Had TWO double-jaw surgeries; first was a complete failure, second bite is OK-ish but I don't like the aesthetics...

[SirUserName]

Hello. This is going to be long, but I'm really lost at what to do with this now...

I'm 24 (male), I had braces ages 14-16 but they didn't do a good job and I ended up with an open bite and an off-midline at the mandible, which probably wasn't present earlier. There was also a bit of underbite, and the left side of the mandible was a bit lower than the right.

I had a bimaxillary surgery in late 2014, which didn't go well. They decided the underbite is due to recessed maxilla, and said they'll forward and rotate downwards the maxilla, while rotating the mandible sideways to improve the midline. I believe both the treatment plan and the surgery itself were wrong. I didn't do specific pre-op ortho before that surgery, but they decided they found a good enough position for the bite. I was wired-shut for 6 weeks, and as soon as the wiring was out and I started moving my mouth I saw it closes completely wrong. I ended up with a bite even more open than before, the midlines still didn't match and apparently they even made the maxilla off (so it was even more pronounced at the mandible).

The surgeon at that hospital tried to play it off like it's just a little less than expected, but still good enough to fix with ortho. Thing is, I saw several orthos and all told me the mismatch is too extreme, with the problem being surgical. I was eventually recommended by a dentist who had her residency at a different hospital to go there, because their PREVIOUS head of orthognathics under whom she studied is the best in our country, and thus she believes the current department is still high quality.

I went to that hospital, which is public and in our country such surgeries are covered by the national healthcare plan in public hospitals. I met with the deputy chief physician (if that's the correct term) there mid-2015 and he agreed the first surgery was pretty bad. He said he thinks I should have a bimaxillary revision, and all the time told me how he aims for perfection and how he would do this and that. I started wearing braces fitted by their "in-house" orthodontist late 2015.

Now, here's the thing where expectations were A but results ended up Z: I actually met with that nationally-regarded surgeon I mentioned earlier in his private practice after my sister asked around and was also given his name. I saw him after I had a couple of meetings with the new surgeon at the hospital IIRC, and the private surgeon actually didn't seem too impress hearing his name. He said "not everyone who write articles on newspapers and have interviews on television are..." (the one from the hospital also works private and advertises himself a lot). Anyway, that reputed surgeon looked at then-current x-rays I brought him, though he also wanted to see pre-op x-rays to compare but I didn't have these on me.

First, he told me there is evidence of a secondary, incorrect fracture at the right side of my mandible. I wasn't told of this by my first surgeon, but this one was certain it is a mishap of the surgery which legally I should have been told of. I'm pretty certain it didn't heal well and deformed the shape of the angle at my right side, which now looks worse. Then, he explained right away that my mandible's angle is too sloped downwards, making for a weak and unflattering jaw line. He said it also could be a worsening from the first surgery, but alas I couldn't provide earlier x-rays. He said his plan for the surgery would be bimaxillary, and IIRC he thought it should combine downwards rotation of the maxilla with an upwards rotation of the mandible. Perhaps he wanted to rotate both of them upwards, but I don't remember.

Anyway, he only worked private - which costs A LOT of money, and he seemed quite old for me, so I wasn't sure if I wanted to go to him after having started with the other surgeon and eventually didn't meet him again. Thing is, when I mentioned his diagnosis to the surgeon from the hospital, he said "yes, this is exactly what I wanted to do as well. We talked about it already" - talking of the idea to rotate the jaw upwards, though I didn't remember him mentioning that earlier. But, from then on my understanding was that he had the same treatment plan and the results should be similar. That surgeon eventually acted completely unethically and ended up presenting me with a plan different than previously discussed one week pre-op.

The available surgery dates at the public hospital he works at were already a year+ ahead when I met him during mid-2015. I started my ortho (late 2015), which was expected to take around 1 year, and not once has that surgeon decided to actually write me down for a surgery date at the public hospital. The ortho thought I was good enough for surgery before 2017 IIRC, but the surgeon said it should get a bit better. Obviously, I was still not given a surgery date and these went closer and closer to 2020, so he didn't mind wasting more time. I was eventually declared ready around July 2017 by the ortho, and here the surgeon told me "welp, dates available at the hospital are from 2020, but if we go private I can operate on you right now".

WTF? This guy knew I came to him after a bad surgery and he was making tricks on me to get more money... It's even illegal here and I just found out he's being investigated for his shady work ethics since two weeks ago by the management of the public hospital he works at.

I have a private health insurance which which I got to cover everything (it's usually only part of the sum), but I'm sorry I went along with this guy. As I said, a crucial point for me was improving the angle of the jaw. It simply doesn't look right, especially on a guy. It should ideally be much more parallel to the rest of the skull, and having it like this harms the visual angularity and width at both the front and side of the face. At the plan he showed me a week before the operation date, he completely disregarded that part even though he previously said it's to be included in his plan. I asked him about it and suddenly he said, "no, you cant improve that in surgery. There isn't enough bone to work with, you don't understand how the incisions are being made. If you'll want, I could fit you with synthetic implants a year afterwards".

I really didn't know what to do with that information and tried getting a secondary opinion from a different surgeon, but couldn't find any available within a few days' notice. I was really divided at whether I should cancel the operation date I had with him, but I was so sick of the process taking years I was also afraid I'll push the date further just to hear the same explanation from other surgeons. I ended up going on with it on December 2017 and I'm sorry I did. The result doesn't look like it should, even if I heard the obligatory "oooh it looks great" afterwards.

The bite itself was a bit better after the surgery, but even that wasn't as good as the models anticipated; I started with some rubber bands which got it a bit better, but the contact points aren't all even so far. The angle? Not good. I was actually hoping it might do end up better as I asked the surgeon helping him "why don't you put the implants in this surgery if you think they could help?" and she said "because we don't know how exactly it would look after the surgery". I took it as "it might be improved enough and the patient won't think the implants are called for in the end". Well, nope. It simply lacks the features you expect the "frame" of the jaw bone to have, but my issue now is that I don't even think adding implants as an afterthought will look right, as they would only add more volume towards the back end of the bone in order to fake a sharper angle, but they won't affect the position and angle of the front end of the jaws, especially the chin.

When I look at it right now it seems pretty obvious to me that the front end itself is too low, with the chin also pointing down too much, and perhaps what should have been done is a combination of fixating the chin-side higher within the skull while partially lowering the back end of the mandible (or perhaps both mandible and maxilla) in order to achieve a less-sloped jaw line while also shortening a bit the vertical length of the face. I suspect the angle is actually wrong with the maxilla as well, as when I smile it makes my nostrils move up too much while the tip points downwards, and from the side it looks like the nose is "falling downwards" as well, which I don't think was the condition before I had any surgery.




What should I do? I simply despise how everything went, and I believe I don't need to accept it as it seems to me like the treatment plan decided upon simply wasn't right and the results aren't visually satisfactory, but has anyone ever went through THREE bimaxillary surgeries?! My family already thought I was crazy doing the second surgery (I can't say they were too accepting of doing the first one either), and the recovery is absolute hell as many of you probably know. I was even left with a prominent desensitization in my left lower lip and chin since the first surgery, and after the second surgery most of the left side of my face was completely numb, though that mostly went away but not 100%. I'm trying to meet again with that reputed private surgeon I didn't continue with back then (who's even older now) to see what he thinks. I just can't have it like this... I know for certain there is what's termed "counterclockwise rotation" of the maxillas, rotating them upwards, and IT IS done routinely in cases where it's deemed worthy. I've seen before-and-afters of people who barely had a face and had it completely rebuilt with such a movement, and I doubt I'm as bad as some of these cases so I can't see why was I told "I can't do it" by this surgeon, who just chose to leave me with unsatisfactory facial features, perhaps even accentuate them by moving the bone structure even further downwards...

Sorry again for the endless rant, I'm just lost at what one should do right now.

[SirUserName]

Anyone? I guess it's too long to read for most, so TL;DR:

Had first surgery to fix open bite, slight underbite and deviating mandibular midline in Sep 2014, result was bad both bite-wise and esthetically. I ended up seeing two orthognathic surgeons afterwards: a highly regarded one I didn't continue with told me right away I should have a revision double-jaw with the plan to lift the angle of my mandible up, as it's currently too much at a slope, which makes for a weak jawline. I eventually didn't continue with that surgeon as he only worked private (which costs A LOT and that wasn't in my plan) but the guy I went with said he agrees and that's it's also his plan for my surgery.

So, I was certain we have the same understanding of what the esthetic goal should be, yet one week before the surgery he presented me with a completely different plan - and the surgery even ended up being through his private clinic due to not providing me with a surgery date in the public hospital he works at, which is actually illegal over here (I met him only through the public hospital for 2 years).

I wasn't sure if to cancel my surgery with him. I eventually went along after he tried to claim this is the best option, but I couldn't manage to get a second (*third) opinion within a few days' time, and I'm sorry I didn't cancel. My bite is OK (not perfect), but the jawline didn't improve one bit. The more senior doctor I met once referred to that part in his diagnosis right away, so I don't think it was "not treatable" like my surgeon claimed at the last minute. I'm also still experiencing difficulty breathing from my nose when lying down, which is quite annoying when trying to sleep, and the nose itself angled downwards when smiling as well, which looks bad.



I plan to meet the more senior doctor again, but I don't know what to do or expect. Doing this darn surgery a third time sounds crazy, but I'm certain counterclockwise movement to lift the jawline was an option, and the surgeon's decision to perform a different movement resulted in a wrong result which I just can't agree with.

[jawguy123]

I would try to maybe consult with one of the bigger name doctors regarding a third surgery. I don't think a second revision is completely out of the question.

One of the patients in this (https://www.jcmfs.com/article/S1010-518 ... 2/abstract) study had 2 bimax surgeries, 3 genioplasties, 2 rhinoplasties as well as some other soft tissue procedures before undergoing another bimax (3rd time) + genio + rhinoplasty + lipofilling, and her result was pretty good.