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Cosmetic jaw surgery Singapore - the preparation for surgery
on November 12, 2015
The consultation process for cosmetic jaw surgery may take several visits, principally to establish treatment goals and to formulate a plan to achieve that goal. By using computer simulation of the facial changes from different surgical plans, we established the treatment goals and the probable surgical plan. The plan would involve either a surgery first approach or an orthodontics first approach. While most patients would like a surgery first approach due to the immediate nature surgery, not all cases are suitable. Situations where we are unable to achieve stability of the bite or an accurate prediction of the soft tissue changes are still better done with a orthodontics first approach. Let’s look at each in detail.
Surgery-first
Before finalization of the plan, I would personally do a “model surgery” on the dental casts that are mounted on an articulator. This is to get an additional “feel” of the surgery. This “model surgery” is also needed to fabricate the surgical guides that we need to position the jaws during the actual surgery in accordance to the surgical plan. This step can be substituted by using the same simulation software linked to a 3D printer to print out the guides. However, I still prefer to do the “model surgery” in the laboratory myself as a sort of “dry run” of the surgery. Once this is done, the guides are checked in the mouth to make sure that they fit. This is very important as these guides determine the accurate reproduction of the surgical plan in the patient.
While the model surgery is being done, we arrange for the patient to go for pre-operative testing. This typically involves some routine blood tests and urine analysis. For double jaw surgery, blood transfusion is usually needed after surgery. The patient can either opt to use blood from the blood bank or to deposit some of her own blood for use after surgery ie autologous blood. Using autologous blood will need a longer lead time before the surgery as the body need time to regenerate the blood. Some patients may be mildly anemic and are not suitable for autologous blood. For them, usually two bags of blood from the blood bank will be cross matched for use after surgery.
Orthodontics-first
If the initial assessment showed that orthodontics need to be done first, the orthodontist will begin with placing braces onto the teeth. The primary objective of pre-surgical orthodontics is to align the teeth within the arch into an ideal position and angulation. At this phase of orthodontic treatment, we are not concern about how the upper and lower teeth bite together. In fact, we want to maximize the discrepancy in the bite. Patients seeking cosmetic jaw surgery often want to achieve a certain change in facial appearance. Shifting the position of the jaw bones can achieve that look but we cannot shift bone to change the look without taking into consideration how the patient is going to bite. As such, the bite is one of the limiting factors to how much we can shift the jaw bones. For example, for a patient with an underbite, if the lower teeth are only 1mm in front of the upper teeth, we can only shift the lower jaw back by about 4mm to maintain the teeth in a proper bite. However, a 4mm setback of the lower jaw may not achieve the change in facial appearance that the patient desired. Orthodontically pushing the lower teeth forward by another 5mm will create a gap of about 6mm and that would allow a setback of the lower jaw by 9mm which may then fulfill the facial aesthetic change needed.
Pre-surgical orthodontics typically takes about a year. When the teeth are in the correct position, surgery can be scheduled. At this point, the process is the same as the surgery-first approach.
Sometimes, the plan is modified to suit the patient’s social schedule. As surgery involves a couple of weeks of down time, the patient will need to schedule the surgery during school holidays or when work is not too busy. For this group, even if surgery-first approach can be adopted, we may start off with braces first to get the teeth as aligned as possible until the patient is available for the surgery. This will also shorten the amount of post-surgical orthodontics time.
Just before surgery...
In the week leading up to the surgery, I advise patients to eat whatever food they enjoy as much as they can as they will won’t be eating for a couple of weeks after surgery. There will also lose some weight after surgery and so some fattening up is not a bad idea. All the eating will stop after dinner the night before the surgery.
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