Am I crazy for wanting this surgery for cosmetics?

[onetwo34five]

Hello all,

I'll start by saying I am 21M. I've noticed for a long time something about my face was "off". For some reason, I never felt like I was attractive or looked like others around me ("normal") growing up from middle school onwards. I realize now that this is likely caused by the fact that I have a recessed mid-face as well as recessed chin. My looks are driving me insane. It's one thing to be average and to want cosmetic surgery, and it's another to be ugly and to want to feel normal. Unfortunately, through "external feedback", I'm afraid I belong to the ugly camp and it seems like orthognathic surgery is one of my few options.

I'll try to keep the backstory short- As a child I had very prominent features and was attractive. Near the start of middle school I started braces, along with headgear and elastics. This is where I believe things went wrong. It seems like my face came out of orthodontics looking recessed and objectively ugly. I believe the restrictive orthodontics I was "treated" with did a lot more harm than good, and this is something that causes me extreme anxiety every single day. Now, I'm left with a perfect bite and teeth, at the expense of a recessed mandible, recessed mid-face, and some functional issues I'll get into below. I HATE looking at pictures of myself when I was younger (and more-so pictures of myself today), because I feel like I was robbed of basic happiness. It doesn't matter what I do to improve myself (and I've done quite well for my age), being ugly makes you invisible.

My question to you all is this: is it crazy to want orthognathic surgery to fix these issues? I'm extremely upset at the orthodontic path I was taken through at an age where I was too young to understand the implications. The functional issues I'm left with include TMJ (popping, clicking when eating, along with pain), trouble swallowing (maybe not related?), trouble speaking clearly (maybe not related?), trouble breathing through nose at any time other than at rest (small airways?), along with possible (undiagnosed!) sleep apnea resulting from aforementioned airways. I'm terrified that I'm in the orthognathic surgery grey-zone, where I would greatly benefit from the surgery, but don't have a severe enough case to qualify for insurance coverage.

Sorry for the wall of text. Is there any hope that orthognatic surgery may help fix my cosmetic and functional issues? I should also mention that my face is obviously asymmetric as well (more-so than normal), probably as a result of some pretty pronounced spinal curvature (which has been diagnosed). Any hope to fix, or at least improve this? Despite doing objectively well in life, I feel defeated and would really like to not have to live like this (please don't give me the "looks aren't everything" rant, they DO matter, especially when they're deficient. I very much wish I could tell you I'm blowing this out of proportion, I am not). I have a consult scheduled for a week from now with a surgeon, but I'm afraid I won't be taken seriously because my bite is great. Any insight on my situation is appreciated.

[snapdresser]

My question to you all is this: is it crazy to want orthognathic surgery to fix these issues?

That's not crazy at all. As long as you go into it expecting improvement but not perfection, I think you'd probably be very happy with your results. I would strongly recommend that you go ahead and get a prescription for a sleep study from your doc. Many insurances will cover orthognathic surgery as a treatment for sleep apnea. If your insurance doesn't but your sleep study says you have sleep apnea, you should consider changing insurance plans to one that will cover it next year. It could save you tens of thousands of dollars.

Also, you should register your account so you can receive PMs. Welcome to archwired!

[glennstanzalone]

No, not crazy at all. I'm getting this for equal parts functional and cosmetic. It's important to be symmetrical and attractive to yourself.

[onetwo34five]

[quote="snapdresser"][quote="onetwo34five"]My question to you all is this: is it crazy to want orthognathic surgery to fix these issues?[/quote]

That's not crazy at all. As long as you go into it expecting improvement but not perfection, I think you'd probably be very happy with your results. I would strongly recommend that you go ahead and get a prescription for a sleep study from your doc. Many insurances will cover orthognathic surgery as a treatment for sleep apnea. If your insurance doesn't but your sleep study says you have sleep apnea, you should consider changing insurance plans to one that will cover it next year. It could save you tens of thousands of dollars.

Also, you should register your account so you can receive PMs. Welcome to archwired![/quote]

Hello snapdresser,

I hope you don't mind if I ask a few questions. Does orthognathic surgery have any effect on the mid-face? I'm thinking in the context of double jaw surgery when I ask this. I've seen massive improvements with geneio + lower to the chin (which I would love!), but less talk about the mid-face. Does it have any effect on cheekbones?

I will look into getting a prescription for a sleep study done. I believe my insurance does indeed cover jaw surgery for sleep apnea. Am I jumping the gun by meeting with an Oral Surgeon as my first step? I don't know what to expect going into the office. Is he going to take me seriously given my good bite?

How does one register their account?

Thank you everyone for the replies!

[snapdresser]

Instructions to register:
http://www.archwired.com/phpbb2/viewtopic.php?f=1&t=4

Though according to http://www.archwired.com/phpbb2/viewtop ... =1&t=37932 you have to post 7-12 times before you get the ability to send/receive PMs, so I guess just keep on keeping on

Maxillary advancement/impaction/etc. has a significant impact on the midface, but it will not affect your cheekbones directly, though you may see some additional "fullness" in the general area. It's difficult to predict how it will affect the soft tissues in your cheeks (as I was told by a top orthognathic surgeon), but I have more fullness in my cheeks below my cheekbones, on either side of my nose now. In your case (and in mine) it shortens the midface, which can lead to a generally fuller appearance, but it won't suddenly give you high cheekbones if you don't already have them. While on the topic, this surgery does seem to lead to a slippery slope. I'm not the only one who had it done and then said to myself "Hmmm... maybe I should get my nose touched up now. Or get my cheeks done..." That's related to my previous comment that you shouldn't expect perfection from this procedure. You will STILL have complaints about your appearance afterwards and it's a slippery slope into The Land of Too-Much-Cosmetic-Surgery

How seriously the surgeon takes you can vary. I saw 3 surgeons and in my experience, those surgeons who perform the surgery dozens of times a year will likely take you seriously, but also probably don't take ANY insurance; they'll take you seriously because they're pitching you procedures they want you to take out a loan to pay them for. Those surgeons who do the surgery more rarely but usually in cases where it's covered by insurance seem to be less likely to take you seriously if only because your bite is already good. In most cases where insurance covers it, it's because of bite issues, so if you present without bite issues, well, like you said, there's a good chance they'll say "That's a serious surgery. You don't need that." That's my experience; your mileage may vary.

[onetwo34five]

Thanks for the reply snapdresser.

By "fuller mid-face", what exactly do you mean? Is there a way you could provide me an example of what you're talking about? I seem to be seeing some kind of improvement in the mid-face of people who have undergone the surgery, but I can't quite put my finger on what exactly changed or improved, if that makes sense. Did the surgery give you a more "square" appearance in your face?

Are there any speaking impacts that the surgery will have (assuming after full recovery)? I have a hard time speaking clearly, and I've heard that speech for some is improved as a result of the surgery. Was this the case in your experience?

As a side note, I'm thinking of seeing an ENT doctor to get my airways examined to see if they are abnormally small. This would explain the difficulty breathing through the nose that I'm having, and could possibly help to build a case for the surgery? Again, I'm terrified that I'm in that "Orthognathic Grey Zone"!

[snapdresser]

By "fuller mid-face", what exactly do you mean? Is there a way you could provide me an example of what you're talking about?

By "fuller mid-face", I mean that my face is puffier directly below my cheekbones, and about 1/4" away from either side of my nose. It appears less shallow in that area now. I don't think I would describe it as a more "square" appearance. That would be from something like a mandibular angle implant. To expect malar implant- or mandibular angle implant-type results from this surgery would be a mistake. You will not look like you got malar implants or mandibular angle implants. Those would have to be separate surgeries **see previous comment on slippery slope**

I can't speak to any changes in speech. I did not experience any change in my speech, but I didn't have any speech issues before the surgery. That would be a question for your surgeon, though I have a feeling they'll tell you the answer is "maybe". But you won't know unless you ask!

Yep, I think that's a good idea to see an ENT and try to build a case for the surgery. I think referrals for sleep studies are generally based on the symptoms you report to your doctor, however. A LOT of people are considered to be in that "Orthognathic Grey Zone" by their insurance company, whether rightly or not. It's par for the course to have to appeal your insurance's denial. The letter from your surgeon will really be what makes or breaks your case. If they know what to put in the letter, that will help tremendously. Again, your mileage may vary.

[onetwo34five]

I visited an oral surgeon today for a consult. I have to say I am both happy and disappointed with the results.

I had x-rays taken. Regarding my bite, it is perfect. I knew this before. Previous orthodontic work "fixed" that (at the expense of actually looking good), that was never an issue. My airway was normal sized, he had guessed anywhere from 12mm to 14mm by looking at the x-ray, which from what I understand is great. Sleep apnea was unlikely in his opinion. I'm happy that I'm considered healthy!

The trouble I have breathing through my nose is likely because of an enlarged turbinate on my right side and a deviated septum. This could be fixed through surgery, but would be unrelated to jaw surgery from my understanding. Regarding facial aesthetics, he suggested a genioplasty or chin implant, and suggested the same guy who could do the nose surgery could do one or the other at the same time. The surgeon told me there wasn't much he could do to help my swallowing situation (or at least that he knew of yet) regarding jaw surgery.

I am disappointed because it sounds like jaw surgery is not an option for me to fix the aesthetics of my face anymore. I'm still half convinced that previous orthodontics moved my face back, ruined the appearance of my face, and now nothing can be done. Sure, a genioplasty would help, but it doesn't address the mid-face, and it doesn't address the fact that I'll probably get sleep apnea in the future as many people with receded mandibles and maxillas develop as a result of headgear and restrictive orthodontics. If I went that route, I feel like I'd simply be masking the problem. That's not what I'm after! The one plus side is that a genioplasty could address asymmetry in my jaw, that would be a big plus, but still! It looks like the only leg I have to stand on is speech articulation and the trouble I have with that, which seems like a pretty big stretch at this point to undergo double jaw surgery.

I refuse to "mask" an underlying issue which I know is there. My face does not look or feel healthy. I don't look like my parents or my brother. I definitely don't look like myself pre-puberty. I just look ugly. I hate being unhappy and invisible. Spending the prime years of your life discontent with yourself a terrible feeling I'd wish on no one. I'm in good shape, make great money, and am otherwise healthy, but what does it matter?

[snapdresser]

make great money

Well then, maybe you can still consider orthognathic surgery! People report out of pocket costs of $25-100k+ in cases where their insurance won't pay for it. Most people finance it, but maybe you can pay cash there, Mr. Moneybags! But seriously, if it's something that you still really want and think will make a significant difference in your life (I know it did in mine) then you should still consider it if the cost isn't prohibitive for you!

[glennstanzalone]

make great money

Well then, maybe you can still consider orthognathic surgery! People report out of pocket costs of $25-100k+ in cases where their insurance won't pay for it. Most people finance it, but maybe you can pay cash there, Mr. Moneybags! But seriously, if it's something that you still really want and think will make a significant difference in your life (I know it did in mine) then you should still consider it if the cost isn't prohibitive for you!

I was going to say that too. Financing a 50k surgery shouldn't be a big deal. Or just get plastic surgery. Cheek/Chin/Nose. Take a home equity loan?

[onetwo34five]

[quote="snapdresser"][quote="onetwo34five"] make great money[/quote]

Well then, maybe you can still consider orthognathic surgery! People report out of pocket costs of $25-100k+ in cases where their insurance won't pay for it. Most people finance it, but maybe you can pay cash there, Mr. Moneybags! But seriously, if it's something that you still really want and think will make a significant difference in your life (I know it did in mine) then you should still consider it if the cost isn't prohibitive for you![/quote]

I guess I'm still considering this as an option.

Is there any way I could get this done for $25K? Would Orthodontics be covered by insurance at all? Would the hospital stay be covered by insurance at all? Do surgeons even so this procedure for mostly cosmetic reasons?

Is going abroad an option? Has anyone gone abroad for this kind of surgery and coordinated the orthodontics?

[snapdresser]

Is there any way I could get this done for $25K? Would Orthodontics be covered by insurance at all? Would the hospital stay be covered by insurance at all? Do surgeons even so this procedure for mostly cosmetic reasons?

Is going abroad an option? Has anyone gone abroad for this kind of surgery and coordinated the orthodontics?

I'm not sure exactly who would do it for $25k but you might be able to find someone. The issue becomes the hospital and anesthesiologist. If you find a surgeon willing to do it for cheap, you'll still have to shell out for those other things. The surgeon would probably cut you a deal simply because you're paying out of pocket. The anesthesiologist and hospital, probably not so much Typically orthodontics isn't covered by insurance, but if your bite is perfect, you only need archbars (that's what I had), which ARE covered by insurance. The hospital stay is typically covered by insurance with some copay. ***Insurance benefits vary greatly from plan to plan. Check the brochure for your insurance plan***

I would guess that most surgeons rarely do this surgery for purely cosmetic reasons, because the cost is prohibitive for most people. That said, most seem to be aware of the cosmetic impact and know what rules they should follow to get good cosmetic results. My surgeon took into account the ideal dental angles, ideal facial measurements, counter-clockwise rotation procedures, etc. and I'm very happy with my results aesthetically.

Going abroad IS an option, but one I wouldn't resort to unless absolutely necessary. Considering the number of people just on this forum who aren't happy with their initial results and want a revision, you'd probably be hosed if you went overseas for it. Following up for plate/screw removal in cases on infection would be very difficult too, and God forbid they really screwed up, you wouldn't be able to file a claim against them for malpractice/damages/whatever. With your financial situation, I wouldn't even consider it.

[onetwo34five]

[quote="snapdresser"][quote="onetwo34five"] Is there any way I could get this done for $25K? Would Orthodontics be covered by insurance at all? Would the hospital stay be covered by insurance at all? Do surgeons even so this procedure for mostly cosmetic reasons?

Is going abroad an option? Has anyone gone abroad for this kind of surgery and coordinated the orthodontics?[/quote]

I'm not sure exactly who would do it for $25k but you might be able to find someone. The issue becomes the hospital and anesthesiologist. If you find a surgeon willing to do it for cheap, you'll still have to shell out for those other things. The surgeon would probably cut you a deal simply because you're paying out of pocket. The anesthesiologist and hospital, probably not so much Typically orthodontics isn't covered by insurance, but if your bite is perfect, you only need archbars (that's what I had), which ARE covered by insurance. The hospital stay is typically covered by insurance with some copay. ***Insurance benefits vary greatly from plan to plan. Check the brochure for your insurance plan***

I would guess that most surgeons rarely do this surgery for purely cosmetic reasons, because the cost is prohibitive for most people. That said, most seem to be aware of the cosmetic impact and know what rules they should follow to get good cosmetic results. My surgeon took into account the ideal dental angles, ideal facial measurements, counter-clockwise rotation procedures, etc. and I'm very happy with my results aesthetically.

Going abroad IS an option, but one I wouldn't resort to unless absolutely necessary. Considering the number of people just on this forum who aren't happy with their initial results and want a revision, you'd probably be hosed if you went overseas for it. Following up for plate/screw removal in cases on infection would be very difficult too, and God forbid they really screwed up, you wouldn't be able to file a claim against them for malpractice/damages/whatever. With your financial situation, I wouldn't even consider it.[/quote]

I'm thinking the hospital stay may be covered by my insurance. I'm very lucky to have some really good insurance with almost non-existent co-pays. If hospital stays are typically covered (even after elective surgeries), then this may not be an issue. I'd have to contact my insurance provider to verify of course!

Do you mean that orthodontics isn't covered by medical insurance? I do have dental insurance as well, which did cover a large part of my braces when I had them before. Perhaps this would be covered? Not sure!!!

Another thing which may be to my advantage - I have a deviated septum and a turbinate that interferes with my breathing through my right nostril (the oral surgeon I initially consulted with told me this after reviewing my x-rays). He suggested I would likely be a candidate of surgery for that, so he mentioned a discounted genioplasty might an option if I did both at the same time since I would be under anyways, thus saving on anesthesia costs. Instead of doing the genioplasty / septioplasty combination, perhaps I'd be better suited finding a surgeon who can do the septioplasty / double jaw surgery combo at the same time and save on anesthesiologist costs???

I live very near the University of Minnesota, which is a very large dental / surgery teaching hospital. I know they do double jaw surgeries there, I just don't know if they'd do a cosmetic case. I wonder if I may be able to get some "bleeding edge" medicine there for cheaper than if I were to go private? Their surgeons-in-training would likely benefit from the experience of seeing / doing a CCW on someone, and I'm thinking the costs may be more reasonable than a private practice? Just a thought.

That being said, is $25k realistic assuming no braces (bite is perfect, teeth are straight), no charge for hospital stay, and discounted anesthesia? It's going to take me a while to save up for this, but I've been doing a lot of thinking on what would make me the happiest. I've pretty much decided that I would much rather spend the outrageous amount now while I'm young and be happy with my face for once in my life. When it comes down to it, my friends have spent that or more on new cars or trucks alone their first years out of school. Also, I should correct my statement above - I don't make GREAT money, I make okay money, but I'm a huge miser!!

[longmidfaced]

Hey I'm another case of wanting surgery for cosmetic reasons.

Although I definitely need an orthodontic treatment which is probably going to start in a few weeks, I'm not sure I'll qualify as an orthognathic surgery candidate.

My midface length bothers me too ! Our stories seem quite similar, to be honest. Viewing old photos of me as a child (9-11 years old) one would say I had the potential to look good when I grow up and hit puberty.

But unfortunatelly things did not turn that way.

For some reason my face got disproportionate and while there are definitely some ways to improve it, I always think that my midface length holds me back from looking the best I can.

I wish you the best with your surgery if you manage to get it !! Contact me if you feel like it.

[LyraM45]

Just my .02, but I absolutely would not go through all of this purely for cosmetics. Soft tissue changes from this surgery can not be promised. You can hope for a certain change, but you may not get it. And what's worse, you may not like what you end up with, and then there is no going back. But, to each their own. As long as you are well aware of the risks (and what I just described as a possibility of happening as a risk-- you may not be happy after or you may not see major aesthetic changes and feel you went through it for nothing), then I guess push forward with it if it's what you truly want and believe the risk is worth the reward in your situation. I'd advise you to love you for you now and then see surgery as whatever happens would be a bonus. I've seen way too many people who do it for cosmetics and then end up disappointed on the other side because they found out it wasn't the ultimate fix all they were looking for.