Lurker finally posting - a few questions

[Guest guest]

Hi everyone. I'm 35 and have been in braces (my second go-around!)

for about 8 months. My ortho thinks I'm ready to start the process

to get a referral (from my primary care doc -- I'm in an HMO) to

finally see a surgeon. I have a significant overjet, a slightly long

face, and a somewhat retruded lower jaw -- I guess it's all

considered a " classic " Class II problem. My ortho thinks I'll need

both upper and lower surgery -- to move my lower jaw forward (and

possibly a chin genioplasty) and to shorten my upper jaw a tad.

A few quick questions:

1. He's recommending a surgeon in Burbank (I live in L.A.) named Dr.

Raffi Margossian. Has anyone had him as their doctor?

2. Are chin genioplasties considered cosmetic, rather than medically

necessary? I've been trying to decipher my HMO's statement about

when they consider jaw surgery medically necessary, and while it

seems they'll pay for osteotomies, I get the sense that they don't

consider genioplasties to be in the same category.

3. Has anyone had any experience (either before or after surgery)

with friends who *don't* seem particularly supportive? I have one

pretty good friend (who also happens to be a coworker -- actually,

she's my superviser!) in particular who seems to react to any of my

concerns/worries/etc. with a rather terse " well, you don't have to do

it, you know. It's mostly just cosmetic, right? The braces should

be enough to make you feel better about yourself. " She herself is

quite an attractive woman, with perfect teeth (never had braces or a

single cavity!) and is frequently the object of much attention for

being so pretty... I wonder if she's got something at stake with me

being the " plain Jane " sidekick? Hmmm, I guess that's a broader

question than the others... maybe I've opened a can of worms with

that one!

Anyway, I just wanted to introduce myself. I'm glad this forum

exists and I expect I'll be posting more as the time gets closer!

Also, if anyone else who's had similar procedures would like to point

me in the direction of their pictures, I'd be curious too see the

results! (There are so many pictures posted here I don't quite know

where to start...)

Cheers,

Sara

[Guest guest]

Hi Sara,

I'm a surgery vet, upper/lower/genio for just about what you

describe. My pictures are posted under Fiddlesticks folder on

site 2 (you'll have to join to view the photos there) at

http://health.groups.yahoo.com/group/orthoganthicsurgerysite2

I had some fairly dramatic change, my family said that they wouldn't

have recognized me out of context on the street ....

> Hi everyone. I'm 35 and have been in braces (my second go-

around!)

> for about 8 months. My ortho thinks I'm ready to start the

process

> to get a referral (from my primary care doc -- I'm in an HMO) to

> finally see a surgeon. I have a significant overjet, a slightly

long

> face, and a somewhat retruded lower jaw -- I guess it's all

> considered a " classic " Class II problem. My ortho thinks I'll

need

> both upper and lower surgery -- to move my lower jaw forward (and

> possibly a chin genioplasty) and to shorten my upper jaw a tad.

>

> A few quick questions:

>

> 1. He's recommending a surgeon in Burbank (I live in L.A.) named

Dr.

> Raffi Margossian. Has anyone had him as their doctor?

>

> 2. Are chin genioplasties considered cosmetic, rather than

medically

> necessary? I've been trying to decipher my HMO's statement about

> when they consider jaw surgery medically necessary, and while it

> seems they'll pay for osteotomies, I get the sense that they don't

> consider genioplasties to be in the same category.

>

> 3. Has anyone had any experience (either before or after surgery)

> with friends who *don't* seem particularly supportive? I have one

> pretty good friend (who also happens to be a coworker -- actually,

> she's my superviser!) in particular who seems to react to any of

my

> concerns/worries/etc. with a rather terse " well, you don't have to

do

> it, you know. It's mostly just cosmetic, right? The braces

should

> be enough to make you feel better about yourself. " She herself is

> quite an attractive woman, with perfect teeth (never had braces or

a

> single cavity!) and is frequently the object of much attention for

> being so pretty... I wonder if she's got something at stake with

me

> being the " plain Jane " sidekick? Hmmm, I guess that's a broader

> question than the others... maybe I've opened a can of worms with

> that one!

>

> Anyway, I just wanted to introduce myself. I'm glad this forum

> exists and I expect I'll be posting more as the time gets closer!

> Also, if anyone else who's had similar procedures would like to

point

> me in the direction of their pictures, I'd be curious too see the

> results! (There are so many pictures posted here I don't quite

know

> where to start...)

>

> Cheers,

> Sara

[Guest guest]

Oh Lordy yes. Are you ever having the same, or similar, problems

others have, over the years.

For some odd reason, if you tell folks you're going to have major

orthopedic surgery because your legs are of different lengths and

your hips are being destroyed -- they " get " it right away. If you

tell them you're having major orthopedic (ok. Orthognathic) surgery

because your jaws are of different lengths and your temporomandibular

joints are being destroyed, they seem to feel it their mission in

life to tell you how wonderful you look and that nothing else

matters, so why put yourself through it.

And even more oddly, parents and siblings can be the most hostile to

the changes. I believe it to be all a product of guilt, a feeling

that I think is seldom productive. But I have known of parents who

never even recognized that there had been any changes, after years of

braces and surgery to repair a 10 mm overbite. Others who saw a

modification of a significantly narrow upper jaw, and repair of an

overbite, both in perfectly gorgeous people, before and after, whose

only comment was, " Well, you still have a long face. " Wanna talk

about toxicity here? Only thing for such is to tell them how lovely

they are and give them handkerchiefs scented with violet water,

methinks.

I am far away from Burbank, so I leave that one to others.

Genios are usually ruled cosmetic. If you have sleep apnea issues,

that may be grounds for approval. (Do not lie if that is not the

case. you can head straight for jail, that way.) Read your policy and

see whassup for you. And you need to know that for most people,

MEDICAL, not DENTAL, insurance offers the available approval. You

need to see whether orthognathic surgery is excluded. My surgeon

filed for me, and got it (lower advancement, not genio) approved as

surgical repair of a congenital, skeletal deformity. Yep. Quasimodo

checking in here -- but no longer, thanks to his forty whacks and a

few titanium screws.

Cammie