Le Fort I advancement or BSSO?

[windycitycassie]

Hi, all.

I've spoken to two different surgeons and one recommended a BSSO and another recommended a Lefort I advancement. Why would they give conflicting recommendations? The Le Fort doctor said it would have a better aesthetic result since I am a bit flat in that area?

I have a 3-4mm Class III malocclusion and had an underbite before braces - now years later it has reverted a bit to be an edge-to-edge, but I obviously still have the Class III jaw.

[Teeth of Cthulhu]

The BSSO setback is suitable for those who are Class III as a result of mandibular excess, while the lefort I treats those whose class III bite is a result of maxillary (midface) deficiency. Many Class III cases are treated with double jaw surgery, i.e. advancement of the upper jaw and setback of the lower jaw.

If your maxillary area is flat you would probably benefit from the lefort I. I've seen too many cases where surgeons have brought the lower jack back to meet a maxilla that is already recessed.

[windycitycassie]

Thanks - yeah that totally makes sense. But, I don't understand how surgeons can have totally different recommendations like this...

Shouldn't a cephalogram make it obvious (or cephalogram + impressions)? Or is it really an aesthetic thing sometimes?

[Teeth of Cthulhu]

You said that your malocclusion is 3-4mm, meaning it's only fairly minor and you could probably easily go either way and get a good result. It's all down to the personal preference of the surgeon.

[windycitycassie]

Thanks again! Yes that totally makes sense. However, since it doesn't look like I'll get this funded by the NHS here I'll have to pick my private surgeon. Hard to decide which route is best if different doctors tell me different things.

[CaliforniaKid]

i consulted with more than half a dozen surgeons before finally settling on one. took close to a year.

i understand nhs is not as flexible as US healthcare though it is "free." since you are going with a private doctor, take your time and choose one you are 100% comfortable with.

[windycitycassie]

i consulted with more than half a dozen surgeons before finally settling on one. took close to a year.

i understand nhs is not as flexible as US healthcare though it is "free." since you are going with a private doctor, take your time and choose one you are 100% comfortable with.

I am going to see a third soon. I have to say I definitely liked both I saw so far, so in terms of personality and experience I can't really choose. :S I think I'll see the majority opinion on which way to go in my case (from the doctors) - too bad these private consults cost money.

Healthcare is 'free' here in terms of us paying taxes and just not really having to worry about medical problems. However, it seems they don't like it if you ever both them with stuff that isn't life-threatening.

[windycitycassie]

Well had a chat with the one who originally recommended BSSO and he now thinks that Le Fort I advancement and impaction is a good idea for me. Still going to see a 3rd doctor for his opinion but don't have a date yet on that...

[Hostet25]

Well had a chat with the one who originally recommended BSSO and he now thinks that Le Fort I advancement and impaction is a good idea for me. Still going to see a 3rd doctor for his opinion but don't have a date yet on that...

hey windycitycassie...I know this is a far fetch since you've been on this post...but im going through the same thing as you...well kind of. 4mm movement....I have an underbite...never thought I would be told moving upper jaw would be better. I try and look for other people in my situation and their before and after pictures and I cant ever find any! maybe because it is such a small movement...I guess im just trying to get an idea of what the difference looks like....peoples noses, cheeks, and how much better their underbite looks. Have you gone through with the surgery? or seen anyone else who has?

[samoorelaw]

Well had a chat with the one who originally recommended BSSO and he now thinks that Le Fort I advancement and impaction is a good idea for me. Still going to see a 3rd doctor for his opinion but don't have a date yet on that...

hey windycitycassie...I know this is a far fetch since you've been on this post...but im going through the same thing as you...well kind of. 4mm movement....I have an underbite...never thought I would be told moving upper jaw would be better. I try and look for other people in my situation and their before and after pictures and I cant ever find any! maybe because it is such a small movement...I guess im just trying to get an idea of what the difference looks like....peoples noses, cheeks, and how much better their underbite looks. Have you gone through with the surgery? or seen anyone else who has?

I had an underbite and I had just the LeFort I. I was originally told by one surgeon that I would need double jaw but that turned out not to be the case. The difference in appearance is quite noticeable according to those who don't see me that often but those who see me every day say they see some difference but it's subtle/natural.

See the attached pics and decide but the profile shots really show the difference.

[samoorelaw]

And here are the before and after shots from the front. I would post an after with me smiling with my teeth showing but that would show my braces and that's against this forum's rules.

[kpw818]

Samoorelaw--how bad was your bite biting down? I've been told upper for sure--maybe lower--and I would love to minimize the impact of the surgery by only having one jaw done. I am definitely a classIII with a little mandible excess, so I'm worried they are going to want to take it back no matter what. The lower jaw seems to have more risks associated than upper, and I kind of want to look the same/not too different after surgery (if that makes sense to anyone, lol).

I saw a surgeon when I was in high school who recommended double jaw surgery. I planned to get another consult for the surgery now that I am actually doing it, but I do really like my current surgeon (she just did my wisdom teeth and it was a really easy and fairly painless process). She's really good, but I'd like to see another opinion.

[samoorelaw]

My bite was pretty bad: my teeth only touched on the left and bottom teeth jutted out pretty far ahead of my upper teeth. Had upper jaw brought forward and widened. I was originally recommended double jaw surgery by the first surgeon I went to but ultimately my ortho and the surgeon I went with said upper is enough. They said this was ideal because, as you pointed out already, there is higher risk with lower jaw surgery, especially with permanent numbness. All the feeling is back in my face and my gums are starting to "wake up" again: reduced sensation still in the gums but I can tell I'll eventually have full feeling back (can take up to 6 months or a year for full feeling to return).

[Hostet25]

samoorelaw wow!! I totally see a difference!!! How far was your top jaw brought forward? How do you feel and how do you like the results? your top jaw just looks so much more filled out! I'm def going to get some before and after pics...I ask myself why since i have about 28 years of before pictures but i usually delete all of the ones that show my worst views! Oh and why were the afters taken? thanks for replying!!!!! i feel like its so hard to get some responses around here! im starting to give up on having some peeps to THIS IS SPAM REPORT TO ADMIN THIS IS SPAM REPORT TO ADMIN THIS IS SPAM REPORT TO ADMIN THIS IS SPAM REPORT TO ADMIN with about all my q's and thoughts!

[samoorelaw]

samoorelaw wow!! I totally see a difference!!! How far was your top jaw brought forward? How do you feel and how do you like the results? your top jaw just looks so much more filled out! I'm def going to get some before and after pics...I ask myself why since i have about 28 years of before pictures but i usually delete all of the ones that show my worst views! Oh and why were the afters taken? thanks for replying!!!!! i feel like its so hard to get some responses around here! im starting to give up on having some peeps to THIS IS SPAM REPORT TO ADMIN THIS IS SPAM REPORT TO ADMIN THIS IS SPAM REPORT TO ADMIN THIS IS SPAM REPORT TO ADMIN with about all my q's and thoughts!

Hi, Hostet,

I'm now just past 16 weeks post-op and I'm mostly back to feeling normal: I say "mostly" because I feel I still tire more easily than I did pre-surgery, even SCUBA diving. Other than that, I'm back to doing and eating everything I did pre-surgery. I had my top jaw widened and moved forward about 6-7mm, which I don't think is very far (and really, they move it a bit further than is needed anyway to take relapse into consideration - almost everyone relapses a bit, and indeed my upper jaw was more forward immediately post-op than it is now, with it almost feeling like an overbite post-op but that is gone now).

I took the after pics myself: I'm taking various after pics, and I've taken them pretty much every week since I've had the surgery. I'm documenting my experience on my FB page for my friends but I'm also documenting it for my surgeon because when my braces are removed, he will be posting my before, afters, and various testimonial videos on his website. I agreed to do this in exchange for him lowering his fee slightly: this was back when I was initially denied coverage for the surgery by my insurance company, which ended up covering the surgery after all.

I understand how you feel about the lack of responses. I see some people on this board having tons of responses whereas I've often felt my posts have been ignored by comparison, which then causes me to wonder why people aren't responding: that is, is it because most people who have this surgery are double-jaw patients and I'm single jaw? Or could it be that they think my appearance/teeth are hideous post-op and just don't want to post out of politeness?