The safety/relapse rate of maxillary down-grafting?

[Eranthe]

Just a quick question if I may about the maxillary down-grafting procedure.

My story is all here in past posts, but briefly I had a bi-max (which left me with a deviated septum, crooked nose to the left and a severe mid-line deviation to the left) two years ago. One year ago, I had a revision Lefort to correct this deviation, however during this surgery my surgeon, in all his wisdom, removed a stupidly large amount of vertical excess. My face is now much shorter, I have less than zero tooth-show and look like an elderly lady. When you combine the complete lack of tooth-show with the much wider nose (from the SARPE) and the flattened mid-face (due to impaction) ... well I look horrible. I was once a reasonably attractive, outgoing and social woman but these surgeries have made me very unattractive and self-conscious ... I am depressed, cry most days and I have withdrawn socially.

I need to fix the situation and have been trying to talk my surgeon into yet another revision for the past year. A few weeks ago he agreed that it needed to be redone ... however this past week he has reverted once again to suggesting I try to fix the problems via plastic surgery. He has offered to arrange a consultation with a colleague to discuss a rhinoplasty and lip-lift. I'm a little afraid of a plastic surgery approach as, whilst the results may improve things, they may make things worse. I have repeatedly requested a revision down-graft ... but my surgeon keeps arguing that the procedure is too unstable with a high relapse rate and he doesn't want to do it.

I have done a little research on maxillary down-grafts and I can see that there is somewhat higher relapse rate ... but I can also see that many people who need to have them, do have them successfully.

I'd be extremely greatful if anyone here with any knowledge on this subject could offer some advice, particularly anyone who has had a maxillary down-graft - successful or otherwise. My jaw surgery situation has been dragging on for three and a half years, and I am really depressed and desperately in need of some support and advice.

Many thanks

[snapdresser]

You have no tooth show at all when smiling as big as you can? Do you have pics you'd be willing to share?

[Eranthe]

By the way, the "yes I do" above was in answer to your question "do you have pics".

The complete lack of tooth-show is at rest. When I smile there is perhaps a mm or two but I suspect that is just because the braces are holding up the top lip a tiny fraction. When the braces come off, that tiny fraction of a mm or two will no doubt disappear too.

Obviously if I scrunch my upper lip upwards in a manner no-one ever would when smiling naturally, then you can see my teeth ... but I would have to be snarling to achieve this ...

[Ravenclaw]

I'm sorry to hear about what happened to you. Have you by any chance consulted with a different maxillofacial surgeon? Since your surgeon has already performed two less than ideal surgeries on you, it might be prudent to have other surgeons look at the problem.

[Eranthe]

I would definitely consult with another surgeon if I could, but I simply cannot afford to pay another surgeon to revise. I need the surgeon who did this to fix it.

Is there anyone at all out there who has had a down-graft of the maxilla that may be able to comment