Deciding against orthognathic surgery

[gabriella36]

I am a 33 year old female in the PNW. My male dentist has been pushing me towards braces for years, and I've been thinking about it for a about a decade. Last fall I finally took the plunge and went for an orthodontic consultation. Then another one. Then a third. Third time's the charm, and I've found a skilled and compassionate female ortho. I just got my spacers on today. Brace date is July 7. Then four extractions, second bicuspids, I think.

Getting to this point and through all the consultations has been a journey in and of itself. I am a fairly attractive woman without self-esteem issues (at least pertaining to my face/smile...at least before this journey started...). At the advice of my ortho, I consulted with an oral surgeon who recommended double jaw surgery. He was rude, condescending, frankly horrible. Talked for about 30 minutes of my 1 hour consult about the dangers of sleep apnea and that my narrow airway predisposes me to sleep apnea (Something that I don't have, and if I do develop, can be treated far less invasively). He went on to tell me how to game the insurance company into paying for a sleep study, something I do not want, and by the way....isn't that fraud?

He charged me $250 for the pleasure of a consultation, and the experience was enough to push me completely away from considering surgery, something I wasn't considering in the first place at all and only wanted to keep an open mind about since my ortho encouraged it. I asked the oral surgeon directly, "In your opinion, is this surgery medically necessary?" All he could do was shake his head no from side to side without saying a word, then say "Well, the definition of medically necessary is complex and...."

At 33, with a 4-6 week out-of-work recovery period and a 20% chance of permanent nerve damage, elective jaw surgery to correct someone else's opinion of my supposed facial deformity is not something I'm interested in. Period. I am apparently in the minority, and even browsing through this message board, I find so many adults who weighed the decision of jaw surgery, and went for it, many at their own expense of time and money. I applaud and respect your decision. I haven't really been able to find too many people who feel as I do -- that I've lived with this face for so long already, and it's not a bad face. I don't want to change it. The whole reason I want braces is for the long-term health of my teeth and jaw. I guess it was surprising to find myself in the minority, and even more surprising to have my choice argued and rejected by professionals ("You'll change your mind" / "You'd be so beautiful" / etc...)

I'd really like to hear from someone who moved forward with braces as an adult, was a supposed 'great candidate' for jaw surgery, and backed away from it.

And, obviously, did not regret their choice. Or even if you did, I'd love to hear your story.

[deathorglory]

I'm in Seattle, where are you?

I opted for the surgery. Like you, I had no self esteem issues, or anything of that sort. I actually asked my dentist about how I could stop grinding my teeth, and he actually suggested braces and I seem to have tried all the other usual routes. When I went for my consult, they gave me the option of extraction and having most of the issues fixed, or jaw surgery and having it all fixed. I figured, in for a penny, in for a buck. I might as well get the jaw surgery and have everything corrected. I've heard before that I might need jaw surgery, as my overbite was pretty large, though unlike most people with a large overbite I have a chin, so it wasn't very noticeable.

My jaw surgeon consults...weren't nearly as easy to decide on. The jaw surgeon I was originally referred to decided to stop taking patients during my treatment, so despite my previous consult with her, she wouldn't do my surgery. I then saw another surgeon in Seattle who seemed very knowledgeable but maybe not too friendly. I saw his partner later on after surgery, and he was much less personable. I was very happy to have selected my surgeon, because at least he could crack a smile.

I did take 4 weeks off work, but my job has a short term disability plan (paycheck deficit is made up with sick pay), so it wasn't like I didn't have any income coming in while I was off. I'm pretty lucky in that regard.

There was nothing about changing my looks that made my decision. It was more like if there's a chance of fixing my bite to where I wouldn't have my current issues and I was willing to shell out money for it, why not get the surgery and have everything fixed instead of just most things? Most thing...I don't know. I always assume that the last few issues that I'd have would become larger issues as I get older (I'm only 29). I've already got some bone loss and my tooth grinding was bad enough to wake my boyfriend out of a dead sleep. He said it sounds like forks and knives on ceramic. I suppose that with extractions, I'd have been able to fix a decent amount of my bite, but with a 10mm overbite, there really wasn't a way to make my molars fit fully together without the jaw surgery. And since those are the teeth I like to grind on...it really made sense to me. It had nothing to do with the "deformity" itself - I thought I looked rather decent with my overbite. It accentuated my high cheek bones

I do applaud your choice though. It is YOUR choice, after all. It just depends on what you think needs fixing, etc. If you're not having too many difficulties now and don't think you'll have them later, is it really necessary? ...probably not. Good luck on your braces journey!

[ItsFreyja]

I've also decided against surgery, although my issues are not the same as yours. I've been told for years that I'm a great candidate for Le Fort I surgery to lop some height off my maxilla and reduce my gummy smile and long midface. No thanks.

Oral surgeons and orthodontists are trained to identify problems and know how to fix them. They don't always have the best chairside manner. (I totally understand both of these habits in my own profession as an editor.) It's your face; you are entitled to be OK with having narrow but functional and healthy arches (or whatever). I'm sorry you had to deal with a surgeon who sounds like a real stinker.

In my case, the advantages of surgery over braces would be entirely cosmetic, and I am not bothered enough by my horsey face to go through (and pay for) surgery. My braces are going to improve the gumminess a little, but I do expect a complete fix of the associated overbite issues that have resulted in some tooth damage, and that's good enough for me.

[gabriella36]

Thank you both for your considerate and thoughtful replies. As I keep reading through this forum, I'm astonished at how little I know, and how little I've thought to question the ortho on, like the clear vs. metal discussion. I had no idea that clear braces were larger and allowed for less specific movements than metal. I'll have to ask the treatment coordinator about that when she calls next week.

I guess I was expecting more comprehensive support throughout this process. So far it seems like I have to ask all the questions, and that no information is volunteered or presented in any way other than verbally. I'm such a novice in this process, and it's been exhausting to ask question after question and have to dig for information. My mindset alone has shifted on several points since getting serious about braces just over a month ago. Thanks for contributing to this valuable resource. I think I'll start my story over on the thread provided for it.

And...yes. I live in the Seattle area.

[ItsFreyja]

Good luck to you, gabriella36! Stick around here and you'll definitely learn something. Probably the #1 thing I've learned here is that when in doubt, ASK YOUR ORTHO!

I'm sure plenty of people get braces without a lot of detailed knowledge about their teeth and their treatment, and there's nothing necessarily wrong with that. This message board obviously attracts a different kind of patient. Personally, I chose an orthodontist who enjoys explaining things to his patients, but not all of them enjoy it or are good at it. It sounds like you have found a good rapport with your ortho, notwithstanding the information shortfall, so don't feel bad about asking her and her technicians for more info every step of the way.

[MoonSwan]

I too decided against surgery. I wasn't aware that my upper jaw was considered too narrow or that I had a crossbite until I finally took the plunge and scheduled an orthodontic consultation this past January. I was mainly interested in Invisalign at the time and as such had to drive to an orthodontist an hour away from where I live. That consultation was one of the worst experiences of my life.

The ortho was distant, standoffish, and rude. She looked in my mouth and not only declared that I wasn't a candidate for Invisalign (which was fine, I had made the appointment to find out if I was), but that she would never even consider treating me with traditional or ceramic braces unless I had upper jaw expansion surgery first. I had never before been told that I needed jaw surgery, so that information along with her poor attitude overwhelmed me. But it only got worse when she went on to say that she wouldn't work with any of the oral surgeons that lived closer than an hour away from me. In fact, there was only one oral surgeon she would work with, and if I went to anyone else she wouldn't treat me. It was so bad that I ended up crying in her office while she just blankly stared at me. I later found out after doing some more research that the only oral surgeon she would accept me going to was her freaking husband. -_- I'm certainly not an expert, but that sounds illegal to me - only allowing your patients to go see your husband, someone you stand to gain money from. If nothing else, it is completely unethical.

That experience really upset me and it took a lot for me to go have a consultation with another orthodontist, but I am so glad I did. The 2nd ortho told me that he didn't see a need for upper jaw expansion surgery at all. In fact, he was completely confident that I could have a beautiful smile in 15 - 18 months with an upper clark expander and full ceramic braces. I've had both for 2 months now and my upper jaw is almost completely expanded and my crossbite almost fixed.

My advice is to always get another opinion, especially if an ortho is really pushing you for surgery that you don't want. No one ortho's opinion is the end all, be all, and it doesn't hurt to have more than one option.

[deathorglory]

I'm just going to assume you saw Dr Bloomquist, because your description kind of sounds like him. His online reviews all say that his bedside manner is rather lacking. He's in the same office as my surgeon (Dr Feldman, much nicer personality) so I saw him when I developed an infection while my surgeon was out of town. He wasn't exactly rude...but he wasn't exactly nice, either. Very to the point, etc.

While I was deciding on braces with extractions or braces with surgery, I spent a week reading online blogs. I only had my bottom jaw operated on and it seems like most blog have both jaws or upper jaw surgery, but it seemed like something I could handle with my insurance and work benefits. It also brought up a number of questions for me to ask the surgeon at my consults (ie, how many jaw surgeries do you do a year, what percentage of your patients end up with post surgery infections, etc).

I'm sorry you feel that people don't support your decision. It is your face, after all... I know what helped me decide was that when I saw my ortho for the second time, she had had a mold made of my teeth and could show me exactly how my teeth fit together and what could be done and what couldn't be done with/without surgery.

[gabriella36]

Not Dr. Bloomquist, althougth the ortho my dentist referred me to (the second of three orthos I consulted with), he referred me to Dr. Feldman as the oral surgeon. To be perfectly honest, I backed quickly away from both that ortho and Dr. Feldman when a Google search turned up his malpractice suit. I'm glad he was good to you.

I'm not sure what the etiquette is on here around naming names, but I will say that I'm now working with a female ortho dual-trained in orthodontics and periodontics and I really like her. So far.

I called her office today to verify that I didn't have to come in for a treatment discussion and continued to feel ignorant. I asked the assistant about metal vs. clear braces and if it made a difference and she swears it doesn't, that with the advancements in materials it doesn't make a difference.

I would just really like to stop feeling like every decision I'm making is the wrong one, and to stop feeling so overwhelmed with information.

[lydime]

Hi! When I was 22 I went to an orthodontist to see about getting brace he really pushed surgery told me it was the only option, etc. like you I felt attractive and confident before, obviously not totally happy with my teeth but he made me feel like a freak. I also couldn't take time off for recovery. So I just didn't do anything. I was ashamed. Years went by and my bite just got worse, I even developed and open bite in my 30s. Fast forward to 34 and I tried another consultation. This ortho said I did not need surgery or teeth removed. I went for it. Let me tell you, it's only been a year and my teeth are so much better. And they were way ,way worse than that initial consultation in my 20s. I would say, shop around, and the most high end places are not always the best. My ortho now is pretty cheap. My only regret is letting that first one deter me for so long.

[deathorglory]

My orthodontist is actually all the way down in Federal Way. She's been consistently rated as one of the best in the area and she's been nothing but nice to me whenever I see her. And when I have questions I feel like she doesn't just give me a cursory answer that's simple and mainly designed to make me stop asking more questions but actually gives me a thorough answer that explains the pros and cons of the decision. Also, her office staff is pretty awesome for the most part. ...And they show Disney movies in the waiting area

Dr Feldman's got a malpractice suit? I'm not sure I came across that when I googled his name (which I did...multiple times in case I missed anything)... I see one now for a podiatrist, but as he's an oral surgeon I'm not sure that's the same doctor...? Most of my research for him was from sites like healthgrades, etc. but I usually take the negative reviews with a grain of salt. I'm aware that people are more likely to complain than they are to compliment and even if procedures are followed to the letter, sometimes infections just happen through no fault of either the surgeon or the patient. I also watched whatever youtube videos I could find listing/mentioning his name as the surgeon, but to be honest there weren't too many of those.

No treatment discussion as in surgery vs extractions? Were your options not fully explained to you at the initial consultation? As for the metal vs clear braces, I wasn't told that either would be faster than the other (I could be wrong...this WAS over a year ago), but I was told that the ceramic braces are a little more fragile and prone to breaking than the metal ones. Maybe that could be the difference in time in treatment...after all if the bracket breaks then it's not really doing it's job anymore, right? I wouldn't really say that there is a WRONG decision here...either way, you're working to fix your bite so no matter if you choose surgery or extractions, things will improve regardless What matters is that you make a decision that you know works with your lifestyle.

I'd suggest reading blogs (plenty on just braces and a ton on jaw surgery) to get more of an idea of what other questions to ask/what you should expect should you choose surgery vs extractions. I know that reading the blogs helped me feel more at ease with the recovery period post surgery. Also, since I only had lower jaw surgery my jaw line/face didn't change drastically - it was mostly my bite, so I had an easier adjustment post surgery than say, people who have both upper and lower jaw surgery whose looks change dramatically.

[Sheriekontul]

[quote="deathorglory"]I'm in Seattle, where are you? :)

I opted for the surgery. Like you, I had no self esteem issues, or anything of that sort. I actually asked my dentist about how I could stop grinding my teeth, and he actually suggested braces and I seem to have tried all the other usual routes. When I went for my consult, they gave me the option of extraction and having most of the issues fixed, or jaw surgery and having it all fixed. I figured, in for a penny, in for a buck. I might as well get the jaw surgery and have everything corrected. I've heard before that I might need jaw surgery, as my overbite was pretty large, though unlike most people with a large overbite I have a chin, so it wasn't very noticeable.

My jaw surgeon consults...weren't nearly as easy to decide on. The jaw surgeon I was originally referred to decided to stop taking patients during my treatment, so despite my previous consult with her, she wouldn't do my surgery. I then saw another surgeon in Seattle who seemed very knowledgeable but maybe not too friendly. I saw his partner later on after surgery, and he was much less personable. I was very happy to have selected my surgeon, because at least he could crack a smile.

I did take 4 weeks off work, but my job has a short term disability plan (paycheck deficit is made up with sick pay), so it wasn't like I didn't have any income coming in while I was off. I'm pretty lucky in that regard.

There was nothing about changing my looks that made my decision. It was more like if there's a chance of fixing my bite to where I wouldn't have my current issues and I was willing to shell out money for it, why not get the surgery and have everything fixed instead of just most things? Most thing...I don't know. I always assume that the last few issues that I'd have would become larger issues as I get older (I'm only 29). I've already got some bone loss and my tooth grinding was bad enough to wake my boyfriend out of a dead sleep. He said it sounds like forks and knives on ceramic. I suppose that with extractions, I'd have been able to fix a decent amount of my bite, but with a 10mm overbite, there really wasn't a way to make my molars fit fully together without the jaw surgery. And since those are the teeth I like to grind on...it really made sense to me. It had nothing to do with the "deformity" itself - I thought I looked rather decent with my overbite. It accentuated my high cheek bones ;)

I do applaud your choice though. It is YOUR choice, after all. It just depends on what you think needs fixing, etc. If you're not having too many difficulties now and don't think you'll have them later, is it really necessary? ...probably not. :) Good luck on your braces journey![/quote]. I agree and it's been a tough journey. I have a 9 mm over bite I am just doing braces on my top teeth and that's it. Don't let them bother you. It's ok I feel strongly against it. I don't have time money etc. I have lived with it my whole life.

[Sheriekontul]

I'm going through the same thing. It's terrible I like you had a consult with a surgeon it was bad my 16 yr old son he wanted to punch him. I have a 9 mm overbite it's causing enamel damage and possible sleep apnea. I'm not going to have the surgery I do not want it. I decided to straighten the top and that's it. I've lived this way my whole life. I'm ok with the way I look. To me it's better than evasive surgery and all the stress that comes with it financially mentally etc. Do what you want to do its your life. By me doing top braces I will get 2 to 3 mm correction and fix one crooked tooth that sticks out. Good luck with this. Please update us!!!!

[Sheriekontul]

Also I have high cheekbones too. It could change our look and we could be unrecognisable. I've been so stressed over this. I'm so glad I have someone to relate too.

[bracesagainno]

I went to an sweetheart first surgeon too. I walked out of the office in tears cause he called me deformed. Maybe seeing one another could change your mind?