Zero Tooth-Show ... Revision Maxilla Down-graft

[Eranthe]

Hello. Some of you may recall my story from a year ago, but briefly ... I had a SARME in 2014, and Bi-Max in 2015 and a subsequent revision Lefort 1 in 2016! The Bi-max in 2015 left me with a severely crooked nose and a mid-line-shift almost one entire tooth-width to the left (think Tom Cruise). However, despite the crooked nose and mid-line issues, I genuinely liked the look of my new face - it just needed some adjustments to get it right. At first when I tried to talk to my surgeon about my concerns after the bi-max, he became extremely emotional and defensive and flatly refused to rectify the situation. I felt completely helpless and suffered from considerable depression during that time. It took a whole year of my life to finally encourage my surgeon to perform a much-needed revision ... which he later conceded to both myself and the registrar "needed to be done" because - quote "we couldn't exactly leave you looking like that"!!!

The revision in 2016 was top jaw only as we decided a redo of the mandible would be too risky at my age. This time my surgeon managed to get my nose almost straight, and my mid-line almost centre (which was close enough for me). That would have been fine ... however for some reason also decided to remove an enormous amount of vertical excess and impacted me so much that I now have a much shorter face, a flat mid-face, wide nose and absolutely no tooth-show! Zero! I don't need to tell most of you that these changes have the potential to create the 'perfect storm' in terms of making a woman look unattractive! I look angry all the time and I look like I have no teeth.

In early 2017, I gathered my courage and went to my surgeon and told him how disappointed I was, and asked him why he had removed so much vertical excess and impacted me so much? My surgeon is a master of saying a great deal without actually saying anything at all. He concluded that I should get plastic surgery to fix the things I didn't like. I have, over the past 12 months, considered plastic surgery. The problem is that because he has removed so much vertical excess, my face has lost a considerable amount of length. If I getting nose jobs and lip lift, it's simply going to create a very centralized and concentrated grouping of my features in the centre of my face, when what I want is greater mid-face length and more tooth-show.

I simply want a maxilla down-graft, however when I went to speak with my surgeons registrar today I was informed that it is not possible to have a maxilla down-graft without bringing the lower jaw forward also (in other words, a bi-max) because the down-graft movement would force the mandible to rotate backwards.

Could anyone please advise if this is, in fact, true? If they could give me a LeFort I last year to to remove (too much) vertical excess, can they not simply reverse this movement in a revision down-graft surgery. I ask as I am an older patient and have significant nerve damage and numbness in my lower lip and chin after the bi-max and would prefer to not to take the risk of another lower jaw surgery.

Thanks for reading. I hope this all makes sense and that someone may be able to offer some advice/perspective etc. I am so angry and sad.
It has been a tough four years and feel as though I am watching each year slip away without any progress or forward movement.

[assertives]

I remember your story. I have been lurking and remember feeling angry.

I am not able to advise you regarding your queries but could not help wondering, after so many screw ups by your surgeon, and quite honestly, his attitude leaves much to be desired. Why do you still want to go back to him? Have you considered a second opinion?

[Eranthe]

Thanks for your message and sorry for the late reply. The reason I keep going back to him is that I'm a public patient. Also, I have so much history with him now, I feel like he knows the situation intimately. I'm scared that if I introduce a new surgeon to the situation it might get even worse. It's hard to know what to do. He doesn't want to do anything to fix it now as it would involve a down-graft and he feels that it would be too unstable. I share your anger, believe me.

[Cezzza]

Omg I need help…. Long story short I have just had double jaw surgery….. 6 weeks post op and I am literally in the same position….. I have no upper tooth show (at all ) when I smile…… I had severe gummy smile previously to no gum show at all….. I at least want to see my teeth…. how do I fix this.

[snapdresser]

Most people don’t fix it. Give it more time to get full movement back and swelling to go away, but that is very common, especially for older patients. It’s a risk of CCW rotation, and an extremely common outcome. Cosmetic procedures may offer a little help. Even a downgraft revision surgery, if you can find a surgeon willing to do it, will likely not leave you satisfied with your results, though some folks on here are extremely motivated to find a surgeon to do it. The fact is, tons of people have zero upper tooth show, especially as they age. Strangers won’t give it a second thought, but since you previously had a gummy smile it’s going to mess with you mentally. The mental aspects are the toughest part of this surgery, IMO. Some counseling might help you see that you don’t actually look worse than before, just different. Good luck!

[Cezzza]

I had the same problem. I had a very gummy smile. Had double jaw surgery and now I have no gummy smile and no teeth show.

I waited a while… did mouth exercises to stretch my mouth. That did help with a little more teeth show but then opted for upper lip lift.

As my philtrum was longer than average anyway… this is the space from bottom of nose to top of upper lip…. Doing the upper lip lift basically corrected the tooth show.

Hope this helps