Help! Totally botched?

[perlkrys]

Hi everyone,

I have been lurking this site for awhile, but this is my first post. I had double jaw surgery to correct an underbite and crossbite (maxilla advanced 5mm, mandible rotated 5mm) four weeks ago and things aren't looking too great. I have a follow up with the surgeon tomorrow morning, and would love any advice you have to give about addressing these issues. Are these legitimate concerns? Am I crazy? Should I push for a re-do or seek out another surgeon entirely?

I've brought up my concerns the last few visits, and so far he's been very dismissive. I brought up the off-center midlines and was told the bones were moved to their correct positions, and not to worry about the cupid's bow (my upper jaw lined up with my face before, and now looks pretty off and slanting away from my face.. actually the whole bottom half of my face seems to be slanting to one side). I believe my upper jaw should have been slightly advanced, and my lower slightly set back, but because he only advanced the upper, my upper lip is looking extremely long and strange. My surgeon countered this by telling me my lip was too short before the surgery (pretty sure it was already on the average to long side). It doesn't look TOO BAD with my mouth closed, but with lips at rest half of my upper teeth show. Whoa buddy. My surgeon says females should show more teeth, but I'm pretty sure this is extreme. The surgical plan was not to lower my maxilla, but it sure seems a heck of a lot lower. My whole bottom face feels very prominent now, and I can see in the X-rays he flared out the backs of my jaw which is making my face bow out strangely on the bottom. I also have lip incompetence now and can't imagine being able to chew food with my lips sealed.

There are some other concerns I have about the orthodontic setup prior to surgery (top incisors are flared out, bottom teeth strangely extruded which isn't great for the long-term stability of my teeth, which is why I had the surgery in the first place). I think these issues could be fixed with orthodontics but may compromise my new bite. For example, if my upper teeth were unflared I would have an underbite again!

I'm pretty disappointed after preparing for two years and going through the hell of surgery to have extremely sub-par results, but even more frustrated that the surgeon seems adamant about admitting no wrong.

Anyone else been there? Words of wisdom? Oof.

My pre-surgery face for reference:
[img]https://s33.postimg.cc/iqyllez0r/IMG_0354.jpg[/img]

[img]https://s33.postimg.cc/4xa8walu3/IMG_0909.jpg[/img]

[img]https://s33.postimg.cc/cq0wo9k3f/IMG_0907.jpg[/img]

Notice the off-center midlines and crazy slant up and to the right?:
[img]https://s33.postimg.cc/r981posnv/IMG_0908.jpg[/img]

[img]https://s33.postimg.cc/rlzfvug2j/IMG_0906.jpg[/img]

[ikn91]

Hi! From your photos, I can see that the midline i off, but not something anyone will notice without knowing/ study your teeth. I wish to see more pictures before and after, especially after from a little more distance. Other than what i said, it looks good! I do not think you show to much teeth at rest! Before my lefort 1, I had -2 mm show, which bothered me a lot. After a 2,5 mm downward movement I now have 0,5 mm. I would absolutely want more, but I still wanted to look like myself, so that was enough for me. Ideally women should have at least 1-3 tooth show at rest, up to 5 mm is considered good.

[snapdresser]

Your results look great! The 1-2mm that your midline is off is completely unnoticeable unless you're looking for it, and even then you have to stare for a minute to see it. It's hard to see how the surgery affected your look as a whole from those close-up images, however.

[PierreDeFermat]

Four weeks is still extremely early in the process and you're still very swollen judging by your pictures. Most of the swelling will be along the osteotomy lines (toward the back of your lower jaw and on either side of your nose), which explains the prominence and visible flaring.

My midline was somewhat off after surgery, but elastics brought it pretty close and a few weeks after my arch bars were removed it returned to it's pre-surgical position (straight). Remember your entire lower 1/3 was just re-positioned so it will take time for your muscles to grow accustomed to their new positions. I would wait at least until your 3rd month before you try to evaluate the results of your surgery, especially since you still have braces.

Also, I like the green hat!

[perlkrys]

Thanks for the encouragement. SO HARD TO WAIT.
And yes, I should probably buy that hat.

[GreyViolets]

You look great. You are still swollen, so I wouldn’t be too concerned about these minor issues that are usually fine-tuned by braces.

[kplatt2010]

I concur with the others; you look great. Not sure what the other folks are talking about seeing teeth when your mouth is at rest and this being natural. Swelling and braces will make it challenging right now.

The swelling will take months to resolve. In one year you will look totally different. Be patient; I know it's super hard.
Karla