. Beyond this both jaws are low risk surgery that carry little risk beyond the usual - i.e. infection and the surgeon mucking up.

However at this stage Izzy if you have any doubts over the surgeon not being able to competently operate on the upper jaw then you should not trust him to operate on your lower jaw.

Oh I dont think he is incompetent - and he is the only one within 50 miles anyways.. he has actually done the surgery on someone I work with and she is pretty happy with her results. My orthodontist swears by him too. I just think at this point it would be very inconvenient for him to have to remeasure and reschedule everything a day from surgery - a bit understandably. Its a little bit my own fault that I waited til last minute to really reconsider this - I guess I was still in denial that it wasn't happening for a while then ops there it is! Hopefully my insurance company will act as a typical one and not have their crap together by tomorrow so I can blame it on them and have a little extra time to decide:) If not then I'll have to decide if I'm taking the extra risk for benefits or be happy with minimal changes to my look.

I would post some pics for you guys opinion - not sure how you do it??

C:\Users\Izzy\Desktop\018 (2).JPG[/img]
[img]http://C:\Users\Izzy\Desktop\018%20(2).JPG[/img]

Izzy, I think pics would really help, if you want more opinions. Try the "How do I" section for info on posting pics. If I can do it anyone can!

Hey Izzy, best of luck with the insurance company being your saviour, however if you do want to take the double jaw surgery then inconveniencing your surgeon a little is justified for such a life changing chance. Be strong!

As for the pictures you first need to host them on a website such as Photobucket or Flickr. You can do this by going to their websites and signing up, then you upload your pictures to their website and they provide you a link to your picture that you then paste here when inserting an image.

So instead of:

[img]http://C:\Users\Izzy\Desktop\018%20(2).JPG[/img]

It will be something like:

[img]http:///www.photobucket.com/pictureworld/jaws.jp%20g[/img]

Alternatively there is some guidance here:

http://archwired.com/phpbb2/viewtopic.php?t=11741

The first 4 pictures are with my jaw shut, the last one is a more "normal" pose with my jaw relaxed. I did Invisalign first and these are all after Invisilign, my upper teeth havent moved much since getting real braces on