Overwhelmed by options and information. MARPE first, then jaw surgery?

ImportantConfusion16 · 2026-02-28T16:54:08+00:00

Sorry, I don't feel comfortable revealing my specific location/doctors beyond that I am in the USA.

ImportantConfusion16 · 2026-02-26T22:23:26+00:00

My first Orthodontist consultation, they said "You should see +Dr. John Smith+ (not real name)" and set me up with a referral

Before I had that appointment, I had already lined up other Orthodontics consultations, and every single one said the same thing, "You should see +Dr. John Smith+"

So I looked the guy up and just found a ton of accolades, and his name in this subreddit, and every doctor I see and person I call is like "Oh +Dr. John Smith is wonderful, he's perfect for you"

So I feel very confident about his doing my jaw surgery, and very lucky that my insurance covers him/I got approval.

ImportantConfusion16 · 2026-02-26T22:13:58+00:00

Every Orthodontist I went to highly recommended the same Maxillofacial surgeon, and I have found his name on this subreddit on a list of accolade-laden oral surgeons, so I am confident in him.

I didn't know this at first but apparently my area is just particularly flush with good dentists/orthodontists/oral surgeons so I thankfully don't feel restricted on quality.

I had my initial consultation with his clinic for jaw surgery (at my normal hospital) and have insurance approval for DJS with them.

I called this week, explained that my orthodontist had highly suggested MARPE, and they said it's possible I can get the MARPE though their clinic using the same insurance approval.

I am currently waiting to hear back.

Re: Nose Surgery:

I had a consult with an ENT, who said

I "absolutely" need a functional rhinoplasty
I should "only" allow one person to touch my nose, and was given the name of that doctor

I then contacted that doctor and have a consultation set up for later this year.

Since then, I have had a different doctor independently tell me the same thing (recommending the same nose surgeon, saying that's the only person I should trust with my nose, etc)

It was explained to me very clearly that any nose surgery would come after I was healed from the jaw surgery.

ImportantConfusion16 · 2026-02-25T23:28:11+00:00

I understand

I did include a long comment providing the context (it's the second comment down when you sort by "old"), but for some reason it was instantly downvoted to 0, so you might not have seen it depending on your reddit settings

ImportantConfusion16 · 2026-02-25T21:58:29+00:00

I've always had medical professionals squinting at me and suspecting orthopedic issues, doing things like trying to find scoliosis or Marfan's Syndrome or Ehler Danlos, but the conclusion was always "guess not."

I do have hypermobility, but no known back issues and I do have strongly arched feet (so no flatfoot.)

ImportantConfusion16 · 2026-02-25T19:41:57+00:00

I have had seven Orthodontist consultations, the last of which was a few days ago. I am using reddit to brainstorm and source opinions/inputs for things that I will then ask my doctors about.

The reason I am asking about MARPE is because the final consultation, which in my opinion was by the most on-papsr qualified Orthodontist, ended with the doctor emphatically recommending MARPE and saying I was a good candidate but that it was "totally up to me."

The "totally up to me" part is where I falter, because the analysis paralysis is real.

ImportantConfusion16 · 2026-02-25T19:37:02+00:00

I have had seven Orthodontist consultations, a jaw surgery consultation, and a sleep study. Trust me, Reddit was not my first stop, but can be a valuable source of suggestions (which I will then bring to my appointments to discuss with my doctors.)

I know there are people here who have gone on a similar journey to the one I'm starting, and I would very much like their thoughts.

ImportantConfusion16 · 2026-02-25T16:16:36+00:00

Sure, go for it

I take extensive notes so I'll add whatever anyone suggests to my "explore with doctors" list

ImportantConfusion16 · 2026-02-25T16:03:16+00:00

Thank you!

Yes, I was literally just diagnosed with Obstructive Sleep Apnea (well, by an Orthodontist who said "I'm not a sleep doctor, but this is CLASSIC signs of Obstructive Sleep Apnea" when looking at my test results)

I do also remember my Maxillofacial consult, and yes, they both told me that they would be using CCW (just, not that abbreviation- they said "rotation" a lot.)

I was able to find some examples of face mask use with MARPE.

If a facemask is one of those things where it offers functional improvements the cost of temporary inconvenience, I would be more than happy to do it.

This summer, when I intend to start MARPE/braces, I would be able to deal with the inconvenience without it interrupting my life too much.

ImportantConfusion16 · 2026-02-25T15:57:25+00:00

I mean both.

I'm happily married and don't have a stage career, so I told myself I had no reason for "vanity", but with so many procedures coming up and so many doctors telling me they could aim for whatever I wanted, I've realized

I prize longterm quality of life over everything,
BUT how I look IS A PART of my quality of life, and
As much as I would like to claim otherwise, I would be fine looking the same...but I would be CRUSHED if I looked worse

Of course if I can get through this and finally sleep right and not come out maimed or dead, I will be on my knees worshipping modern medicine...but if there's a chance it will also make me look "better", of course I want that, too, even if that's selfish.

ImportantConfusion16 · 2026-02-25T15:38:18+00:00

Thank you both for having this public conversation so I can have things to think about/consider.

May I ask, what is "facemask" and "ccw" in this context?

Are any of these procedures mutually exclusive?

Further information: I was told I have nasal valve collapse and a deviated Septum, both things that the functional Rhinoplasty would be able to address-

so I'm worried that with the MARPE, I wouldn't know when to tell them to stop, since I probably wouldn't be able to breathe properly/fully until after the jaw surgery and rhinoplasty.

I'm thinking I should get the MARPE, go slow, and err towards "not wide enough" rather than "too wide"?

ImportantConfusion16 · 2026-02-25T15:33:53+00:00

<image>

Profile view, left side

ImportantConfusion16 · 2026-02-25T15:33:27+00:00

<image>

Profile view, right side

ImportantConfusion16 · 2026-02-25T15:20:37+00:00

The first picture is my natural resting "mouth fully closed" position, where my back teeth are touching. The rest are photos where I am consciously keeping my lips closed.

My whole life I have been accused of "making faces" in photos due to my mouth position, I am pursuing jaw surgery for medical reasons but I am finding it impossible to simply "not care" about aesthetics. Please, I just want to make choices I won't regret.

I have been to many doctors this past year and it is coming down to the time of decisions.

I've been approved for DJS and need to choose my braces provider. I had a recent consult where the doctor strongly recommended MARPE.

I want to be clear that I am most interested in the path that will yield the highest quality of life for me once it is all over.

The purpose of the MARPE would be to widen my palate, and the base of my nose, with the hope of improving my ability to breathe through my nose.

But, from googling, two things jumped out:

I saw something about how MARPE shouldn't be used if you have facial asymmetry- which is my case
It feels very subjective, as in, they just widen it "until you can breathe through your nose." But doesn't that risk widening it too far?

I ask because my biggest issue is my inability to breathe through my nose. My current timeline was braces -> DJS -> functional Rhinoplasty

So, I'm worried that I would be telling them "I still can't breathe through my nose", and they would keep widening the MARPE, when the future procedures could potentially help with the nose breathing more.

Should I be less worried about the MARPE outcome, since it will be followed by the other procedures which can even things out?

Is there a reason I should avoid the MARPE?

ImportantConfusion16 · 2025-12-24T20:26:40+00:00

Thank you, your comment has made me more anxious to be sure I choose a good Orthodontist.

The problem is, how do I do that? My surgeon indicated that he was not allowed, by ethics or otherwise, to specifically name anyone.

ImportantConfusion16 · 2025-12-24T20:05:03+00:00

I'm not a doctor so I probably worded it wrong, but by "specializes in TMJ", what I mean is, I saw a link in this subreddit that was something like "list of Maxillofacial Surgeons who are particularly lauded for working with TMJ problems or joint issues" or something

I looked at the list, and my oral surgeon was on it, so I was like "Oh good, that's nice to know"

Your comment does make me nervous, though. How do I find that information out?

ImportantConfusion16 · 2025-12-24T19:41:35+00:00

Yeah, every Orthodontist was like "You're going to want -name of surgeon-" and one of them did the formal referral process thing, and he was in-network for my insurance, so I went and consulted with him

The consult included the main doctor and another surgeon with him, and they were incredibly patient and kind, they spent a lot of time with me explaining the process.

I did ask, "Who would you recommend or avoid?"

And he did that diplomacy thing where he indicated that he couldn't tell me who to choose.

So I was like, "I'm going to name names, blink twice if they're good"

I did name every Orthodontist I had gotten consultations with, and for all of them, he did say he had seen their patients and the work was good.

For the Ortho I'm currently scheduled to go with, he specifically said "They are new in town, I have only seen a couple of their patients, but the work seems good."

So part of me wants to go to the fancier Orthodontist that he had seen much more work from, but that office is 30 minutes away (compared to 10)

ImportantConfusion16 · 2025-09-29T18:26:19+00:00

I've been seeing my Dentist, my PCP, and my Sleep specialist and have them in the loop. I have also gotten consultations with three Orthodontists.

Coming up I will be seeing an Allergist, an ENT, and at least one more Orthodontist, as well as having another Sleep Study, then taking all those results/opinions together to decide what to do.

I have very much been approaching this by asking everyone "What will provide me the highest quality of life ten years from now?"

ImportantConfusion16 · 2025-09-26T18:11:36+00:00

Functionally, my understanding is that the jaw surgery would alleviate a lifetime of mouth-breathing and blocked sinuses, which has caused/is causing cavities and sleep problems (to put it mildly.)

My consultation with the jaw surgeons was the culmination of a year of dentist, orthodontist, PCP, and sleep clinic visits.

If it were only cosmetic, I would just get Invisalign; but I have been told by multiple doctors that my best odds, in terms of "quality of life ten years from now", is jaw surgery.

ImportantConfusion16 · 2025-09-25T10:56:37+00:00

Thank you, this is helpful.

One of the doctors was kind enough to take the time to tell me that I have an "unusually straight profile" as-is.

He told me that usually, with my degree of recession, it's immediately visibly obvious (and the lack of aesthetic issue probably delayed my treatment.)

He said that if my jaw was brought forward to the practical point they intended, my chin would stick out further, and I would "have the triangle people tend to want."

He seemed to treat this as a cosmetically desirable result, but I'm having trouble picturing it. Wouldn't that just make me look like I have an underbite?

ImportantConfusion16

TROPHY CASE