Fall/Early Winter 2016 Surgery Buddies

[kpw818]

hey everyone, so i went to go see my surgeon for my pre op consultation where they took a bunch of measurements, molds, and i got to speak with the surgeon about any questions I had. It's a little weird having a professional look at your face and tell you everything that is wrong with it. My face is wrecked!

The game plan: Double jaw surgery moving the upper jaw forward and lower jaw back to fix the underbite. Then rotating the lower jaw to fix some asymmetry. Because moving the lower jaw back may give me a weaker chin, he may decide to do a genioplasty in the OR if he deems it necessary. In addition, because i have a VERY flat midface, we are also going with cheek implants to compliment the upper jaw being moved forward as well. The kicker, is that because of my nose structure (or lack thereof), my surgeon mentioned to me that I may/will probably end up with a "piggy" like nose after the upper jaw is moved forward. Which was devastating to me because that is exactly what I wanted to avoid. Although he did say that he was going to try his best to minimize that effect. I really do trust him and his abilities so maybe it will still work out.

When I went to go see him last year for my initial consultation, he briefly mentioned that I could probably get away with just an upper jaw surgery and nothing else without mention of the piggy nose. Now that surgery is a month away, and I know what to expect, I'm a little less optimistic about everything. Kinda just feel like I've been in a funk ever since speaking to him. I honestly do appreciate him being completely honest with me though. I am now going into the surgery with much lower expectations and less optimism about the results, but maybe that's better than expecting perfection and being disappointed.

Anyway, sorry for my rant and pessimism! I wanted to wish everyone else good luck on their surgeries! Does anyone else know their surgery plan? Hopefully yours is a lot less complicated than mine!

Ooh I haven't had my pre-op yet. Did they give you your measurements for what they will do in surgery? They took my measurements at my last appointment, but didn't give me details on what they do (they use a computer to plan the whole thing I guess). Sounds like we will have very similar procedures done in terms of upper/lower and adjusting for asymmetry. I did have another surgeon mention genioplasty, but this one has not.

Did he say anything about what he can do to minimize? Or just that he would try?

What are your main concerns with the surgery? Cosmetic? Functional? I can totally agree with being less than happy about looks if things are kind of meh after. I'm wondering if they don't do a genioplasty if my lower jaw/chin will look weird or jut out :C

[wcom939]

Hi all (suggested cross post from Summer surgery thread),

I'm hoping for some emotional support here, having surgery in a week, originally was excited now very nervous.

Having an IVRO, Lefort 1 and sliding genio to correct a major cant, minor chin relocation, and mandible reduction on the bottom jaw, and minor cant on the top jaw. Happily all 3 are being covered under my insurance due to a fair amount of pain I get on the right hand side of my jaw from grinding/chewing.

I don't see many postings about IVRO's. My surgeon who is relativly well known out on long island (Dr.Capuano) mainly does IVRO's and told me I will be wired for 2 months after, which im perfectly fine with that (as fine as one can be). My main concern is what is going to happen when I wake up, as far as the amount of blood and i read alot of people vomit blood when they wake up due to the ingestion of blood.

Any idea you can give me on how it is to wake up from one of these I would appreciate!

Thanks,
Dan

[pantlover]

Ooh I haven't had my pre-op yet. Did they give you your measurements for what they will do in surgery? They took my measurements at my last appointment, but didn't give me details on what they do (they use a computer to plan the whole thing I guess). Sounds like we will have very similar procedures done in terms of upper/lower and adjusting for asymmetry. I did have another surgeon mention genioplasty, but this one has not.

Did he say anything about what he can do to minimize? Or just that he would try?

What are your main concerns with the surgery? Cosmetic? Functional? I can totally agree with being less than happy about looks if things are kind of meh after. I'm wondering if they don't do a genioplasty if my lower jaw/chin will look weird or jut out :C

hi kpw818, thanks for taking the time to read my long winded post! i do appreciate it.

my surgeon actually did not give me the exact measurements as to how much he would move each jaw during surgery (although i did ask!) He said it's because he can tell me the exact measurements but it won't mean much to me and it wouldn't give me a clue about how I would look after surgery. he warned that everyone's face, bone structure, soft tissue, facial skin, tolerance, etc, are all different so even if he told me exactly what he was doing, it won't at all be an indication of how my results would be if i try to compare it to someone else's results.

in terms of the possible piggy nose, this may not pertain to you. a lot of people's noses if they have the "normal" structure, can tolerate the upper jaw being moved forward without the nose upturning into a "piggy" like look. I, however, literally have no structure in my nose lol so it's a lot more susceptible to being manipulated by the movement. my surgeon mentioned that ethnic background has a lot to do with this (i'm Asian btw). he didn't mention how it would be minimized, just that he'll try his best and i do trust him on that. so if you're concerned, ask your surgeon what's the likelihood of you maybe getting the piggy nose look? i've very rarely seen people with piggy noses in the after shots so hopefully it's something you won't even have to worry about.

[tdhenson86]

Hey, everyone!

Thanks for all your replies! It's great to hear from others and know the mix of anxiety and excitement are normal. I'm so sorry to those of you who are having complications with insurance or other issues (like worries of your physical appearance afterwards). Hope all works out in the end!

I was wondering if anyone knows what to expect at my last orthodontic adjustment before surgery. Mine is on 09/26 to have surgical hooks, surgical wires, etc. Surgical work up with scans, etc. is on October 14 and surgery isn't until November 10. Will they still use the power chains I've had on? Or, should I just expect the normal bands on the surgical wires? I still have a spot where there is a 2mm gap and another 1mm gap. I don't know if these need to be closed before surgery and if I can expect them to postpone surgery because of that. Any guidance from others would be appreciated!

[littlebird]

hey everyone, so i went to go see my surgeon for my pre op consultation where they took a bunch of measurements, molds, and i got to speak with the surgeon about any questions I had. It's a little weird having a professional look at your face and tell you everything that is wrong with it. My face is wrecked!

The game plan: Double jaw surgery moving the upper jaw forward and lower jaw back to fix the underbite. Then rotating the lower jaw to fix some asymmetry. Because moving the lower jaw back may give me a weaker chin, he may decide to do a genioplasty in the OR if he deems it necessary. In addition, because i have a VERY flat midface, we are also going with cheek implants to compliment the upper jaw being moved forward as well. The kicker, is that because of my nose structure (or lack thereof), my surgeon mentioned to me that I may/will probably end up with a "piggy" like nose after the upper jaw is moved forward. Which was devastating to me because that is exactly what I wanted to avoid. Although he did say that he was going to try his best to minimize that effect. I really do trust him and his abilities so maybe it will still work out.

When I went to go see him last year for my initial consultation, he briefly mentioned that I could probably get away with just an upper jaw surgery and nothing else without mention of the piggy nose. Now that surgery is a month away, and I know what to expect, I'm a little less optimistic about everything. Kinda just feel like I've been in a funk ever since speaking to him. I honestly do appreciate him being completely honest with me though. I am now going into the surgery with much lower expectations and less optimism about the results, but maybe that's better than expecting perfection and being disappointed.

Anyway, sorry for my rant and pessimism! I wanted to wish everyone else good luck on their surgeries! Does anyone else know their surgery plan? Hopefully yours is a lot less complicated than mine!

Hey pantlover, my surgeon did something similar with regard to a change in surgical plan--at first, he said he was just going to do the lower jaw and a genio, then a couple months ago he said he needs to do the upper jaw, too. I've been concerned about the change in plan but I keep trying to tell myself that he's the expert and that if having upper, lower, and genio means a better result, then that's what just needs to happen. But it has been hard for me to wrap my head around it, and I was a bit depressed for a couple weeks. As for your potential piggy nose, the good news is that the surgeon is aware of it being a possibility and is going to try to minimize it. Hang in there!

My surgeon gave me my measurements:

Upper jaw--bring up (I'm sure there's a fancy word for this but I don't know what it is) 7 mm in front, bring up 5 mm in back, then move 6 mm forward
Lower jaw--move 11 mm forward
Genio--move chin 10 mm forward

Those seem like really high numbers, and I'm particularly concerned about the upper jaw forward movement and how I will look afterwards. The lower jaw/genio numbers make sense to me because basically I have no chin. Does anyone else think those numbers are high? I'm kicking myself for not taking pictures of the models when I was at my surgeon's office last--they provided a good comparison of pre- and post-surgery (he had been practicing on the models, so I was able to see what my mouth will look like afterwards but not what my whole face will look like). Next time I'm in there I'll take some pics and post them here so you guys can see how drastic the change is.

[pantlover]

I was wondering if anyone knows what to expect at my last orthodontic adjustment before surgery. Mine is on 09/26 to have surgical hooks, surgical wires, etc. Surgical work up with scans, etc. is on October 14 and surgery isn't until November 10. Will they still use the power chains I've had on? Or, should I just expect the normal bands on the surgical wires? I still have a spot where there is a 2mm gap and another 1mm gap. I don't know if these need to be closed before surgery and if I can expect them to postpone surgery because of that. Any guidance from others would be appreciated!

Hey tdhenson 86, I'm not sure about what will specifically happen at your last ortho appointment, but just to give you an idea, here's what happened at mine. I had xrays (pano and ceph) taken, the wire taken out for a set of molds, then a bite imprint thingy (i literally just bit down on a rubber thing for 5 seconds for them to get an impression of how my bite fit together), and then they put in the thickest wire and the surgical hooks. At this point, they said that between now and surgery, my teeth will no longer be moving at all. The wire they put in stabilizes the teeth where they currently are. I didn't have any gaps or power chains at all during my treatment so I'm not so sure what will happen in your case. Although, I will point out that my bottom right incisor is still slightly crooked but neither my ortho nor surgeon even mentioned it as being an issue for surgery.

Did your ortho send pre op molds to your surgeon 3 months before the surgery? For mine, the ortho assistant mentioned that those 3 month pre op molds if when the surgeon will determine whether or not my teeth would be ready for surgery in time and it's also when the surgeon may point anything out to your ortho that he would like moved/fixed before surgery can occur.

There was also this pre op logistics thread that may answer your question here: http://www.archwired.com/phpbb2/viewtop ... 15&t=44603

Regardless, let us know what ends up happening tomorrow!

[pantlover]

My surgeon gave me my measurements:

Upper jaw--bring up (I'm sure there's a fancy word for this but I don't know what it is) 7 mm in front, bring up 5 mm in back, then move 6 mm forward
Lower jaw--move 11 mm forward
Genio--move chin 10 mm forward

Those seem like really high numbers, and I'm particularly concerned about the upper jaw forward movement and how I will look afterwards. The lower jaw/genio numbers make sense to me because basically I have no chin. Does anyone else think those numbers are high? I'm kicking myself for not taking pictures of the models when I was at my surgeon's office last--they provided a good comparison of pre- and post-surgery (he had been practicing on the models, so I was able to see what my mouth will look like afterwards but not what my whole face will look like). Next time I'm in there I'll take some pics and post them here so you guys can see how drastic the change is.

Hi littlebird, thanks for taking the time to read my long post. It's been difficult mentally preparing for this surgery mainly because well, I really don't know what the final result will be. It's the unknown I think that's causing 99% of my anxiety.

As for your measurements, those do seem high at least in my view, but of course I'm no expert. Do you know how big your bite discrepancy is? Do you have another appointment with your surgeon before the surgery itself? If so, maybe ask him what the effects of each movement will have aesthetically and medically (if you haven't already). My surgeon did a really good job explaining what effect each movement might have on my specific face (of course this is then the piggy nose was mentioned) and he also showed me with my molds what my teeth will look like after. Hopefully your surgeon will give you some good news and good answers!

[kpw818]

Ooh I haven't had my pre-op yet. Did they give you your measurements for what they will do in surgery? They took my measurements at my last appointment, but didn't give me details on what they do (they use a computer to plan the whole thing I guess). Sounds like we will have very similar procedures done in terms of upper/lower and adjusting for asymmetry. I did have another surgeon mention genioplasty, but this one has not.

Did he say anything about what he can do to minimize? Or just that he would try?

What are your main concerns with the surgery? Cosmetic? Functional? I can totally agree with being less than happy about looks if things are kind of meh after. I'm wondering if they don't do a genioplasty if my lower jaw/chin will look weird or jut out :C

hi kpw818, thanks for taking the time to read my long winded post! i do appreciate it.

my surgeon actually did not give me the exact measurements as to how much he would move each jaw during surgery (although i did ask!) He said it's because he can tell me the exact measurements but it won't mean much to me and it wouldn't give me a clue about how I would look after surgery. he warned that everyone's face, bone structure, soft tissue, facial skin, tolerance, etc, are all different so even if he told me exactly what he was doing, it won't at all be an indication of how my results would be if i try to compare it to someone else's results.

in terms of the possible piggy nose, this may not pertain to you. a lot of people's noses if they have the "normal" structure, can tolerate the upper jaw being moved forward without the nose upturning into a "piggy" like look. I, however, literally have no structure in my nose lol so it's a lot more susceptible to being manipulated by the movement. my surgeon mentioned that ethnic background has a lot to do with this (i'm Asian btw). he didn't mention how it would be minimized, just that he'll try his best and i do trust him on that. so if you're concerned, ask your surgeon what's the likelihood of you maybe getting the piggy nose look? i've very rarely seen people with piggy noses in the after shots so hopefully it's something you won't even have to worry about.

Of course!

It seems like people don't get their measurements as much now. I used to see people post, I had the front moved Xmm and the back Xmm. It sounds like he is giving good insight on how those movements don't really affect aesthetics afterwards. I'm always amazed at how some movements result in people who look relatively the same, and then smaller ones create entirely different looks!

Ah I see. I think the most I've seen with the noses is that some people have swelling in their nose longer than the rest of their face. I expect a bit of widening on mine and the upturning, since my upper jaw will be moved forward and widened I think---3 piece lefort 1. Seems like your surgeon is really listening to you and providing good information--that's great! That would make me feel better about the whole thing for sure.

Are you getting nervous/excited for the surgery? Yours is October too, yes? I feel like someone was having surgery the same week as me (I'm 10/18)

[wcom939]

I just got my measurements today for my jaw surgery tomorrow. It's a Lefort I with an IVRO and a genioplasty. He did not give me my genioplasty measurements but the largest movement is slightly above 1mm on my top jaw for the lefort. All the other movements are about .5 mm.

The only reason I needed this surgery was to fix a severe cant on my bottom jaw, and a minor cant on my top jaw. Although braces would have straightened my teeth into a somewhat acceptable bite due to the cants as soon as the braces are removed my teeth go back to their old position. This is my third time in braces so my orthodontist insisted on the surgery.

Wish me luck!

[tdhenson86]

I was wondering if anyone knows what to expect at my last orthodontic adjustment before surgery. Mine is on 09/26 to have surgical hooks, surgical wires, etc. Surgical work up with scans, etc. is on October 14 and surgery isn't until November 10. Will they still use the power chains I've had on? Or, should I just expect the normal bands on the surgical wires? I still have a spot where there is a 2mm gap and another 1mm gap. I don't know if these need to be closed before surgery and if I can expect them to postpone surgery because of that. Any guidance from others would be appreciated!

Hey tdhenson 86, I'm not sure about what will specifically happen at your last ortho appointment, but just to give you an idea, here's what happened at mine. I had xrays (pano and ceph) taken, the wire taken out for a set of molds, then a bite imprint thingy (i literally just bit down on a rubber thing for 5 seconds for them to get an impression of how my bite fit together), and then they put in the thickest wire and the surgical hooks. At this point, they said that between now and surgery, my teeth will no longer be moving at all. The wire they put in stabilizes the teeth where they currently are. I didn't have any gaps or power chains at all during my treatment so I'm not so sure what will happen in your case. Although, I will point out that my bottom right incisor is still slightly crooked but neither my ortho nor surgeon even mentioned it as being an issue for surgery.

Did your ortho send pre op molds to your surgeon 3 months before the surgery? For mine, the ortho assistant mentioned that those 3 month pre op molds if when the surgeon will determine whether or not my teeth would be ready for surgery in time and it's also when the surgeon may point anything out to your ortho that he would like moved/fixed before surgery can occur.

There was also this pre op logistics thread that may answer your question here: http://www.archwired.com/phpbb2/viewtop ... 15&t=44603

Regardless, let us know what ends up happening tomorrow!

Thanks for the reassurance. So, there was another change. My orthodontist decided there was enough time between now and surgery that he did a normal adjustment. I still had a 2mm gap on one side and 1mm gap on the other-both on the bottom. He changed wires on the bottom to a thicker wire, kept the top the same, put power chains back on the bottom, and added a double power chain just between the two teeth that had the 2mm gap. The gap is already half as big and I'm only 8 hours out from the appointment. It's the most drastic change I've seen in my whole treatment. Can't believe it's literally closing before my eyes.

So, as an update:
I had a normal adjustment today
Will have my pre-surgical work up (with scans, molds, etc.) on October 14
Get surgical wires and surgical hooks placed on November 4
Surgery is on November 10

[kpw818]

I just got my measurements today for my jaw surgery tomorrow. It's a Lefort I with an IVRO and a genioplasty. He did not give me my genioplasty measurements but the largest movement is slightly above 1mm on my top jaw for the lefort. All the other movements are about .5 mm.

The only reason I needed this surgery was to fix a severe cant on my bottom jaw, and a minor cant on my top jaw. Although braces would have straightened my teeth into a somewhat acceptable bite due to the cants as soon as the braces are removed my teeth go back to their old position. This is my third time in braces so my orthodontist insisted on the surgery.

Wish me luck!

Good luck! It will be over before you know it

[WiredJon]

I'm going in for double jaw surgery on November 24th. It was originally just supposed to be for the lower jaw, to fix an underbite, but as the surgeon at the consultation pointed out, the upper jaw is lopsided, comes forward too much on one side, and needs moving out in another direction that I can't quite visualise. After that, they'll be able to set my lower jaw into the correct position during the operation.

I've already been through SARPE this year, so have a very good idea of what to expect (from the upper jaw anyway), and I'm not expecting the lower jaw to be significantly more painful or swollen, so I'm okay with that.

What does scare me a little is that this will be a 4 hour operation vs the 40 minute SARPE (I know the operation itself isn't called SARPE, but for ease of typing!), plus there seems to be more danger of a nerve being damaged in the lower jaw.

I'm interested in knowing how much this has cost other people - I'm in Germany, and the quote I've received is 8,000 Euros (think that's 10-12K$US). Hopefully my insurance company will cover at least some of this.

[tdhenson86]

I just got my measurements today for my jaw surgery tomorrow. It's a Lefort I with an IVRO and a genioplasty. He did not give me my genioplasty measurements but the largest movement is slightly above 1mm on my top jaw for the lefort. All the other movements are about .5 mm.

The only reason I needed this surgery was to fix a severe cant on my bottom jaw, and a minor cant on my top jaw. Although braces would have straightened my teeth into a somewhat acceptable bite due to the cants as soon as the braces are removed my teeth go back to their old position. This is my third time in braces so my orthodontist insisted on the surgery.

Wish me luck!

Wishing you well! I hope surgery and recovery go well for you!

[pantlover]

wcom939, please keep us posted on how your surgery went and your recovery! you're the first in this thread to get it! ahhh, i hope everything went swimmingly for you!

kpw818, do you know why your surgeon decided on a 3 piece lefort 1 vs say, a 1 or 2 piece? this is just out of curiosity (i'm getting a 1 piece lefort 1) but have always been curious about the reasoning for the 1 and 2 piece.
and yes, i have surgery the same week as you! 2 days after, in fact (10/20). tbh, i'm completely terrified/anxious/nervous. i think it's because i keep dwelling on what could go wrong, since that's just who i am as a person. it was the same with when i had my wisdom teeth surgery, i just constantly thought about what could go wrong even though everything (surgery and recovery) went perfectly smoothly. wisdom teeth surgery seems like such a breeze now in retrospect though lol. please be strong and positive for the both of us because I just don't think i can!

tdhenson86, i'm glad things worked out for you at your ortho appointment!

[kpw818]

yes, wcom939 please let us know how it went!

pantlover, I don't know, but I can certainly ask at my pre-op in a couple weeks. I have a narrow upper palate (had an expander that didn't do a ton) and kind of an open bite, so I think they have to move the maxilla down and forward. I'm totally interested as well! I think it allows them to move things around more. I definitely have an open bite + underbite, so being able to move things around a bit more makes sense.

I hear you on being anxious. I got my CBC back yesterday and my platelets are low, but surgery is still on (surgeon is not concerned). I'm considering donating some of my own blood in case something goes wrong. I eat pretty healthy, and everything else was normal, so I'm a little worried on why the platelets are low...No one seems super concerned as far as general physician or surgeon, so I'm trying to take that as a good sign.

I find that keeping busy is helping me a lot with worries or anxiety. I set some pre surgery goals for cleaning my house, working up to a 6 mile run, etc. so I am trying to focus on those. Might help! You are going to do fine. Just think of all the ice cream you can eat after

I'll definitely check in that week to see how you are doing! It is creeping up on us for sure. And then be over before we know it!