Differing opinions, who to trust?

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#1 Post by **killa** » Mon Dec 15, 2008 3:28 am

I'm in my early 20s and have an overbite. Had braces as a teenager, but they never totally fixed my problem. I've also been told I have "long face syndrome". I have difficulty closing my mouth (lip strain), an asymmetrical smile and TMJ. I recently went and got 4 opinions - 2 from orthodontists, 2 from oral surgeons. The first orthodontist and oral surgeon recommended braces for a few months, upper jaw surgery, and genioplasty. They estimated the total treatment time to be around 6 months. The second orthodontist said she could fix my problem with less than a year of braces alone.. when I expressed to her that I had doubts, she referred me to an oral surgeon who recommended braces for one year before upper AND lower jaw surgery, possibly a genioplasty and then braces for 6-12 months following the surgery. Obviously these opinions are a lot different from each other and while I do like the idea of being done with treatment in 6 months, I want to have the best possible results. What should I do?

#2 Post by **killa** » Mon Dec 15, 2008 4:15 am

I'm not even sure what questions to ask really, all I know is that I'd like to be able to close my mouth comfortably and I hate the way my teeth look. Does anyone know what treatment is "standard" for fixing this problem? I think one of the orthodontists said it was a 40% overbite.

#3 Post by **Graceful58** » Mon Dec 15, 2008 5:48 am

I would agree with Meryaten. I think you have to go with the ortho you felt most confident in as well as the oral surgeon who made the most sense. If you're still unsure then seek one more opinion for ortho and one more for oral to help give you a the best choices and then make your decision based on the info you have received. Decisions like these are always difficult but really it comes down to who you felt would meet your expectations and had good outcomes of previous types of surgeries like the ones that are being recommended. There's a lot of info out there as to questions to ask your oral surgeon, here's a link to Brandy's website with specific questions to ask. Good luck to you!!

http://postsurgeryquestions.blogspot.com/

#4 Post by **jonathon003** » Mon Dec 15, 2008 7:02 am

For what it's worth, and obviously I'm in no position to evaluate your specific case, but it sounds like we're in similar positions. You can read about my situation if need be here...

viewtopic.php?t=29042

It's a little lenghty, but basically I found out that to correct the problem we have, lip strain or incompetence, a lefort impaction (where they shorten your upper jaw) sounds like the best route to go, from everything I know anyway. Thats what my oral surgeon has recommended, along with genioplasty and expansion of the upper jaw. No surgery on the lower jaw, even though I thought it was the biggest problem (ie. too far back and no chin). But reading some journal articles I've found out that the lefort impaction, while fixing the lip incompetence issue, it *also* rotates the bottom jaw farward to align more with the upper jaw. Obviously it depends on how much your lower jaw is back though. Anyway the title of the journal article I found pretty helpful is "Profile Changes Following Maxillary Impaction and Autorotation of the Mandible".

Hope any of that helped.

#5 Post by **killa** » Tue Dec 16, 2008 1:17 am

The first surgeon didn't really talk about what the braces would do, but said the total treatment time would be 6 months. He said that they would be shortening my upper jaw "just a tiny bit" and that a genioplasty would benefit me more than anything. To me, 6 months doesn't seem like enough time to move the teeth and I don't really see how genioplasty would fix my bite problem. The second surgeon said that a year of "decompensation orthodontics" would be necessary before the surgery, that he needed to get my front teeth to flare out to achieve a normal bite, then during the surgery he would be moving my upper jaw back about 9 mm and my lower jaw forward about 5-7 mm.

The first surgeon is a general plastic surgeon at a private practice, the second surgeon is a devoted oral/maxillofacial surgeon who also teaches oral/maxillofacial surgery and writes books about it. I am more inclined to trust the second surgeon but the thought of getting the braces put back on for such a long time and knowing that they are making my bite worse sounds like the absolute worst thing in the world to me. I am already afraid to talk to people and make friends because I always feel like people are looking at my teeth and thinking I'm this ugly deformed person. I want to do what the first surgeon recommended because I want to be done with this in 6 months but I just don't trust that I'll have the best results with him. On the other hand, I don't know if I can mentally deal with a year of my teeth getting worse, and possibly having 2 years before I can be done and completely move on with my life.

I just want to be normal. I feel like I'm never going to get my teeth fixed or I'm going to be old before it happens.

#6 Post by **Figamentation** » Tue Dec 16, 2008 6:05 am

I know you want to get this process done quickly, but if you read throughout this board you will find people left and right that went with a plastic surgeon, usually out of ignorance and not knowing that the oral surgery route existed and to a man they are almost all disappointed and did not achieve the desired results. Your problems sound very much in line with what an oral surgeon is best at correcting. It may be a longer road but most likely the correct one.

Just to give you some comfort, the decompensation movement for the teeth (which I also had) it usually isn't as bad as you would think. I had to do the same thing and expected my teeth to look horrible for that year but really almost no one noticed but me.

Ultimately you have to be the one to make the commitment so if you go the shorter route, I guess no one could blame you at the chance it could all be done so quickly. But based on what I've read here and on the internet you would be better off doing it right the first time. Good luck!

#7 Post by **gatorseh** » Tue Dec 16, 2008 10:47 am

I would go with a devoted oral surgeon who teaches this, writes about it, and does it often. The better the surgeon the better the results.

#8 Post by **switchblades** » Tue Dec 16, 2008 8:34 pm

Meryaten wrote:the people around us think about it far less than we do, if they think about it at all. Perhaps getting some help with this - help truly to believe that it's not a big deal to other people - might help you get through the long course if that is the path you choose.

Too true, my parents, my boyfriend's parents, my boyfriend and a lot of my friends have always said to me "your teeth are fine, you don't need braces" and my mother calls me every day to try and convince me not to get surgery. I'm in a similar boat as the OP, I'm at month 3 of 24-30 months of braces, with surgery in there somewhere, and while it is going to take a heck of a lot longer than I want it to, it will vastly improve my quality of life, my self-confidence, and how I feel about myself.

Ultimately, it is your decision, but I think you should consider the credentials very closely before dealing with someone who is only versed in plastic surgery. The cosmetic aspect may be important, but if you fix the functional as well, you'll have a much nicer smile later in life too.

#9 Post by **neener** » Wed Dec 17, 2008 12:27 am

i would love to be your age, making this decision, after knowing what i know now. i would definitely agree with the previous writers and say that max fac route has so much better results than plastic surgery. i don't understand why all these shows were created about plastic surgery and not maxillofacial surgery when the latter has so much more pleasing results. i'm not saying plastic surgery doesn't have a place but most people who are unhappy with their appearance have some over or undergrowth of their jaw bones so it makes sense to fix the root of the problem rather than exacerbate it by adding plastic etc.

i have seen a plastic surgeon slash max fac who teaches at the university here and is head of the hospital max fac unit. he was a little arrogant and basically told me that i wouldn't look much different even if my upper jaw was to be shortened 5 mm as he thinks it should be. i can't understand that statement given what i've seen in some of the blogs on the net. everyone i know says i've got an unusually long face and because of my chin implant and assymetrical face, i have a long pointy and uneven chin. i've asked about removing the plastic and getting ortho surgery at this point but i guess it's never been done b/c no one has responded on this forum. i guess i'll just have to keep researching. sorry for the long winded message...i guess i'm just thinking in cyberspace. neen.

#10 Post by **PuppySmiles** » Wed Dec 17, 2008 12:28 am

I'd have to agree with Meryaten, especially her advice that you get another opinion.

If you see two doctors - one who's just fine and one who's got crazy ideas - it's going to skew your idea of what's available, and what's reasonable.

One more doc can give you a more well-rounded idea of what you're actually dealing with here!

#11 Post by **Graceful58** » Wed Dec 17, 2008 6:11 am

As someone who went back into braces at the age of 46 for the second time as an adult I'm very glad I made this decision. First, I wasn't happy with how my teeth looked and although I was told I would be a year in braces before surgery I just looked at it as the opportunity to fix what I didn't like. All my close friends and family members told me the same thing...you don't need braces and surgery you're teeth look fine. I appreciated what they had to say but really, I'm the one who has to live with my looks and ultimately the one who has to make that decision for myself. You're young and I would suggest you focus on the results you're wanting rather than how you'll look in the process. We are usually are our own worst critics and really no one else is noticing all that we notice about ourselves.

It sounds to me that you know what the right route is but you're not wanting the time frame but you want the best results possible. Sometimes we just have to focus on the end result and not on the process that will get us there. I'm confident that you will make the best decision for you.

#12 Post by **ElenaM** » Wed Dec 17, 2008 6:00 pm

killa wrote:The first surgeon didn't really talk about what the braces would do, but said the total treatment time would be 6 months. He said that they would be shortening my upper jaw "just a tiny bit" and that a genioplasty would benefit me more than anything. To me, 6 months doesn't seem like enough time to move the teeth and I don't really see how genioplasty would fix my bite problem. The second surgeon said that a year of "decompensation orthodontics" would be necessary before the surgery, that he needed to get my front teeth to flare out to achieve a normal bite, then during the surgery he would be moving my upper jaw back about 9 mm and my lower jaw forward about 5-7 mm.

The first surgeon is a general plastic surgeon at a private practice, the second surgeon is a devoted oral/maxillofacial surgeon who also teaches oral/maxillofacial surgery and writes books about it. I am more inclined to trust the second surgeon but the thought of getting the braces put back on for such a long time and knowing that they are making my bite worse sounds like the absolute worst thing in the world to me. I am already afraid to talk to people and make friends because I always feel like people are looking at my teeth and thinking I'm this ugly deformed person. I want to do what the first surgeon recommended because I want to be done with this in 6 months but I just don't trust that I'll have the best results with him. On the other hand, I don't know if I can mentally deal with a year of my teeth getting worse, and possibly having 2 years before I can be done and completely move on with my life.

I just want to be normal. I feel like I'm never going to get my teeth fixed or I'm going to be old before it happens.

I would trust the second surgeon. It might sound tough getting your braces on again but it won't be too bad. The end result will be a much better bite.

#13 Post by **jonathon003** » Wed Dec 17, 2008 8:19 pm

Graceful58 wrote:As someone who went back into braces at the age of 46 for the second time as an adult I'm very glad I made this decision. First, I wasn't happy with how my teeth looked and although I was told I would be a year in braces before surgery I just looked at it as the opportunity to fix what I didn't like. All my close friends and family members told me the same thing...you don't need braces and surgery you're teeth look fine. I appreciated what they had to say but really, I'm the one who has to live with my looks and ultimately the one who has to make that decision for myself. You're young and I would suggest you focus on the results you're wanting rather than how you'll look in the process. We are usually are our own worst critics and really no one else is noticing all that we notice about ourselves.

It sounds to me that you know what the right route is but you're not wanting the time frame but you want the best results possible. Sometimes we just have to focus on the end result and not on the process that will get us there. I'm confident that you will make the best decision for you.

that's a great attitude and the attitude I'm currently about to take in my LOOONG journey. I can't compare to yourself necessarily since I'm just 23, but at the same time I've already had braces once and am looking at (because of extractions) another 2.5 years of braces with the surgery in between. After my retainer and all that stuff afterwards, I will be nearing 26 before my face can look 'normal' again. Is it a little disheartening especially at this age? Absolutely. I mean your early 20's I'm sure can be argued as the perceived best years of one's life. I don't have a gf right now and feel this is setting me back quite some bit. But the way I see it, I might be taking 2 steps back (ie. looking like a teenager, brace face, etc) but then taking like 5 giant leaps forward when I hit 25/26. So I, like you, am going to spend these 2.5 years busting my tail off to shore up all my 'insecurities' and weaknesses, in hopes of coming out of this a new man.

May sound kind of silly, and you'd think the attitude might just wear off eventually, we shall see. But as of right now, I'm excited to just get this journey started (should be braced in january hopefully) and start this giant 'self-project'. I think we should all set many goals and work on areas you may feel weak in, etc. Take this as a huge opportunity. It surely will be a long road, but it can serve as a huge life change, which can act much more than just changing ur face/smile etc.

Sorry if I have gone off on a tangent..

#14 Post by **Graceful58** » Thu Dec 18, 2008 9:12 am

Hey Jonathon...I think you're making a very wise and mature decision that you will be most happy with on the long term. I should have had surgery in my early twenties when I had my braces the first time, but I didn't do it. In hindsight I should have done it, so at this point in my life I didn't have be in braces having surgery...but I'm doing it now and that is all that really matters...right?

I look foward to hearing about your journey and good attitude in the process.