Some questions about surgery

[VanDerKluge]

Hi, I'm completely new here, so I hope this questions arn't too stupid. Please feel free to answer as many or as few as you want, any help is appreciated. I'm a 25 year old guy btw.

1. I have a long face and I was wondering if jaw surgery could help reduce my face length. Ideally I want to make my face less long but I would like to have a masculine jaw too. Can oral surgery help achieve this? What kind of procedures will they do?

2. What kind of costs am I looking at for this sort of surgery. I know it's hard to say precisely, but a ball park figure would be really usefull.

3. I have a decent income, so I payment shouldn't be too much of a problem (hopefully), but is it hard to get a surgeon to agree to the surgery in the first place? I don't my face is that bad (but it could be a lot better) and I have some worries they will refuse to perform surgery. Is this likely, or are they usually pretty easy going about it?

Sorry for all the questions, I will be extremely thankfull for any help.

[Marisama]

1.
It really depends on you individual situation. The majority of people get lower, upper or double jaw surgery. For a long face and a weak jaw, I would imagine you'd get double jaw surgery, consisting of a BSSO and Leforte 1. Don't take my word on it.

2.
Orthognathic surgery can be very expensive. It depends on your surgeon and what type of insurance you have. Sometimes insurance will cover it entirely and sometimes not at all, especially if it is cosmetic. I've heard figures from $10K to upwards of $50k.

3.
Usually a maxillofacial surgeon will perform surgery if he sees there will be enough benefit. Even slight cosmetic issues could have underlying functional problems. Again, it depends.

Good luck and ask more questions if you have any.

I have yet to have surgery but I've been lurking around here for a long time.

[chicago29]

First off, it sounds like you're contemplating this surgery for purely cosmetic reasons. If your bite is good and your teeth are satisfactory, I would not contemplate this surgery. That's just my opinion, and obviously you're free to do what you feel is best for you.

That being said, here is my opinion on your questions:

1) It depends on the complexity. For a long face that is almost always a bi-maxillary (double jaw) procedure. Your upper jaw will be impacted and moved forward, and your lower jaw will be moved forward. Also keep in mind that orthognathic surgery is not really going to vastly improve your jaw line. It might define it more for those that had no definition before surgery, but do not think for a second you're going to come out of this with a jawline like you see on the catwalk. It isn't going to happen, and if somebody says it will, they're lying to you.

2) In the US, surgical fees for a bi-max range from $15K to $50K, depending on where and who you have do the surgery. Those upper amounts are for the "rock star" surgeons (I won't mention their names but you can find them by searching this message board), but those guys are not going to operate on somebody for purely cosmetic reasons. Figure another $5K for anesthesiologist, and a 2 night hospital stay that will likely be around $25K to $30K. If this isn't medically necessary that means all of this is out of pocket. You should negotiate heavily on everything you can, but do be warned that most oral surgeons won't negotiate their fees that much. Tack on another $5K for miscellaneous things like pre-surgery tests, prescriptions, and just things you don't plan on.

3) Any reputable surgeon will try and talk you out of doing this for purely cosmetic reasons. However, if you search hard enough, you're bound to find somebody that will do it.

I hope this helps. If I were you, I'd think long and hard before going down this path. This surgery, generally speaking, is for people that have bite issues and misaligned jaws. Yes, we get cosmetic benefit from it, but that's not the primary motivation for a vast majority of patients.

Best of luck to you.

-Chicago29

[VanDerKluge]

First off, it sounds like you're contemplating this surgery for purely cosmetic reasons. If your bite is good and your teeth are satisfactory, I would not contemplate this surgery. That's just my opinion, and obviously you're free to do what you feel is best for you.

That being said, here is my opinion on your questions:

1) It depends on the complexity. For a long face that is almost always a bi-maxillary (double jaw) procedure. Your upper jaw will be impacted and moved forward, and your lower jaw will be moved forward. Also keep in mind that orthognathic surgery is not really going to vastly improve your jaw line. It might define it more for those that had no definition before surgery, but do not think for a second you're going to come out of this with a jawline like you see on the catwalk. It isn't going to happen, and if somebody says it will, they're lying to you.

2) In the US, surgical fees for a bi-max range from $15K to $50K, depending on where and who you have do the surgery. Those upper amounts are for the "rock star" surgeons (I won't mention their names but you can find them by searching this message board), but those guys are not going to operate on somebody for purely cosmetic reasons. Figure another $5K for anesthesiologist, and a 2 night hospital stay that will likely be around $25K to $30K. If this isn't medically necessary that means all of this is out of pocket. You should negotiate heavily on everything you can, but do be warned that most oral surgeons won't negotiate their fees that much. Tack on another $5K for miscellaneous things like pre-surgery tests, prescriptions, and just things you don't plan on.

3) Any reputable surgeon will try and talk you out of doing this for purely cosmetic reasons. However, if you search hard enough, you're bound to find somebody that will do it.

I hope this helps. If I were you, I'd think long and hard before going down this path. This surgery, generally speaking, is for people that have bite issues and misaligned jaws. Yes, we get cosmetic benefit from it, but that's not the primary motivation for a vast majority of patients.

Best of luck to you.

-Chicago29

Hi, thanks for the help guys. It is for cosmetic rather than functional reasons. Why? Because you only live once and I want to look and feel as good as I can. I work out every day, but that can only do so much. I want to look my best, this is shallow, yes, but we live in a rather shallow world where people will make snap judgements about others based on appearances.

I have some follow up questions for both of you if you don't mind:

1. You say it won't give me a 'catwalk' jaw line, why is this? Surely they can make it an ideal shape?

2. You also say some surgeons will try to talk me out of it. Does this mean they will flat out refuse if they cannot persuede me to change my mind or that they will still do it if it's still my wish? If not, and I have to look elsewhere, is it safe to trust a surgeon willing to perform the op for cosmetic reasons? And if I were to tell a more reputable surgeon who is trying to talk me out of it that I will just go to other surgeons could this cause him to change his mind?

I understand the risks, but I truly want this to happen (and accept the dangers that go with it). I doubt anyone can persuade me otherwise.

Thanks for the answers, they were both extremely helpful to me.

[chicago29]

I'll try my best to answer. Also keep in mind I'm not an oral surgeon...just an informed patient

1) A 'catwalk' jaw line (I made this word up) is genetic. You either have it or you don't. In addition, musculature and soft tissue play a great deal in a pronounced jaw line. Surgery does not impact those things - at least for the positive. Orthognathic surgery will not take an undefined jaw line and make it pronounced. It's impossible. If this is your goal, look at jaw implants and talk to a plastic surgeon

2) When somebody has a good bite, the oral surgeon's job is limited. Your jaws must be moved in tandem in order to keep a good bite. This may or may not even be possible depending on how your jaws currently align. Most oral surgeons will NOT operate on somebody when there is no medical benefit. As I said, if you try hard enough you'll find one. Would I want the person I found to operate on me? Hell no...but that's just me. And, you're never going to change an oral surgeon's mind that feels they are doing what is best for you.

I don't mean to sound callous, and trust me...I get how society is with appearance. But, I also know that we as individuals often make a bigger deal out of things than they really are. I'd be willing to bet 5% of the population EVER notice your jaw structure. Now, if you're like most of us that have had to have surgery with misaligned jaws and overbites, underbites, crooked teeth, etc...then that 5% goes up to probably 100% of people that notice. And, there are many other bad things we have to deal with outside of what society may think...

If "looks" are your primary concern, I think you need to deal with those feelings through counseling. And, if you still feel this cosmetic work is necessary, see what a plastic surgeon says. Honestly, they often can work wonders in a much less invasive and risky procedure...

I truly feel orthognathic surgery is NOT a good idea in your case. I'm not saying that to be hurtful - I just hate to see somebody go into this surgery with false expectations. Once again, this is just my opinion so take it with a grain of salt.

I wish you the best...

-Chicago29

[beowulf68]

I think Chicago29's Last Post was spot on. If one is considering a major jaw surgery like a bi-max for purely cosmetic reasons and has no functional deficit or other problems like Obstructive Sleep Apnea, they should really think twice!

I'm having both of my jaws moved forward because I have pretty severe Obstructive Sleep Apnea and even though I have the Apnea (which could kill me if left untreated) issue my surgeon asked me multiple times if I really wanted to go through with the surgery. The surgeon was quite frank in stating that he was going to "break my face" and then adjust everything to eliminate the Sleep Apnea.

Bottom line....This type of surgery isn't something to take lightly!! Hopefully after doing research and talking with enough people you can make the best informed decision for you.

Good luck to you!!!

[Broadway Bill]

I agree with Chicago as well. Just 2 days post-op, but I can safely say two things:

I'm happy ruth my results
This would NOT be worth it for purely cosmetic reasons.

I had a serious underbite, and it affected nearly everything in my life. I had constant headaches from trying to correct it, my teeth were suffering because of my chewing patterns, and it gave me some self esteem issues to boot. That said, if the only issue was self esteem, it would not be worth it. It is a major, painful and intrusive procedure, and ideally (for me at least) the final outcome is subtle, as opposed to suddenly looking like a model. I just want to look like myself, but with a healthy bite. Already, after only 2 days, the most exciting thing is that I can feel with my tongue that my lower jaw no longer juts out, but that's not something others will notice immediately.

[mountaingirl]

I think it's important to be aware there's a chance you may not be happy with the cosmetic result of surgery. Then again, you could be very happy. I totally support people doing surgery for cosmetic reasons if they strongly dislike a feature about themselves. I had my surgery for functional reasons and do think my face is less pretty post surgery even though braces and surgery and supposed to improve appearance. Once you have the surgery you can't take it back so just be sure before you go ahead with it.

[sarahorsomeone]

Hi, I'm completely new here, so I hope this questions arn't too stupid. Please feel free to answer as many or as few as you want, any help is appreciated. I'm a 25 year old guy btw.

1. I have a long face and I was wondering if jaw surgery could help reduce my face length. Ideally I want to make my face less long but I would like to have a masculine jaw too. Can oral surgery help achieve this? What kind of procedures will they do?

2. What kind of costs am I looking at for this sort of surgery. I know it's hard to say precisely, but a ball park figure would be really usefull.

3. I have a decent income, so I payment shouldn't be too much of a problem (hopefully), but is it hard to get a surgeon to agree to the surgery in the first place? I don't my face is that bad (but it could be a lot better) and I have some worries they will refuse to perform surgery. Is this likely, or are they usually pretty easy going about it?

Sorry for all the questions, I will be extremely thankfull for any help.

1. It'd be worth pointing out.. that although jaw surgery can shorten the appearance of the lower face; either by maxillary impaction (shortening the upper jaw vertically) or/and shaving a bit of bone off your chin. It'll only shorten the appearance of your lower face and not the midface or forehead. Therefore if your lower face isn't allready disproportionatly long, by having it shortened you'll then make it look disproportionatly short! In other words, it'll make your lower face look squashed up and the rest of your face look abnormally long! You'll be able to find diagrams online, but I think your lower face (chin to nostrils) is supposed to ideally be the same length as your mid-face (chin to brow?) for the best aesthetics.

Also, if you have a maxillary impaction (which will be the way to make the biggest change), and you don't have a gummy smile and/or lip incompetance (lips that don't meet), you could end up showing your bottom teeth rather than your top teeth when you smile, or even having puckered lips like an old man without his false teeth. This is because you'll be shortening the bone structure, but the soft-tissue and skin will still be exactly the same!

As for giving you a more masculine jaw-line.. the only time I've seen people ending up with a more masculine jaw line from orthognathic surgery is when they've had a recessed lower-jaw (overbite) advanced. If you have a good bite and had your lower-jaw advanced you'd just end up with an underbite! They're may well be other surgeries that can achieve this, I don't know.. but I doubt orthognathic surgery will do too much in this deparment.

2. Well my double jaw surgery in the UK has come to about £6,000... but most people in the US (or even in the UK) seem to have paid an awful lot more than that. Most people have to pay for their braces too, which I didn't.

3. I can't speak from experience, because my issues were partly functional but if you have no functional problems, and nothing actually abnormal about your jaw position/structure; I can see how it might be tricky to get a reputable surgeon to do this. I wonder if this surgery would even do anything to physically enhance your appearance, but I can't say without a picture (and even then I couldn't say for sure, not being an orthognathic surgeon ).