Debating LeForte, in addition to BSSO and TMJ Arthoplasty

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#1 Post by **allisonh** » Sun Apr 20, 2008 9:44 am

So, my surgery got pushed back to mid-August because my orthodontist said my teeth would not be ready at that point. Part of me is happy, because I think I can squeeze in a triathlon and some summer fun before surgery, but part of me wants to just get the darn thing over with.

So, in my waiting period, I am now starting to debate adding on a LeForte I, in addition to my BSSO and TMJ Arthoplasty. The surgeon said it wouldn't be neccessary, especially since we are paying cash (and a lot of it) for the surgery, but that it is an option to reduce the appearance of gum tissue. At first, I thought that since it isn't necessary, no thanks. But now that I have had some time to think about it and look at some pictures, I am starting to change my mind. While I dont think I show a lot of gum in my pictures, looking over some pictures, I am noticing that I kinda look like a gummy horse. So, any advice or opinions would be appreciated. My husband is kinda leaning toward having me get it done, but then again, he doesn't have to directly go through it, just listen to me whine and help me recover, which will probably be a pain of a different sort.

Pictures of a recent trip to Disneyland in Feb08- If I consciously think about my smile, I can avoid the gums, but its seems like if I am actually happy, the ugly gums appear. So, do I just fake it or go for the surgery and finally allow myself to be happy without worrying about people teasing me?

So I think its obvious where I got the gums from... (thats my mom)

#2 Post by **allisonh** » Sun Apr 20, 2008 9:45 am

I swear I resized the photos on photobucket but it didnt seem to take....

#3 Post by **phil** » Sun Apr 20, 2008 10:13 am

allisonh,

My personal opinion for you would be to avoid the LeFort I if you can. I think that you have a lovely smile, by the way!

I might pose this question to you, since apparantly you are a person with TMJ issues--would adding the LeFort I also possibly complicate that by slightly changing the gonial angle? It's just something to consider. Studies also show that orthognathic surgery in most cases does not improve TMJ issues, and in some it makes it worse. Anyway, all of this is something to ask your surgeon about. If he looks puzzled when you ask him all this, you might seek out a second opinion, just to be on the safe side.

In my opinion, it wouldn't be worth the potential risk of complicating TMJ matters, just to not have a gummy smile. Best of luck to you as you make your decision!

#4 Post by **suetemi** » Sun Apr 20, 2008 10:25 am

Are you having a lower advancement? If so , isn't it possible that the gum exposure will be less noticeable once the lower teeth are further forward and visible in your smile? i.e. maybe the gumminess of your smile is exaggerated by the imbalance between your two jaws. just my opinion. i will be getting a lefort and do not look forward to the risk of damaged tooth roots, the splint, the sinus problems, etc.

#5 Post by **allisonh** » Sun Apr 20, 2008 10:33 am

On the TMJ issue, I am actually having a TMJ arthroplasty, where they are actually going to stitch my joints back into place and do a complete reconstruction. As for the lower jaw advancement, it is what caused the TMJ. I have a Class 3 Overbite and in order for me to eat and talk, I actually dislocate my jaw in order to bring it forward. At this point, I can barely talk and eat because there is such a difference. So, the BSSO is 100% necessary. I actually had a TMJ arthrogram, where they injected dye into my jaw space and did a live x-ray and cat scan where they could track the movement of my jaw and jaw condyl as I open and close my mouth. It revealed major dislocation and displacement on both sides. It was pretty cool to get a real answer and i guess portland and the surgeon I am seeing is one of the few surgeons who actually has access to this test and does the TMJ arthoplasty.

Thanks for the compliment on the smile... I hate it right now. I work with kids and they can be the toughest critics. I get so many laughs about how I need to go to the dentist. I guess I am really self-conscious, but with good reason. I have been teased since I was little about my teeth and my smile. I even had a guy walk up to me in a bar and tell me I might be pretty if I actually fixed my smile. I guess I am just worried about doing this right the first time, or having regrets later that I didnt do the upper as well. I really just want to be able to smile and be happy!

#6 Post by **phil** » Sun Apr 20, 2008 10:43 am

allisonh,

My opinion again...the guy in the bar was SO NOT WORTH IT! Oh my goodness. If someone can only love you without a gummy smile, do you really want to date him anyway???

#7 Post by **ohmyjaw** » Sun Apr 20, 2008 1:26 pm

Hi Allison,
I agree with Phil - you do have a beautiful smile, and the guy in the bar needs someone to teach him a few manners. You already look great; whatever you do is going to be icing on the cake.

I had my upper jaw shortened as part of my surgery. I needed a lefort in any case, because I needed to have my upper jaw expanded as well as moved forward. In addition to that, I had a slightly gummy smile, and some lip incompentence. So I had all that fixed. I'm very happy with the result.

Do your lips close easily when you relax your face?

#8 Post by **allisonh** » Sun Apr 20, 2008 2:55 pm

thanks everyone for the support. Phil- I really like your presonal goal.. it is mine as well! OMJ- My lips do not close right now, because my lower jaw is severely recessed, I can with some effort, and right now, elastics. I went for a run, and thought about it, and I think I am just going to stick with the necessary. If there was any complications (such as I am prone to excessive bleeding, and I hear that is a problem with the upper jaw) I would regret doing it. I guess I will be happy enough with the lower jaw, Im sure it will change everything, it might even help with the gummy-ness on my upper teeth, especially once these darn braces are off.

Thank again everyone.