One jaw or two: Any advice?

[suzyscientist]

I was wondering if I could get some advice from people, especially those post-surgery!

I've had braces since March for an underbite and was under the impression that I needed:
1. SARPE
2. Lower jaw moved back

Yesterday I had an appointment with my ortho and I've made it only stainless steel wires (OUCH) and a powerchain to match up the mid-lines. When she did that she called the consultant ortho (the boss!) over and he started talking about upper jaw advancement. So...

The good news is I probably don't need SARPE.

The bad news is that after the decompensation it looks like there is more movement required from my upper jaw than my lower jaw. So that means I'm looking at double jaw surgery: upper jaw forward, lower jaw back (but just a little).

But, I have the choice of having one jaw or two jaw surgery.

My concerns about two jaw are:
1. Actual surgery itself - more dangerous?
2. Recovery time - I'm a grad student and teaching assistant and I need to teach to supplement my income. Recovery time (and time before I don't look swollen) will be longer with double jaw, right?
3. PAIN - generally I have a decent pain barrier, but is double jaw worse than single jaw?
3. Barfing blood (sorry to be gross). I've blog posts about it and now I'm really worried.
4. My nose. I love my nose. It's straight, narrow and cute. My boyf loves my nose too. Will upper jaw surgery change my nose?
5. Another vanity aspect: cheekbones. Mine aren't great. Will they disappear if my upper jaw comes forward?
6. Final vanity aspect: I have a pouty bottom lip. My nickname at school was Mick (as in Jagger). If I get upper jaw moved forward, the ortho said I'd have an "Angelina" pout... but, what if I end up looking like a fish?

But the benefits of two jaw are:
1. The result will be aesthetically better and I'll have a better profile
2. If I'm going to let a surgeon play hammer-and-chisel with my jaw anyway, I may as well go the whole hog... because surgery sucks no matter what, right?

I guess I just need some help sorting out my thoughts! I know I'm probably saying some pretty stupid stuff but none of my friends have *ever* had braces or surgery so nobody has a clue what to say to me.

I won't get to see the surgeon until March and my ortho says she can't really answer questions on his behalf, because he's the expert...

Anybody got any wisdom?

Thanks (and sorry for all the stupid points)

Suzy (confused-y)

[Broadway Bill]

Just a couple things, quickly, and I'll chime in later on some other points when I have a few minutes:

I just had double surgery to correct an underbite. My cheekbones are, under the swelling, looking a tiny bit MORE prominent, which is actually great.
My nose did not change a bit. My surgeon said that with this procedure, it was possible that my nose would point up a tiny bit after, but that does not appear to have happened.
My lips are also the same, but that's tough to tell for sure right now because of swelling.

[bb]

1. more dangerous?- don't think so. The lower jaw surgery is close to some major arteries so I'd say lower is actually more dangerous.
2. Recovery time - I was grossly swollen for about 4 weeks. Remember though that you'll be tired from lack of nutrition and general recovery.
3. PAIN - The lower jaw is what really hurt- right at the joint- shooting pain and spasms. Top jaw was a breeze.
3. Barfing blood- didn't happen to me.
4. My nose. -yes it will change. tell your concerns to your surgeon- he'll stitch your nostril bases together a bit to keep them narrow as possible.
5. Another vanity aspect: cheekbones.- made mine more prominent- you get these plump apples of your cheeks.
6. Final vanity aspect: I have a pouty bottom lip. - was/am the same. My lips changed very little in the end.

[tdawg7669]

From reading this forum I say do both jaws. I havent seen any poster who had a similar decision to make do both and regret it in the long run. I HAVE however seen posters who opted only for one jaw and ended up regretting it. If you are going through the hell that is this process, you might at well go all out imo.

[ColoradoGirl]

My cheekbones are also more prominent; my lips are still way swollen so I can't tell; barfing blood is gross but makes an excellently hideous story to tell people after the fact (and since you're drugged anyway, it's not nearly as bad as it would be with a clear mind). I didn't want my nose to change, either; it did a bit but I like the result (seems slightly shorter and *less* pointed up). I only had the option of double jaw, but I'm really glad I did it that way. The lower is much more of a pain (literally and figuratively), so just adding the upper should be relatively easy.

I'm also a grad student & TA. Are you doing the surgery over spring break? I wanted to take only 10 days, but it ended up being 2 weeks--and 2.5 before I could really talk and be understood. So, if you have a week off and can get someone to cover your sections for a week, you should be fine. I've found that everyone I work with, from undergrads to colleagues to professors, has been super supportive. The students have even been very sweet about the swelling and weird speech. If I were you, I'd talk to whoever you're TAing for and see what s/he thinks about you taking a bit of time in recovery. Also, do try *not* to take Medieval Latin during your surgery semester (augh!!!).

[Izzy1979]

Well I am one week out of doing only bottom jaw surgery. I also had the option of doing upper jaw as well - my situation was different in that both my jaws would be advanced - upper would be 4-5 mm and down a little, and the lower would have needed to be advanced by that much more (already had 9mm as it is). I pondered upon my decision til the day of surgery. Ultimately I made my decision after talking to my surgeon about the following deciding factors:

1) Would doing both jaws have ANY medical advantages ? aka better bite, lesser chance of relapse,etc. - Answer was NO, none at all, purely esthetic

2) If I did the upper, for only esthetic purpose, HOW MUCH improvement would we be talking about compared to doing just the lower - his answer was that in my case, the change would be minimal, he felt I would get a 5-10% improvement at most (I took it as the difference between being an "8" or a "9")

3) Is the recovery harder? - his answer was a definite YES. There is more swelling. There is more jaw movement. There are more structures involved (sinus, bleeding, nose change, higher chance of permanent nerve damage etc)

4) Ultimately I put him in the hard spot of really asking him if he thought it was worth doing in my case. He said he felt the difference would be so minimal he didn't feel like I should do it unless I had extreme concerns about my appearance, and that really, slapping a few veneers on my upper front teeth would probably obtain a very similar result

My decision was that since there was no medical reason to do it, increased risks with minimal outcome, it wasn't worth it. Will I always wonder how I would have looked if I did it? sure. Am I happy with my decision - so far, yes, I already see major improvement in my chin region yet Im still swollen like a balloon, and I honestly can't imagine having my nose clogged up while I couldnt open my mouth post op!
The bottom line came to -> if it was gonna make a big difference, or had medical reason to it, would have done it. Since that wasn't the case, why put yourself through it?

Now if your surgeon is anything like mine, he may not have the best bedside manner and didn't take the time to really discuss at lenght in the beginning, which put me in that last minute crunch. It that is the case, force him to sit down with you and have an honest talk about your case, your expectations, and what he thinks your results will be like. Then go with your gut!

[Izzy1979]

Oh and also... as a side note
Just take the appointment with the surgeon now. I saw a surgeon before an orthodentist ( I had been told about the need for surgery by every dentist Ive ever seen in the past) - that way I got some answers before going through braces. Don't wait til March if you want to get an opinion now

[suzyscientist]

Wow you guys are amazing, thank you so much.

I think that I will get both jaws done, but it's a bit scary. I know any surgery is going to be really hard, and if I'm going to take time off work I should do it all at once, rather than regret not getting the top jaw done... The ortho said 90% of the movement would be my top jaw, and only 10% in the bottom. So if I don't get the top done, then it might not be as good a result. Does that make sense?

If I'm in the stainless steel wires now, and in December I'm getting a whole set of head x-rays and molds taken. I hope that means I am getting closer to surgery, but I'm not sure when the surgery will be. I'm hoping it will be over the spring break, or in the summer. The course director I'm teaching for is really understanding, and has back-up teachers if I need to have time off during the semester...

And, I can't see the surgeon until March, once all the xrays and molds are done. I am an NHS patient in the UK so everything moves slowly and we just have to wait for appointments

I guess I'm just freaking out a little bit because it seems very real now and I think I'm just panicking over little things...

I'm so grateful for all the advice, I really don't have anyone who understands what this is all about

Suzy (a bit less confused-y)

[Broadway Bill]

Looks like you some great advice and came to a tentative decision!

One other thing to consider:
I my case, my surgeon felt that he could get almost the same results from lower-only, but that would mean moving my lower back 12mm, which he thought could interfere with my airway and breathing. As it is, he moved the lower 5mm, and the upper 7mm (roughly). Going by the models and predictions, it was a much more balanced and subtle outcome.

And don't worry too much about school. I'm in law school, and I found that when I REALLY explained the procedure, people were shocked and freaked out by it enough that they just let me take all the time I needed!

[suzyscientist]

Thanks Bill! It sounds like my surgery will be very similar to yours...Balance sounds good so I guess I should stop being such a chicken and get over it

I'll speak to my professors and colleagues... at the minute I think they see me as an over-enthusiastic Ugly Betty fan...

Thanks to everyone for your input, I feel so much better about it (for now...!). It's great having this community of people who all understand!

Suzy

[suzyscientist]

P.S. Izzy! Medieval latin! Oh my gosh! I though advanced econometrics was scary... Your professors must think you're a hero for taking that class in your surgery semester

[sarahorsomeone]

Well, I had upper and lower about five weeks ago; so I'll try and answer from my own experiences. I had a maxillary impaction (upper jaw moved up and in my case forward a tiny bit) and my lower jaw moved forward; aswell as a-symmetry correction in both; so not quite the same, but I'll do my best.

1. Actual surgery itself - more dangerous? Well seeing as you'd effectively be having two surgeries rather than one; and you'd be under anaesthetic for much longer, I suppose it must be; but I think this surgery is reasonably safe anyway.

2. Recovery time - I'm a grad student and teaching assistant and I need to teach to supplement my income. Recovery time (and time before I don't look swollen) will be longer with double jaw, right? Well, think of it this way, it's not going to be less! Personally my recovery took nowhere near as long as I thought it would; I felt pretty normal again (other than my diet) after the first two weeks. That's despite having a chronic medical condition I was warned would probably be aggravated by it for a good few months!

3. PAIN - generally I have a decent pain barrier, but is double jaw worse than single jaw? I didn't really get much pain; but most of the small amount of pain I did get was from my lower jaw.

3. Barfing blood (sorry to be gross). I've blog posts about it and now I'm really worried. I did get that a few times on the day of surgery; but I believe that can happen with lower-jaw-only aswell. It was something I was pretty worried about too, but in the end it wasn't as bad as I imagined even though I was quite violently sick!

4. My nose. I love my nose. It's straight, narrow and cute. My boyf loves my nose too. Will upper jaw surgery change my nose? That's something you need to speak to your surgeon about; but they can put stitches in to minimise the change as much as possible. That said, even despite aforementioned stitches, my nose has changed a little; it's slightly tipped up and looks a bit smaller in profile, but if anything I prefer it.

5. Another vanity aspect: cheekbones. Mine aren't great. Will they disappear if my upper jaw comes forward? I don't see why they would, but I'm not sure. My jaw was moved forward a tiny-bit and I can't really see any difference with my cheekbones; but mine was only moved forward by a couple of millimetres.

6. Final vanity aspect: I have a pouty bottom lip. My nickname at school was Mick (as in Jagger). If I get upper jaw moved forward, the ortho said I'd have an "Angelina" pout... but, what if I end up looking like a fish? No idea on this one; but I've never seen anyone who's looked worse after jaw surgery.

[suzyscientist]

Thanks Sarah!

It's so helpful to hear everyone's opinions.

Although now I feel a little stupid for worrying so much about things... *sigh*

Suzy

[Brant]

Ask them about stability. Think double jaw tends to be the most stable results for underbite.