Deflated :(

[PrincessLea]

Hi guys,

I had my appointment with my surgeon and pre op today and was hoping to find out all the details about my surgery as its 4 weeks today! This is the first time I've seen my surgeon since before all of the treatment started and I have probably only seen my ortho about 3 times since treatment started! They didn't book my impressions, pictures and xrays prior to this meeting so i was wondering how it was going to work.

She originally said at the beginning she was 99% sure she wanted to do bi max for my open bite and I was really happy as I don't like my weak jawline. When I saw her she looked at me and said she couldn't make a decision or go through things with me as she didn't have the impressions and the shape of my arches have changed a lot. At this point it looks like she wants to just do the top jaw. (Apparently my bottom teeth have moved a lot more out than expected leaving a smaller gap and she likes the placement of my top teeth atm so didn't really want to bring bottom forward and top forward) I mentioned my weak jawline and she agrees with me - its like me skin on my neck just has no where to go and kind of looks stretched up to chin?? If you know what I mean. Now she is toying with the idea of chin work and top jaw. But......... I don't find out now until 1 week before surgery. I know this isn't then end of the world but there was such a build up to the meeting I'm just absolutely gutted now. I think also because I've had it in my head bi max to say one jaw feels weird?? Don't know why as I know they know what they're doing but...

Don't know how long I'll be in hopsital for, how long off work, how long no chew, how long banded shut etc as couldn't ask the q's because she hasn't decided what she's doing she can't answer!

then to add more confusion when I went in to see my ortho he disagrees and thinks the lower jaw should be done geeeez. I feel blue Sorry for the big moan!!!!

[CaliforniaKid]

have you considered a chin or jaw implant?

[sirwired]

Sounds like the ortho needs to get a set of impressions and x-rays over to the OMFS's office and have a chat with them before the OS does the "model surgery" (this is where the OS hacks up the models to figure out exactly where you are going to be cut.) Proper co-ordination between the OMFS and the ortho is crucial, and it sounds like they aren't talking to each other. If I were in your place, I'd refuse to schedule a surgery date until the two get the plan worked out.

As a side-note, the standard for surgery nowadays is to NOT band you shut. This was necessary before the advent of "internal fixation" (the permanent titanium plates and screws that hold the surgery together.) Now, the most common thing is to unwind your surgical wires at the end of the operation. Banding shut still happens occasionally , but it isn't nearly as common as it used to be.

[keeponsmiling]

That is so frustrating, and not the sort of thing to fill you with confidence this close to surgery at all - I really sympathise with you. I think when they impact the upper jaw, they can't always predict how far the lower jaw will rotate, and that's why it's crucial for them to have impressions of where your teeth are now and do a practice surgery. Have they booked all those appts in for you now? Another thing my surgeon did was cut up my X-rays and match them to photographs to try to see how altering the bone structure would alter my features. You should get to see all this before you agree to surgery, but my worry would be that if you don't like what they present to you there will be very little time to make a 'plan b' before your surgery date. That said, it's apparently quite straightforward to get chin surgery a few months after jaw surgery when you've had a chance to let the swelling go down and see you new face.

As for all the questions about time off etc, doctors seem to be annoyingly vague on that score from my experience! I guess because it varies so much from one person to another. It's unlikely you'll be wired shut but expect heavy banding, and even if your diet isn't liquid it'll still be soft/no chew for at least a couple of weeks I'd have thought. As for time off work, it'll depend on your job and how physically demanding it is. Ultimately these are all unpredictable and I think you'll find more answers here than from your surgeon as they just haven't experienced it first-hand.

Still - I think you're very much entitled to a big grumble!!

[PrincessLea]

Thanks for your replies guys!!! Its good to know other people would feel a bit poo in this situation and I'm not just being crazy!

@Californiakid - i'd never considered prior to yesterday but this is now something the surgeon is looking into! I'd be really interested to see some people who have a similar profile to me that just had upper jaw and chin work!

@sirwired - they did the impressions and xrays yesterday thankfully so my surgeon should be looking over them and doing the mock surgery on some kind of machine. No chance of not scheduling the op date as that has been scheduled in for months. Need to keep this one too as its been strategically planned around other stuff going on atm. I was told yesterday that I will be banded shut afterwards. The pre op nurse said it will be the day after surgery. Tightly for 2 weeks so liquid only, loosened a little bit for two weeks so very mushy stuff, then loosened a bit more for 2 further weeks so soft foods! that was when she said for bi max though so it may be a shorter time for one jaw - not sure! I am an avid teeth grinder though and a tongue thruster so I'd be happy to be banded.

@ Keeponsmiling- I know that's what its doing. really stressing me out and draining any shred of confidence I had in the process!!!
I've got my appt on 20th to find out what's happening - impressions and xrays were done yesterday. Then its 27th for hooks then its operation day on 1st! So not much time in between it all. DOn't think they'll be doing any xray manipulation or anything. They haven't even taken any fresh photos of me since treatment began. I think If i did go ahead with the chin surgery it would be at the time of the jaw surgery op. Don't think the NHS would just cover it after as it really is aesthetics! The silly thing is I never had an issue with it before. Its just since getting braces and becoming more attuned to everything and knowing how the balanced face and profile should look I've developed an insecurity about it

Thanks for listening guys!!!!

[PrincessLea]

Here's a couple of pics of my profile:

non smiling




Smiling




What do you guys think? Could this be improved by just chin work on the bottom?

[Bullfighter]

If you're not happy with your chin, you could consider genioplasty -- much less of an ordeal than lower jaw surgery, permanent and predictable results.

That said, based on your photos I wouldn't think you'd want a huge change. Male profiles can take a larger chin, but at some point it looks ungainly on women. A good surgeon can advise you.

[PrincessLea]

Thanks for your reply! My surgeon is looking over my moulds and she is also considering a genioplasty. I'm going to have a look into them as I don't know anything about them. I just want to look normal thats all especially with the surgeon agreeing that my profile isn't balanced - I now know its not just all in my head!

[Bullfighter]

Thanks for your reply! My surgeon is looking over my moulds and she is also considering a genioplasty. I'm going to have a look into them as I don't know anything about them. I just want to look normal thats all especially with the surgeon agreeing that my profile isn't balanced - I now know its not just all in my head!

A profile that isn't balanced is actually a geometric fact -- mine was far from balanced. It's now much better.

Genioplasty involves making a cut in the lower portion of the mandible and sliding that bit forward (in my case, and probably yours) to provide more extention/definition to the chin. The portion that is moved forward is held in position with surgical screws. The bone heals in the new position.

The advantages include permanence -- i.e., no implant to become dislodged or shift about -- and the fact that apart from bits of titanium it is your natural chin bone, no foreign plastics or materials that can leak, rupture, etc.

One drawback, however, is that genioplasty is more complicated surgery than an implant.

[CaliforniaKid]

What do you guys think? Could this be improved by just chin work on the bottom?

considering the hundreds and hundreds of before/after photos at gunson, i can definitely see your symmetry benefiting from a chin augmentation although it is unlikely posters can give you an honest opinion without a brow ratio. but seriously, if you are still uncomfortable try and get a second opinion. i dont know if that is possible in the UK, but the last thing you want is a re-do surgery.

also your nose appears sharp and symmetrical which is ideal for women. BUT my ortho said that if your lips don't seal naturally when your mouth is at rest the only way to correct that is through jaw surgery. a cosmetic procedure won't help it. also, if your jaw didn't develop correctly, the muscles in your face mess with the way it handles your jaw. the brain thinks your bones are in a place they aren't. at least that's what my surgeon said and my profile is close to yours.

also, i totally get your frustration about not knowing what will be done specifically a week before surgery. With my surgeon he doesn't make a final decision until the day before the surgery. It sucks big ones because the cost could totally change if he thinks something needs to be done beyond the original plan.

i dont know how the UK works but my ortho/surgeon were in contact with other every each regularly and i received several updates a month from the assistants for the surgeon.

[PrincessLea]

@Bullfighter - Yes I definitely prefer the sound of a genioplasty rather than an implant. I want to be all me and not have forign bodies in me - apart from the plates and screws of course. Hoping if they decide to do chin work it will be this!

@Californiakid - Thanks for your reply. It honestly really helps having agreement from others Its not really something that I can do getting a 2nd opinion in England. I mean of course I COULD but it would be difficult as each hospital is under whats called a different primary care trust and you go to the hospitals nearest to yourself. There isn't tons of specialists aswell and I'm lucky to be in an area with no waiting lists! I do know someone who has had surgery with her though and said she is amazing. i'm just going to have to trust that between her and my ortho they do whats right for me! She seems to listen to my views too

That's interesting what you've been told about your face muscles. I've been having problems for the last two years with more teteh grinding/clenching and what I thought was sinusitis. Went to see a specialist and they said my nasal passages are narrow but no infection. When he looked at my face and had a feel he reckoned it was the muscle, as my jaw was in an abnormal place, which is causing the headaches and face pains. Hopefully it will lessen after the surgery!

That must be so annoying knowing the cost could be affected. How much are you out of pocket for it? I guess I'm so lucky to get it free on the NHS! As for keeping in contact that side is rubbish. I never get updates and rarely see either my ortho or my surgeon!

[CaliforniaKid]

That must be so annoying knowing the cost could be affected. How much are you out of pocket for it? I guess I'm so lucky to get it free on the NHS! As for keeping in contact that side is rubbish. I never get updates and rarely see either my ortho or my surgeon!

All of it. 55k pre-surgical estimate last week.

That is odd you don't see your ortho or surgeon often. When you got your bands tightened every 4-6 weeks your ortho didn't mention anything? if you're comfortable with your surgeon don't over-think it. it took me forever to find one that wasn't recommending extremely invasive or silly solutions. but that's california. a million doctors with their own opinion .

[PrincessLea]

Wow that's a lot! Are you covered by your insurance for that??!

Not really. I had my appointments every 6 weeks but I've probably seen my ortho about 2 or 3 times in the past 10 months! He was never at my appointments it was always his assistants doing the work! annoying as they would NEVER answer any questions so you had to wait months until he was at an appt!

[CaliforniaKid]

Wow that's a lot! Are you covered by your insurance for that??!

Not really. I had my appointments every 6 weeks but I've probably seen my ortho about 2 or 3 times in the past 10 months! He was never at my appointments it was always his assistants doing the work! annoying as they would NEVER answer any questions so you had to wait months until he was at an appt!

insurance covers approximately zero dollars of the surgery.

i always had my bands done by the assistants but i would also would see the ortho during molds and major changes, like new wires that can't be done by the assistant. but ive had braces for four years. i seriously wouldn't sweat it. if you have concerns can you just call or email? im constantly harassing my ortho and surgeon, they're usually ready to give info out on request. i am paying them after all. then again healthcare in the US is probably delivered different than in UK.

must be some posters here who have had experiences with british oral surgeons.

[keeponsmiling]

Just a thought, but could you call the surgeon's secretary? Even if you can't speak to the surgeon, secretaries are often really good sources of info about practical things like what procedures the surgeon goes through prior to actual surgery. They may be able to tell you if it's unusual not to have a definite surgical plan at this point. Perhaps your surgeon never works things out too far in advance and this is all totally normal to them? They may be the experts, but they've never experienced this first hand and I don't think they fully appreciate how unnerving it is to feel like you're not fully informed. Sure they can sympathise, but they can't truly understand how frustrating it is, so you should list all the issues and give them a call. You've nothing to lose.