How to choose a surgeon for corrective jaw surgery

Whose territory is it?

"Turf fights" are common between different specialties in Medicine and Dentistry. The jaw and face (ie maxillo-facial) area is one part of the body that many different specialties lay claim to. As the name suggests, the one who are most intimately associated with the maxillofacial area is the maxillofacial surgeon. This is the specialty that dedicates itself to management of conditions that affect this anatomical area. However, the jaw and face overlaps with the ear, nose and throat, which is another well established surgical discipline. While these two specialties define themselves based on an anatomical region, plastic surgery defines itself in an ideological way without confining itself to any specific anatomical area. Plastic surgeons also does procedures on the face, further complicating the issue of who is the best person to do corrective jaw surgery. So, if you are in the process of considering corrective jaw surgery, how should you choose?

A rose by any name....

Of the three specialties mentioned above, only the Oral Maxillofacial Surgeon and the Plastic Surgeon does corrective jaw surgery in Singapore. Personally, I do not know of any ENT surgeon in Singapore who does corrective jaw surgery. Some plastic surgeons are trained in corrective jaw surgery but the majority are not. Most oral maxillofacial surgeons are trained though not all. As such, one such not choose a surgeons simply by which specialty he or she is in. What is more important is whether that surgeon is trained to do the surgery. 

Let's look at the training of an oral maxillofacial surgeon (OMS) in Singapore. OMS training in Singapore is dentally-based. Dental graduates who desire to specialize in OMS goes through two years of general training after graduating from dental school before commencing their 3 year residency program which leads to a Master of Dental Surgery degree. Thereafter, they undergo another 2-3 years of advanced training, logging a specified number of cases, including corrective jaw surgery before presenting to a specialty board for certification. Upon successful certification, they are then registered as specialists in OMS.

Plastic surgery is based in Medicine. Medical graduates who desire to specialize in plastic surgery (PS), goes through a year of general training after graduating from medical school before commencing a six year residency in plastic surgery which may or may not include corrective jaw surgery. However, those with a special interest may go do a year of fellowship training in craniomaxillofacial surgery, of which corrective jaw surgery is a part of.

In choosing a surgeon, you need to look at his credentials. Be it an oral maxillofacial surgeon or a plastic surgeon, the bare minimum credential is that he must be registered as a specialist in OMS under the Singapore Dental Council, or as a PS under the Singapore Medical Council.  If he is an OMS, then chances are he is trained in corrective jaw surgery. However, having said that, the training provided during residency may not be sufficient for one to be proficient. As such, you should ask to see some photos of past patients that have a similar condition as yours. Unfortunately, in Singapore, clinics are not allowed to publish before and after photos on their websites due to a certain rule set by the Ministry of Health. However, the surgeon can show you the photos in the clinic, after you become a patient of his. This can be a bit of an expensive exercise because once you consult the surgeon, consultation fees are payable. Nonetheless, it is an important part of your fact finding process in choosing the right surgeon to advise and operate on you. By checking out his previous cases, you can gain an idea of what kind of aesthetic sense this surgeon has and whether it is something that agrees with you.

If you consult a plastic surgeon for corrective jaw surgery, in addition to the same questions above, you should ask him if he is trained and if so, where. Not all plastic surgeons have the basic training in corrective jaw surgery and you certainly do not want one who is doing it infrequently. Most plastic surgeons busy themselves with soft tissue work such as eyelid surgery, nose surgery, liposuction, breast surgery, etc. Many do not have an interest in hard tissue surgery like corrective jaw surgery. Furthermore, corrective jaw surgery is intimately related to dentistry and a good plastic surgeon who does corrective jaw surgery must understand basic principles of dental occlusion and anatomy. If you come across one who has a special interest and has gone through the necessary training, choosing a plastic surgeon to do the job is perfectly ok.

As a patient, you need not concern yourself with the "turf war" between specialties. What is important is to find the right person to do the job. After ascertaining his training background and some case studies, you need to check out his aesthetic sense and what he intends to do for you. Ask to see a computer simulation of the surgery. Current predictive software has not reach a high enough level for us to predict with great certainty what the final result will be. As such, the simulated facial appearance is usually not very authentic or somewhat cartoonish. Nevertheless, it serves as a communication tool. You can ask for the chin to be move a bit more, the midface a bit less, etc. This way, you understand what surgeon is trying to acheive and you can tell him what kind of look you like and what you don't like. Aesthetic sense is very subjective. what the surgeon think is nice may be different from your own idea of beauty. Make sure that your surgeon is prepared to spend the time to understand your aesthetic sense. 

Patient testimonials are not allowed on clinic websites due to strict advertising rules by the Ministry of Health. As such, you will not be able to read what past patients have to say about a particular surgeon. Nevertheless, some surgeons have patients who are willing to provide testimonials and that will give you a confidence boost. However, this is not commonly practiced as many patients who have had surgery don't really want to go around talking about it. 

Naturally, cost is always a factor. However, do not simply for the cheapest. I have had several "re-do" cases whether by someone else had done the surgery previously but the results are not what the patient wants. It is usually not a matter of technical competence as most surgeons only take on procedures that they do well. However, it is the aesthetic outcome that was not clearly communicated before the surgery that is the problem. The revision surgery is usually more difficult and the results less predictable. Furthermore, paying twice is always more expensive. So, choose wisely.

Ultimately, you need to have a certain rapport with the surgeon. He doesn't have to be your best friend but there must be some chemistry such that you can trust him to do the best for you. Corrective jaw surgery is fairly invasive and you should seek more opinions if you are not perfectly comfortable with the first surgeon you see.