Who is the best orthognathic surgeon?

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brutal_blackpill

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I am getting double jaw surgery soon in about a month and am now having fears. Why? My surgeon is well reviewed but he’s basically unknown and has no before and after results. On Yelp, I only saw two people get it. Should I just wait another half year or a year and save up to

a) Try to get surgery from Arnett/Gunson (50k + would be the cost from what I’ve heard)
b) Find a blackpilled surgeon in the US (Are there any good ones that you guys know of)?
or
c) Go to Europe for a good surgeon? I know of Sailer and heard the cost is 100k+

The most important concern of mine is this. How COMPLEX is this surgery in that how much of an impact does a person’s skill make on this surgery as long as I manage to convince the surgeon that I want an aesthetic result? For example, why exactly is Sailer 100k+ whereas the cost in the US is about 20k on average? For example, I know eyes are delicate areas and certain surgeons will simply be better. How true is this for the jaw area?

Secondly, why is it so common for me to see results where the lower jaw still seems recessed compared to the upper jaw? Look at Andreischev’s results for example and you’ll notice that. Is this because they’re just not good enough surgeons or is it because of some functional limit to how much jaw surgery can protrude your lower jaw? I have attached an example from Dr.Andreischev where the person’s lower jaw still seems to be a bit further back compared to the upper (unless I’m missing something). I really want to ensure that my lower jaw is extended well enough such that there is no hint of a recession.
@Golden Glass @Dude420 @SurgerySoon @facemaxxed
 

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Go consult with Gunson (if you don't have to wait for 1+ years to schedule) and use his plan as a baseline with another good surgeon who won't charge you 50k for a fucking bimax + 20k for hospital fees JFL
 
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With Bimax, it's all about the surgical plan/proposed movements
 
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good and cheap
 
With Bimax, it's all about the surgical plan/proposed movements
Yeah but assuming it’s the same plan, wouldn’t someone like Sailer do a better job compared to another good surgeon who’s not known given the higher cost? What is the reason for the higher cost is what I’m asking?
 
Yeah but assuming it’s the same plan, wouldn’t someone like Sailer do a better job compared to another good surgeon who’s not known given the higher cost? What is the reason for the higher cost is what I’m asking?

I think Sailer is a geriatric quack with frauded results, but yes there is a fair bit to planning and executing the surgery and someone good is probably more likely to get a stable result with everything oriented properly and fewer complications. That said, is someone like Gunson worth X% more than a relatively unknown but competent surgeon in the US with a similar surgical plan? Maybe, maybe not. As for WHY some doctors charge so much, that's easy: because they can
 
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Secondly, why is it so common for me to see results where the lower jaw still seems recessed compared to the upper jaw? Look at Andreischev’s results for example and you’ll notice that. Is this because they’re just not good enough surgeons or is it because of some functional limit to how much jaw surgery can protrude your lower jaw? I have attached an example from Dr.Andreischev where the person’s lower jaw still seems to be a bit further back compared to the upper (unless I’m missing something). I really want to ensure that my lower jaw is extended well enough such that there is no hint of a recession.
@Golden Glass @Dude420 @SurgerySoon @facemaxxed

Three main reasons.
- Aesthetic eye, personal choice of the surgeon. Normally according to certain "aesthetic rules" that give some wiggle room.
- Technical difficulties during the operation / surgeon's skills.
- The more forward the mandible is set with the intervention, the higher the risk for a postop relapse.

My advise is that you do not bring one surgeon's plan to another.

Hope this helps,

Sergio
 
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Try Raffiani/Zarrinbal/Andreishchev. I would not go for an unknown surgeon when its about your face tbh. I would rather spend a bit extra than worry about appearing on "Botched Surgeries".


functional limit to how much jaw surgery can protrude your lower jaw?

Yeah any movement greater than 10mm and the risk of complications rise significantly.
 
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Try Raffiani/Zarrinbal/Andreishchev. I would not go for an unknown surgeon when its about your face tbh. I would rather spend a bit extra than worry about appearing on "Botched Surgeries".

He's in the US
 
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Try Raffiani/Zarrinbal/Andreishchev. I would not go for an unknown surgeon when its about your face tbh. I would rather spend a bit extra than worry about appearing on "Botched Surgeries".




Yeah any movement greater than 10mm and the risk of complications rise significantly.
Yeah. At this point, my best option is Europe imo given reward vs. cost. I will try to consult with Arnett or Sailer though anyways because I do have sleeping issues. The only hassle would be legal issues in case something goes wrong.
 
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Yeah. At this point, my best option is Europe imo given reward vs. cost. I will try to consult with Arnett or Sailer though anyways because I do have sleeping issues. The only hassle would be legal issues in case something goes wrong.

My honest opinion is you shouldn't leave the US to have Bimax. We have good surgeons here, and post-op complications necessitating a follow up visit are pretty common. And good luck finding a local orthodontist willing to work with a surgeon in another country.
 
My honest opinion is you shouldn't leave the US to have Bimax. We have good surgeons here, and post-op complications necessitating a follow up visit are pretty common. And good luck finding a local orthodontist willing to work with a surgeon in another country.
That’s a good point. Fuck, I don’t know what to do now JFL. My braces that align my teeth and worsen my bite a bit to make the jaw surgery easy end in a month and I will have to convince the orthodontist to work with another surgeon.

My main concern is the simple fact that there are no before afters. The orthodontist recommended a particular jaw surgeon and he is aware of my aesthetic goals along with the orthodontist (she works at a cosmetic dentistry specifically). It’s just that because it’s such an invasive surgery, ive been pondering whether it’s worth it to do the surgery with a surgeon who’s done the kind of surgery countless amounts of times like Raffaini with good before after results.
 
That’s a good point. Fuck, I don’t know what to do now JFL. My braces that align my teeth and worsen my bite a bit to make the jaw surgery easy end in a month and I will have to convince the orthodontist to work with another surgeon.

My main concern is the simple fact that there are no before afters. The orthodontist recommended a particular jaw surgeon and he is aware of my aesthetic goals along with the orthodontist (she works at a cosmetic dentistry specifically). It’s just that because it’s such an invasive surgery, ive been pondering whether it’s worth it to do the surgery with a surgeon who’s done the kind of surgery countless amounts of times like Raffaini with good before after results.

I understand, that would concern me as well to an extent. Did the surgeon give you a copy of the surgical plan, and/or explain the movements to you? Have you consulted with anyone else?
 
I understand, that would concern me as well to an extent. Did the surgeon give you a copy of the surgical plan, and/or explain the movements to you? Have you consulted with anyone else?
I have not consulted with anyone else primarily because I assumed that jaw surgery is a supposedly trivial (skill wise, not invasiveness wise) and so I thought any competent doctor should be able to do it well. Kind of like an organ transplant or something.

After stumbling upon this forum, I have been trying to do consultations with a surgeon in Canada and another surgeon in the US but am waiting currently.

He did not explain the movements to me but he said he would do a bimax with a genioplasty that would supposedly bring both my jaws forward, along with increasing the vertical and horizontal length (not sure if this is even possible which made me skeptical).
 
I have not consulted with anyone else primarily because I assumed that jaw surgery is a supposedly trivial (skill wise, not invasiveness wise) and so I thought any competent doctor should be able to do it well. Kind of like an organ transplant or something.

After stumbling upon this forum, I have been trying to do consultations with a surgeon in Canada and another surgeon in the US but am waiting currently.


I think it takes less "skill" from an artistic standpoint than most cosmetic surgeries, and I know people who have had excellent results from local surgeons, and bad results from big names. The other thing is if you're nearly done with your orthodontic treatment you may be passed the point of no return in terms of switching surgeons unless you scrap the entire process and switch orthos too. And even then finding one willing to work with a European Surgeon will be a huge pita, take it from someone who's gone through this before.
He did not explain the movements to me but he said he would do a bimax with a genioplasty that would supposedly bring both my jaws forward, along with increasing the vertical and horizontal length (not sure if this is even possible which made me skeptical).

Not sharing any sort of tangible surgical plan with proposed movements is a little concerning. Without seeing that, there's really no way to judge the outcome. Do you know how many double jaw cases this person does per year?
 
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Old generation
Arnett, Wolford.
Middle generation
Rafaini, Alfaro, Defranq, Gunson,Relle
New generation
Antipov
 
I think it takes less "skill" from an artistic standpoint than most cosmetic surgeries, and I know people who have had excellent results from local surgeons, and bad results from big names. The other thing is if you're nearly done with your orthodontic treatment you may be passed the point of no return in terms of switching surgeons unless you scrap the entire process and switch orthos too. And even then finding one willing to work with a European Surgeon will be a huge pita, take it from someone who's gone through this before.


Not sharing any sort of tangible surgical plan with proposed movements is a little concerning. Without seeing that, there's really no way to judge the outcome. Do you know how many double jaw cases this person does per year?
Can’t I just wear the last retainer of Invisalign in a delayed way once I’m done? I’m presuming the brace movement is similar to anything that is done before jaw surgery, no? I’m pretty sure your bite is always moved back for the surgeon to work with it more easily. Correct me if I’m wrong, although I’ll find out once I consult with other surgeons.

I believe the exact proposed movements were going to be detailed in my next appointment before my Invisalign is taken off. There is two weeks of metal braces before the surgery once the Invisalign is taken off. I also had no knowledge of anything during my last appointment which was many months ago and not a good grasp of aesthetics either (apart from the fact he mentioned he will move my jaws forward and ideally try to make them vertically taller and wider with a genioplasty and some other technique I have no knowledge of).

I don’t know how many times he does it per year. He is a maxfac surgeon although he mainly does dental surgeries such as wisdom tooth removals.
 
Old generation
Arnett, Wolford.
Middle generation
Rafaini, Alfaro, Defranq, Gunson,Relle
New generation
Antipov

Good list, but Arnett's basically retired and Wolford is too old and starting to botch people. It's too bad Posnick stopped practicing last year, he was honestly better than all of them. Relle is a great surgeon, a little more conservative than Gunson in terms of his ideal amounts of projection, but very good.
Can’t I just wear the last retainer of Invisalign in a delayed way once I’m done? I’m presuming the brace movement is similar to anything that is done before jaw surgery, no? I’m pretty sure your bite is always moved back for the surgeon to work with it more easily. Correct me if I’m wrong, although I’ll find out once I consult with other surgeons.

I believe the exact proposed movements were going to be detailed in my next appointment before my Invisalign is taken off. There is two weeks of metal braces before the surgery once the Invisalign is taken off. I also had no knowledge of anything during my last appointment which was many months ago and not a good grasp of aesthetics either (apart from the fact he mentioned he will move my jaws forward and ideally try to make them vertically taller and wider with a genioplasty and some other technique I have no knowledge of).

I don’t know how many times he does it per year. He is a maxfac surgeon although he mainly does dental surgeries such as wisdom tooth removals.

It depends. The orthodontic movements needed correspond to the surgical plan. A different surgeon may very well have wanted different inclinations/rotations/movements. Bottom line is if you show us a surgical plan (usually a 2d tracing with ceph measurements, skeletal landmarks, and a soft tissue outline, both before and after), I can give you an opinion on it.
 
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Good list, but Arnett's basically retired and Wolford is too old and starting to botch people. It's too bad Posnick stopped practicing last year, he was honestly better than all of them. Relle is a great surgeon, a little more conservative than Gunson in terms of his ideal amounts of projection, but very good.


It depends. The orthodontic movements needed correspond to the surgical plan. A different surgeon may very well have wanted different inclinations/rotations/movements. Bottom line is if you show us a surgical plan (usually a 2d tracing with ceph measurements, skeletal landmarks, and a soft tissue outline, both before and after), I can give you an opinion on it.
Yeah, I will try to get that and send it to you. Did you have jaw surgery? How was the process? Feel comfortable to tell it to me on PM if you don’t want to. You seem very knowledgeable
 
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Yeah, I will try to get that and send it to you. Did you have jaw surgery? How was the process? Feel comfortable to tell it to me on PM if you don’t want to. You seem very knowledgeable

I had multiple disastrous implant surgeries and removals, then Bimax. I also consulted with basically every big name is the US along the way.
 
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I had multiple disastrous implant surgeries and removals, then Bimax
Were you satisfied with the result? Was the surgeon a well known one or a good local one? Sorry to hear about the disastrous implant surgeries and removals but I’m glad it sorted itself out
 
Were you satisfied with the result? Was the surgeon a well known one or a good local one? Sorry to hear about the disastrous implant surgeries and removals but I’m glad it sorted itself out

They did a decent enough job given how much damage was done from one of my previous surgeries, and how many times the area had been operated on. I also had sleep apnea and curing that made the entire procedure worth it on it's own. In my case it was a relatively local surgeon for my Bimax, not anyone who's name I've seen on the forums. But I consulted with a few top guys and had a good feel for what was going to work for me in terms of surgical plan
 
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I had multiple disastrous implant surgeries and removals, then Bimax. I also consulted with basically every big name is the US along the way.

Can you elaborate on your implant surgeries?

I.e when? What type of implant? What went wrong? Which surgeon?

Asking because I'll be flying to the states likely for a wrap around jaw implant
 
@hebbewem
 
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lol Gunson is more then 50k bro
They did a decent enough job given how much damage was done from one of my previous surgeries, and how many times the area had been operated on. I also had sleep apnea and curing that made the entire procedure worth it on it's own. In my case it was a relatively local surgeon for my Bimax, not anyone who's name I've seen on the forums. But I consulted with a few top guys and had a good feel for what was going to work for me in terms of surgical plan
how many mms were both jaws moved foward?


I heard anything more then 7-8mms on both is more likely to cause nerve damage/numbness.

Do you think 7-8mms projection for both jaws on someone with a relatively normal but flat maxilla would make a decent difference in regards to aesthetics?
 
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Arnett isn't "basically retired", he is retired. Gunson's total cost is a significant amount more than $50k.

Nevertheless, I will probably have surgery done with him.
 
Arnett isn't "basically retired", he is retired. Gunson's total cost is a significant amount more than $50k.

Nevertheless, I will probably have surgery done with him.

Arnett still lectures/teaches
lol Gunson is more then 50k bro

how many mms were both jaws moved foward?


I heard anything more then 7-8mms on both is more likely to cause nerve damage/numbness.

Do you think 7-8mms projection for both jaws on someone with a relatively normal but flat maxilla would make a decent difference in regards to aesthetics?

My maxilla wasn't moved forward much, most of my advancement came from the ccw. And it's impossible to say
Can you elaborate on your implant surgeries?

I.e when? What type of implant? What went wrong? Which surgeon?

Asking because I'll be flying to the states likely for a wrap around jaw implant

The surgeon who messed me up is someone Ive never seen mentioned here. He's out of Florida, I can elaborate more via pm if you like but it's a situation I doubt anyone else will experience if it's not a complicated revision.
 
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Arnett still lectures/teaches


My maxilla wasn't moved forward much, most of my advancement came from the ccw. And it's impossible to say


The surgeon who messed me up is someone Ive never seen mentioned here. He's out of Florida, I can elaborate more via pm if you like but it's a situation I doubt anyone else will experience if it's not a complicated revision.

Is the surgeon who messed you up R.J. ? Edit: nvm, thought you were talking about jaw surgery
 

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