orthognathic vs. nose surgery (rhinoplasty)? any advice?

[MAR2012]

Hi everyone. I am new to this forum and could use some advice.
I have been considering orthognathic surgery for a while but never proceeded with it since I'm pretty apprehensive about having to wear braces again and the outcome of the surgery. I have a moderate open bite of 4 mm, an overjet of about 4 mm and a right cross bite where my lower dental midline is about 5 mm to the right of the facial midline (as per ortho). Aesthetically speaking, my cross bite and open bite are kind of noticeable when pointed out but definitely not obvious. I can see that my facial proportions are asymmetric in pictures where I am smiling wide and I also notice a cant when my mouth is closed. It also kind of bothers me that my cheeks are pretty flat. Functionally, thank Gd, my only issue is a lateral lisp because of an open bite. I hear clicking in my jaw joints when opening my mouth wide but I do not have any pain. I was in braces for 3.5 years in high school (I am now 26) but decided not to go forward with the surgery. I consulted with a couple of surgeons in the last year, both of whom said that I will most likely have to undergo a Lefort 1, and either BSSO or IVRO as well as a possible genioplasty.

The reason I'm asking for advice is because I am torn between getting braces on and having orthognathic surgery or just having a rhinoplasty. My nose also really bothers me. It is large for my face, bulbous and hangs down. It is not terrible but definitely bothering me enough that i want to get a rhinoplasty. I've consulted plastic surgeons who feel that it is a good idea but oral maxillofacial surgeons weren't sure about it and say that if i do the rhinoplasty and then have my jaw done in the future, it may mess things up.
I am having a hard time making a decision just because i feel that the easier way out is to do my nose and just forget about the jaw, but I'm afraid that down the road, if i do have to have my jaw done for functional reasons, it may end up ruining my nose (prob make it very pinched up).
I think I will just feel better about myself if i have my nose done, especially since aesthetically, my bite isn't so bad, but i really just don't know. I'm also afraid that my bite will become more noticeable if I have my nose done.
I know that the better option is having my jaw done, but it seems so incredibly hard and I just don't know if I could really be that committed to it.
I know this is prob a very personal decision, but any advice would help.
What do you guys think?

[Marisama]

I have a cant and asymmetry as well. I suggest just fixing the problem, which is your jaws. I think you'd be unhappy with just a rhinoplasty after considering orthognathic surgery.

[CaliforniaKid]

the nose issue is definitely problem and a lot of surgeons still don't seem to have a handle over it. many will harp about arnett/gunson but when it comes to noses they're under control. but you only have a 4mm open bite which isn't that bad. i would never recommend jaw surgery purely cosmetic reasons. if your cheek bones bother you they can be shaved done. a nose job and chin implant will be cheaper than jaw surgery assuming your insurance doesn't cover it. that would probably be a redline for me if I were in your shoes.

jaw surgery recovery is long, 6 months to a year. you can't eat real food for 2 months, and after that you're trapped eating very very soft food, assuming you can open your jaw wide enough to fit food in. you'll probably have to have braces 6-18 months before your ready for surgery and that's a huge expense.

[trossi]

You sound a lot like me.
I'll be 26 this year and jaw surgery was a big decision. Prior to deciding on jaw surgery I was planning on having rhinoplasty for a few years beforehand.
I know exactly how you are feeling but trust me, the more you look into it you will realize that a lot of the things you don't like about your face are in direct relation to your jaw and will be corrected with jaw surgery.

You can look at my blogs if you would like to see pictures
http://openbiteblog.blogspot.ca

When they move the upper jaw your nose will appear smaller than it already is. The chin can also create an issue, a lot of people with these issues may have a weak chin which makes the center portion of the face appear larger.

I got my second set of braces on at 24 and it wasn't an easy decision but its worth it, and the time goes by so fast.
My surgery was put off for october but I have really come to terms with my face and with this decision. I am very happy I didn't go ahead with rhinoplasty because I think this surgery will have a much better outcome than rhinoplasty ever could.
Try to find a lot of before and after cases similar to yours and you might see what I mean.

Good luck with everything.

[MAR2012]

Thank you so much!!

[CaliforniaKid]

I'd get the surgery. Get to the root of the problem, you know?

4mm openbite isn't that bad, and without seeing pictures I just cannot recommend surgery for generally cosmetic reasons after going through it. I'm quite satisfied with my recovery but I would never wish the surgery on someone unless there was a moderate or severe medical condition. for example, I would first see a speech therapist before getting my jaw cut up because of a lisp. jaw implants augmentations/bone shaving/nose job, those are smart choices to be pursued before going through jaw surgery if looks are a concern. I would think about seeing a plastic surgeon.

[CaliforniaKid]

i wasn't talking about you, but the OP. we aren't doctors and I don't think its truly wise to jump to surgery when there are so many other treatment plans to correct facial balance/harmony. 4mm openbite isn't that bad and his midline is 1/5 of an inch off. I guess it's hard to really judge someone without seeing a picture. OP seems concerned about his nose and jaw surgery isn't going to correct it, although it would probably make it appear smaller.

[MAR2012]

Thanks for all your replies! They are greatly appreciated!
In response to CaliforniaKid, I would only have the jaw sx done assuming that insurance would pay for it. I've looked into it and chances are good that they would cover it after a $3,000 deductible + $5,000 for a genioplasty which would not be covered since it's considered cosmetic. I live in NYC so the orthodonist I would like to use is kind of pricey, around $8500 or more for braces with ceramic brackets. Total Tx time is expected to be 20-24 months.
The rhinoplasty surgery would run me $11,000.
I think I agree with everyone, specifically "Trossi" when you say that the root of the problem is the jaw and a lot of things I don't like about my face are prob directly related to my jaw.
The only thing that sets me apart from everyone who responded to my post is that I do not have any significant medical or functional issues that are related to my malocclusion which makes it a bit difficult for me to justify having this surgery.
I know it may be easier for you guys to give me advice if you see a photo and I could definitely send one if anyone wants to give me more feedback.
Thanks a ton!
Mary
You can post your emails and I will email you a photo... For some reason, I am not authorized to post my email address.

[clockworkrabbit]

Rhinoplasty is 100% cosmetic, while fixing your jaws is functional *and* cosmetic. I would get your jaws fixed first, especially since your nose will change somewhat if they need to move your upper jaw at all.

If you get your nose done, then later your jaws, you may need a revision rhinoplasty.