My Consultation with Dr. Gunson - result and thoughts

[ReoSity]

Hey everyone, I finally was able to see the doctor yesterday and to put it simply, it went great. Reiterating other people's experiences, the staff was beyond nice and Dr. Gunson was very pleasant (although I think he was worn out from all his consults, apparently everyone except me that he saw that week had joint issues).

My facial issues I was seeing him were primarily for:
-my 10mm lip incompetence
-my mentalis strain on lip closure

I am a somewhat difficult case, since I've had a sliding genioplasty in the past which masks my long face quite well and if you saw me walking down the street you'd think I I wouldn't need any surgery. But as expected, Dr. Gunson confirmed my facial abnormalities.

The treatment plan is as follows after being in braces for approx. 6 months (my bite and teeth are decent they just need to be titled).
-3.7mm upward movement of my upper jaw
-forward movement of the upper jaw (don't know the value)
-cheek augmentation (he said it was necessary and due to the space the upper jaw leaves when moved)
-2mm upward movement of my lower jaw
-10mm forward movement of my lower jaw (right now my lower jaw is 13 mm short of where it should be)

So there it is and I'll actually have a bigger airway afterward as mine is slightly smaller than it should be. The cost without hospital fee's and braces is about 40,000. I'm going to get in braces sometime soon but I'm not sure how I'll pay for the surgery which could realistically happen by the end of this year. Hopefully my insurance will cover some of the cost however minor as my case is functional in nature and according to blue cross blue shield medical coverage guidelines, I should qualify.

I will post my predicted images if I can get my scanner to work but any questions people have I'll be happy to answer.

[treevernal]

Very interesting! Glad to hear your consult went well and that you'll possibly be able to get surgery done soon! Just out of curiosity, did he mention anything about possibly reversing the genioplasty or did he not think it was necessary?

[ReoSity]

Very interesting! Glad to hear your consult went well and that you'll possibly be able to get surgery done soon! Just out of curiosity, did he mention anything about possibly reversing the genioplasty or did he not think it was necessary?

No he didn't actually although he did say he probably would have moved it only 4-6mm since I'm getting significant movement of the lower jaw. In fact there was a concern my chin would be too strong but the digital projection showed that my chin would be pretty much in the perfect position after surgery.

[qwertz1]

hi,

this was all in one appointment?

-3.7mm upward movement of my upper jaw
-forward movement of the upper jaw (don't know the value)
-cheek augmentation (he said it was necessary and due to the space the upper jaw leaves when moved)

can you tell me more about this? 4 mm upper jaw movement doesnt seem too large so I wonder how they decide whether cheek augmentation is "necessary".
did he say why you were a candidate for that?

[Christina28]

I am curious about the 3.7 mm impaction of the upper jaw. It does seem small for 10 mm lip incompetence. Not having the joint issues is great, many patients that need surgery do.

[ReoSity]

hi,

this was all in one appointment?

Yep.

can you tell me more about this? 4 mm upper jaw movement doesnt seem too large so I wonder how they decide whether cheek augmentation is "necessary". did he say why you were a candidate for that?

That I don't know and will bring up again, I'm still in the very early stages as you know.

I am curious about the 3.7 mm impaction of the upper jaw. It does seem small for 10 mm lip incompetence. Not having the joint issues is great, many patients that need surgery do.

I agree, almost 4mm isn't a huge movement and honestly I should have pressed him more about this. I'm fairly certain though that the reason for only that much is my smile line and lack of gummy smile. Usually people with vertical maxillary excess show too much gum but I show maybe 1-2mm so more than 4mm of impaction and I would show too little teeth smiling and that's not esthetically pleasing. I do show 6.5mm of front teeth when my mouth is relaxed so after the surgery I'd show 2-3 mm which is ideal apparently.

I don't why I didn't ask these questions at the consult, I think I was just really excited to meet a doctor who could treat me. However I'll definitely communicate to Dr. Gunson that I'll compromise an "ideal" smile in heartbeat for total lip competence w/out mentalis strain.

And here's the before/after, Dr. Gunson said my lips would be slightly closer together since there software has trouble predicting lip position.

[ColoradoGirl]

As you may know, I had a great experience with Dr. Gunson; he knows his stuff as far as movements, etc., are concerned. My upper jaw moved 4mm and my lower over 18 (!), so it may be that your upper jaw is in a fairly decent position and doesn't need too much movement. But, I don't actually know how much my lip incompetence was, since I disguised it even from myself by pressing my lips tightly together at all times (which I still do and which looks really silly now, hehe). I'm sure I could find out; I just never asked.

Best of luck!

[ReoSity]

As you may know, I had a great experience with Dr. Gunson; he knows his stuff as far as movements, etc., are concerned. My upper jaw moved 4mm and my lower over 18 (!), so it may be that your upper jaw is in a fairly decent position and doesn't need too much movement. But, I don't actually know how much my lip incompetence was, since I disguised it even from myself by pressing my lips tightly together at all times (which I still do and which looks really silly now, hehe). I'm sure I could find out; I just never asked.

Best of luck!

I'm not too familiar with your case although I did see your before/after pics in one thread (you look great btw!) but I didn't see any lip incompetence. Did you have mentalis strain as well, where you chin dimpled up when you closed your lips? I do trust Dr. Gunson's judgment in general, his reputation is outstanding but if I'm paying that much money, I expect (near) complete correction i.e. total lip competence w/ strain, especially since I'm not an extreme case.

Oh and did you have cheek augmentation too?

[qwertz1]

while it looks very good I dont see a difference on the upper jaw or cheeks in your before-after. is that supposed to be included in the computer simulation?

I´d appreciate it if you let me know when you learn more about the "indication" (if there is such a thing for cosmetic surgery) for cheek augmentation in your case.

[ReoSity]

while it looks very good I dont see a difference on the upper jaw or cheeks in your before-after. is that supposed to be included in the computer simulation?

I´d appreciate it if you let me know when you learn more about the "indication" (if there is such a thing for cosmetic surgery) for cheek augmentation in your case.

The cheek augmentation isn't included, he pointed that out to me. And I'll definitely let you know, are you looking to have surgery Arnett/Gunson as well?

[treevernal]

Yeah, Arnett/Gunson's simulations do not show the associated changes to the nasal base or cheekbones. This is probably because it is so difficult to predict. Arnett told me though that the actual result looks better than the morph.

Btw, ReoSity, cosmetically speaking, you are so lucky to already have nice "throat length" (aka: a very defined neck/throat area pre-op) I can tell you're gonna look amazing after surgery. Arnett is doing a whopping 20.3mm pogonion (chin) advancement via a LFT1/BSSO on me and I still will not have quite the angular neck/throat area post-op that you have; so jealous! He told me it was because of the position of my hyoid bone; who knew?

[ReoSity]

No one's ever complimented my "throat length" before but thank you! Wow 20mm is a lot of movement, what are your jaw problems if you don't mind me asking? I can relate a bit to your case though, with the 8mm sliding genioplasty I previously had and the amount Dr. Gunson is moving, that will be 18 mm altogether!

[qwertz1]

The cheek augmentation isn't included, he pointed that out to me. And I'll definitely let you know, are you looking to have surgery Arnett/Gunson as well?

thanks.

no I'm with another doctor, I just suspect that cheek movement might be "necessary" once the upper jaw is where it's supposed to be. so I wondered in which cases it is because your upper jaw movement is rather small, too.
also wondering if I should bring it up myself...and how.

[treevernal]

Hey ReoSity,

I had braces as a teenager (which were done very poorly) resulting in a lot of dental compensation, facial decline, and arthritic TMJ joints. I've been a mouth-breather my whole life due to nasal obstruction (allergies/deviated septum) and that led to very little mandibular growth which led to my tongue obstructing my airway which led to obstructive sleep apnea, Yay! Hehe. Needless to say, it's taken me years to figure out what my underlying issues are after doing a lot of online research and finally learning about orthognathic surgery.

I'm starting braces this fall with an ortho Arnett recommended here in San Diego. How about you? When are you going to start braces?

[drgnchsr36]

Hey ReoSity,

I had braces as a teenager (which were done very poorly) resulting in a lot of dental compensation, facial decline, and arthritic TMJ joints. I've been a mouth-breather my whole life due to nasal obstruction (allergies/deviated septum) and that led to very little mandibular growth which led to my tongue obstructing my airway which led to obstructive sleep apnea, Yay! Hehe. Needless to say, it's taken me years to figure out what my underlying issues are after doing a lot of online research and finally learning about orthognathic surgery.

I'm starting braces this fall with an ortho Arnett recommended here in San Diego. How about you? When are you going to start braces?

Curious, which ortho are you using in SD? Just wondering