Please HELP!!!!!! JAWS NEED ADVICE!!!!!

[brownsugar22]

Very straight to the point. I met with two orthognathic surgeons. I have mild sleep apnea score of 6.1 (cannot breathe properly through my nose; but NO throat airway problems because I have a wide palate). I have a long face with vertical jaw growth or "high occlusal plane angle", mouth protrusion which really bothers me, and a recessed dimply chin. The thing is, these two surgeons at two different hospitals each said they want to bring both my jaws forward which I heard is common practice for people who have sleep apnea. They also mentioned they can shorten my face a little which is cool by me, I wanted that so badly. But The problem is both my jaws are NOT recessed at all, they look nothing like patients I've seen who had recessed/pushed back jaws. I feel those patients actually need to have their face brought forward, cosmetically speaking. I do not want my face brought forward because it is not recessed. For someone who does NOT have recessed jaws would this still be the proper treatment or are there other options? Since I only have nasal breathing problems can't the surgeon just operate on my nose and do regular jaw surgery too? My preference was to actually bring my jaw back because my face is soooooooooo long (longer than any man or woman I've seen) and just big in general. One of the surgeons told me my mouth protrusion WOULDN'T be fixed either, that it would be still there and maybe even more prominent?? which is really a downer because I want it gone. Wanted it gone for years. I wasn't born with that mouth protrusion or this long face/recessed chin problem. They made it seem like this is the only option I have (if I want the surgery covered by insurance) and I'm not so happy about it. Does anybody know if there are OTHER ways to correct sleep apnea through jaw surgery without bringing the jaws forward?? I would be so happy if someone could share some info/advice. Thank you.

(btw, I know mild sleep apnea doesn't warrant jaw surgery but I'm really not happy with my deformity/unbalanced face so that's why I'm stuck on this)

[joecinq03]

If you do indeed have a high occlusal plane then CCW (counterclockwise) rotation of your maxilla- mandibular complex (MMC) is likely called for. For something like sleep apnea you would require a maxillary mandibular advancement or MMA to correct it. An MMA is exactly as it sounds, both your upper and lower jaws are advanced to increase your airway and give more room for your tongue in your mouth so it doesn't slide back and block your esophagus. You simply need more room to correct this, there's no way around it.

I would highly recommend you seek out a surgeon who performs an MMA with CCW, as many surgeons still do not perform this procedure and instead do a straight MMA with no rotation. The benefits of CCW of your MMC when called for include both aesthetics and a larger airway, and will certainly help that recessed chin and dimpling (mentalis strain). A genioplasty may also be called for to get the proper chin projection, but overall your results will be excellent.

tl;dr: Asks your surgeons about MMA with CCW, if they don't do it then find someone who does.

[mrkdilkington]

See if you can get one of the surgeons to make a computer generated 'after' image for you. Dr. Relle in Los Angeles made one for me. The advancement might look better than how you think it would - especially if they do both jaws and ccw rotation.

[snapdresser]

brownsugar22 - I understand that you don't want your jaws advanced, but that's how sleep apnea is treated with jaw surgery. Yes, you can get nose surgeries that may help or even have your adenoids shaved down, but if they're moving your jaws to treat it, it'll be an advancement. The rule of thumb is to advance your jaws by 10mm each. They can also impact them (upward) at the same time which will shorten your face, but you would still have that extra projection. They can advance your jaws by less than 10mm and still get good surgical outcomes in terms of treating the apnea, but the point is: there's no way to get insurance to cover orthognathic surgery for the treatment of sleep apnea without advancing your jaws at least a few mm. Unless maybe you find a shady surgeon who's willing to bill it as a sleep apnea treatment while not actually making jaw movements useful to treating sleep apnea?

If you really want orthognathic surgery but don't want jaw advancement, you should look at other ways to get it covered by your insurance. Maybe you have a bite issue or something? Otherwise you can always finance it and pay out of pocket

[brownsugar22]

Thank you guys for your responses!!!! I already talked to one surgeon about CCW rotation, but he said that since I don't have a gummy smile that he can't do it or else my upper teeth won't show after surgery? Idk. I don't show gums when I smile, but only my upper teeth show completely now when I smile, my lower teeth are hidden. Yet somehow my face still qualifies for "high occlusal plane" with vertical jaw growth. I will speak to another surgeon about CCW but I do want to have a nice smile after surgery with all teeth showing (upper and lower) so that is important. Both surgeons said they can shorten my face but didn't explain exactly how. Both definitely mentioned genioplasty, and one surgeon said they would shave some bone off of it (to shorten?). They also did a lot of measurements on me with these weird tools. I am scheduled to go back next month to get more information from both about how this will be done cause I'm really really scared about the change of my face!!!!! At first I was excited but now I am legit tense. I will see if they can make a computer generated image or atleast draw an image or show me some before/after pictures of people with similar profiles like mine who had an advancement.

One thing I have observed about my face is that my cheeks are quite long and flat. There is no roundness. There is no volume in them. The area around the mouth protrusion or nose looks VERY sunken on each side making my face look unbalanced/older. I see other people with slight mouth protrusion but they don't have the sunken appearance that I do (I'm in early 20's). The last thing I want is to have an even more sunken appearance because my mouth is pushed even more outward because of advancement. I'm hoping that the sunken look would atleast disappear. :/

To snapdresser, hon is a 10mm advancement alot? Cause it sounds like that would be a huge change during surgery and I would not look like myself. I want to look the same except with a balanced face. I was looking for a subtle difference but that sounds like major movement. I definitely do not want a shady surgeon either. I want a surgeon I can trust.

[snapdresser]

brownsugar22 - In my opinion, a 10mm advancement is pretty big. Some people have gone bigger than that, but I talked my surgeon into only advancing my maxilla a few mm instead and even then my face looks totally different. If you're trying to do this for cosmetic reasons and only want a subtle difference, I'm not sure this procedure is for you. Based on what you're describing, maybe cheek implants would do the trick? Of course, I'm not a doctor and I haven't even seen your pics so take that with a grain of salt

[brownsugar22]

Yes, to be honest I am doing this for cosmetic reasons, I can't even begin to explain how having the outer appearance that I do has caused me problems in my social life, it is seriously a downer. But I also care about being able to breathe better because that's something I've been annoyed with since my teen years. I was never able to get relief, doctors always said I had allergies and threw allergy meds at me when in fact it was deviated septum. I am taking naps pretty much everyday and falling asleep while doing certain things. Sleep apnea also runs in the family (mom, grandma and aunt had it). My mom's sleep apnea is worse than mine, her throat airway is narrow & she uses cpap. I do want to get the sleep apnea corrected. But I also want to be sure that I'm gonna be okay with this new face cause I have to live with it forever. About two years ago I wanted cheek implants extremely bad, and was planning to go through with it but then realized that there was other problems with my face, and with the excessive length (it is longer than anybody I've come across because it goes downward instead of horizontal) that my face would still look unbalanced. It's hard to explain but the jaw structure is destroying my face. I just can't stand it. I don't wear makeup because it looks clownish on me, and I have to wear huge hair to disguise my face. My parents don't even have any of these face issues (they both have shorter face with horizontal jaw growth, no sunken look, no mouth protrusion, no weak chin, no lopsided jaw). I know the best thing is just to get this corrected through maxillofacial surgery cause that would address all the problems I'm having with breathing and the aesthetic appearance. In June when I go back to meet with the surgeons, I will discuss w/ them how many MM's my jaw will be moved and ask how this would look. I guess I'm ok with them advancing the jaws as long as it looks normal. I'm not trying to look like a supermodel or anything, that is definitely not what I'm after. I have realistic expectations but just want to look normal and function better.

[brownsugar22]

I'm sorry if I come off harsh, I just really want this problem to go away.

[snapdresser]

I think virtually everyone in this forum knows about the social problems that can arise from poor jaw positioning/growth, so I don't think you have to try and explain it

This is really hard to picture. You apparently have such a long face but not a gummy smile? If you posted a picture it would be easier to give you input. Otherwise I'd just have to recommend you talk to your surgeon about aesthetics, knowing that it may be that you have to pay out of pocket for the movements that make you look the best.

[brownsugar22]

Well, I do have lip incompetence where I cannot close my lips when I lay down. I sleep with my mouth open. I posted a picture of my smile on another jaw forum and someone said I look like I have a gummy smile, but when I visited the surgeon they said I didn't have gum show. It's been mentioned that I have really full lips (by people online) and an orthodontist in real life, so maybe that could be disguising my gums. I have no idea. So I'm not sure why my face is like this, but it long/steep for sure. I will post pictures as well as a side xray in 2 weeks (first week of June). As well as explain what the surgeons recommend and get your opinions based on pics. I'll be back on here but for now I'll just have to do a bit more research. Once again thanks to everyone for their help.