My surgeon is not sure what to do

[Class2geo]

I been in braces for 10 months in about two months my ortho is going to finish up the pre ortho phase. I went in for an evaluation with my surgeon prematurely because I was getting a little impatient. He pulled up the X-rays and kinda measure me out and evaluated my bite and jaw. He said that its difficultly to know what to do because I have a very small gap between my bottom teeth and upper teeth and that simply moving my lower jaw forward just a tad won't really make any notable differences in terms of my profile. But can't he just move my upper jaw forward more so he can have more space to move my lower jaw forward? Also he said he is going to have to either to genioplasty or a chin implant because my chin is recessed atleast cm but that there's nothing he can do to make me have straight profile it's always going to be a little concave. He said he is going to wait for the models of my teeth and talk to my ortho to figure something out. I feel a little uneasy that he doesn't really know what he's going to do or is it normal since I went in prematurely and still doesn't have any models of teeth and bite?

[glennstanzalone]

It's quite common for the surgeon to need to look at the models before coming up with a plan. If you don't have a serious bite issue, maybe you just need like cheek implants and a genio? I can't really tell without seeing any photos or xrays though.

[Class2geo]

This is my profile pics

[glennstanzalone]

We both look similar! Hows your occlusal plane? If it's steep they can do a CCW rotation of the maxilla which will bring the lower jaw forward. However, you might be able to away with a simple sliding genio or implant to give you more projection to your chin.

[glennstanzalone]

So like, you need at least this much movement. Probably more because you're a guy. Your upper jaw doesn't look like it needs to come forward at all, so I would say you'll probably just get a good genio? I believe the upper limits of a genio are 7mm of projection.

[Class2geo]

Haha maybe you're the reason people always say I look framiliar. He actually mentioned that my plane was normal so itl look weird if tried rotating it. He did mention just getting an implant and "calling it a day" but I told him I been in braces for almost year and would like to not only fix cosmetic issues but also open up my airway and get my lips to close without straining them. However I'm starting to realize that perfection is just not gonna happen.

[glennstanzalone]

Hmmmm. It looks like your ramus is pretty short. Idk I brought your maxilla and mandible forward w a genio with a sh**ty photoshop in like 5 min and it looks pretty decent. You might be able to get 3mm of projection which might give you room to move your lower forward w 5mm or so of genio. I'm just ballparking here

Screen Shot 2016-07-23 at 6.41.48 PM.png

[glennstanzalone]

Are you hispanic? I'm half mexican and our midfaces are very similar. I'm a woman though. I'm getting my final surgery plan next week, I'll update ya with what my surgeon says. I have like a 5mm overjet though so that gives him room to work with.

[Class2geo]

Wow that looks like my uncle haha. Props on the photoshop skills btw! If those were my results I would be more than happy.

[Class2geo]

Yea I'm Mexican. Would love it if you kept me updated!

[glennstanzalone]

Does your surgeon know what you want to look like afterward? I showed mine some photos of the chin I want lol. I'll keep you updated!

[Class2geo]

No but il definetly show him a couple pics now that I think about it. Thanks!

[EWUgal15]

Personally, if my surgeon told me that he wasn't sure what to do, I'd be looking for another surgeon.

I know every case is different, but I met my surgeon after my initial consult with my orthodontist and got informal treatment plans, expectations, costs, everything, before I started with braces. There was no way I was going to walk in blind. And I had check ins with my surgeon every 3 months or so until the orthodontist gave the OK for surgery.

Take that for what it's worth as I'm on the other side of the bridge.

[Class2geo]

Can I change surgeons when I'm almost done with braces pre surgery?

[glennstanzalone]

You can absolutely change surgeons! Just find another one who works with your insurance. I've been working with mine for like 5+ years to get this stuff approved. His treatment plan has changed a bit but he's kept me informed and in the loop the whole time. Also make sure your surgeon is a board certified OMFS not just a dental surgeon. Orthognathic surgery is different & complex and I feel like I see people get their faces hacked up by fools who don't even have MDs. My surgeon teaches OMFS and he is the head trauma doc at the hospital I'm getting it done at. He sees the worst of the worst facial trauma and knows how to do anything. He's awesome. I would look up the credentials of your surgeon, like what school he/she attended and their residencies.