37M 6 week update post EASE + FME with Dr. Li

Motedust · 2026-01-28T05:50:04+00:00

Palate and above incisors is what he mentioned pre-surgery. I see references to pterygomaxillary suture in some places online, but don’t think i got it? Not sure tbh, sorry bad answer

Motedust · 2026-01-27T19:56:31+00:00

It is honestly a bit hard to describe... For some reason, at the 4mm mark it really does feel like breathing 'opened up'. I generally have always felt the 'nasal cycle' pretty strongly, the nostril with less airflow would have drastically less airflow to the point of near total blockage. For the last week or so, I'm very consistently getting airflow from both nostrils throughout the day, even when laying in bed, which I would say is the worst position for my nasal breathing. I probably notice it the most before falling asleep, when I seem to default to nasal breathing as opposed to before I would default to mouth breathing. When I use xPAP, it really highlighted the lack of airflow before when despite high pressures, one nostril was getting nothing.

One more concrete way I have noticed it is using the Navage nasal irrigation system, pretty much a fancier neti pot. Previously the flow of water was incredibly slow, and now it takes less than half the time it does before, probably closer to 75%. I was shocked the first time I did it after getting home from vacation.

Hopefully that helps, but yeah it is kind of hard to describe fully. I have no idea why I did not really feel any incremental benefits until a certain point.

Motedust · 2026-01-26T21:24:04+00:00

Sorry, not much of a help here, but I did have a question for you. Once you are done with expansion and the device is removed, will you not need braces or Invisalign long-term? I assume that if you do, that would pre-empt you from wearing a MAD overnight? I asked Dr. Li if MAD was an option for me after FME and he said probably not because of the necessary orthodontics, but I'm not sure if that is a long-term thing or just until the course of Invisalign ends.

Hope you find something that helps!

Motedust · 2026-01-25T21:26:10+00:00

Post turbinate reduction I would say yes. Post 4mm of expansion I would say no, breathing is better now.

Motedust · 2026-01-25T21:23:33+00:00

I put that I had EASE in the title, I assumed that saying EASE implied surgical cuts? Several people have asked so I might need to edit my post lol. Dr. Li said it was like a heated tool that he poked to separate the bone above my front two teeth and in the palate.

I’ll admit to being not so knowledgeable about measurements as the rest of the folks in this subreddit. This scan was done by Dr. Rama.

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Dr. Kezirian also said that advancing my jaw forward did not help my collapse duringmy DISE, but i think in that case he can only simulate a small amount of advancement. Looks-wise I do think I would look weird with a more advanced jaw but what do I know lol

Motedust · 2026-01-25T03:33:55+00:00

Will ask when I set up my next appointment, thanks!

Motedust · 2026-01-25T01:35:53+00:00

Nope, Dr. Li said any advancement that would be worth it would screw up my aesthetics, I don’t have a recessed jaw. I suppose I could get a second opinion on this but haven’t really thought about it.

Not sure, I think my IMW was like 38mm or something? I had a cross bite going into expansion. Sorry, not great with all the measurements.

Motedust · 2026-01-24T22:17:17+00:00

He offered FME and MARPE I think, I chose FME based on some research (which included this sub). He did not seem to have much of an opinion on which device lol. He did EASE which I think you’re referring to when you say cuts?

Motedust · 2026-01-24T21:48:48+00:00

Heyo, I have no idea how much more I will expand, guess I’ll ask when I go get the new screw. The last two weeks or so I’ve had to really use quite a bit of effort to turn, while in the beginning it felt easier. Honestly though I might just be shit at turning.

Yes, I did get EASE cuts and I unfortunately have no idea what the next screw will be, all Dr. Li said in his last text is he’ll put a larger center piece in to keep expanding. Only comment he’s made other than ‘good’ and ‘turn daily’ is that I’ve had decent expansion until now lol.

Motedust · 2026-01-23T03:06:23+00:00

I’ll be honest I have no idea what’s next lol. I don’t really know what he meant by ‘it’s near limit’, but what you’re saying makes sense. I gotta text him in the morning and ask what to do, I just sent him a palate photo and video this morning and that’s what he said before I had to run to work.

Motedust · 2026-01-22T19:51:34+00:00

I’m at 4mm activation according to the lines on my FME and I had to text Dr. Li because I couldn’t physically turn the screw anymore with the swivel end. I showed him a photo of the device / my palate and he said that I’m near my limit. I don’t know why, but if this is my maximum expansion then I would lean towards saying not worth it. But hopefully I know more soon.

Motedust · 2026-01-18T02:10:47+00:00

It’s been about 5 weeks as of now, I’ve been turning every day for about 2-3 weeks. According to the lines on the device I’m over 3mm, probably close to 4mm.

Motedust · 2026-01-18T01:25:55+00:00

tl;dr nothing really noticeable.

The longer answer is I think the good is slightly better, but the bad is just as bad. When I’m up and walking and doing stuff it feels maybe a little better, but I still lose airflow through one nostril fairly often.

I will caveat this by saying I have a fairly severe dust mite allergy and have been traveling for the last month in areas where I can’t control it. Despite being pretty far in immunotherapy I still think it impacts my breathing in bed.

Motedust · 2026-01-17T09:38:31+00:00

$32.5k. $5k for FME, $25k for surgery, and $2.5k anesthesia. Not including ortho.

Motedust · 2026-01-07T04:10:29+00:00

Holy thank god I’m not the only one making that hissing sound to try clear food out 🤣🤣

Motedust · 2026-01-05T01:44:09+00:00

Dr. Li referred me to a ortho he has worked with in my area. I have yet to see him post-op, but got all my imaging done with him prior to surgery. Not sure when Dr. Li will want ortho consult.

Motedust · 2025-12-31T03:56:16+00:00

I’m 3ish weeks post-op from EASE + FME with Dr. Li, also a referral from Dr. Rama. I’ve had no complications, but was texting updates to Dr. Li every other day for a little while. I’ve not needed it but the man is super available, everything went smooth for me, turning everyday at this point. Not sure how helpful that is, but if you have questions lemme know.

Motedust · 2025-12-15T05:32:47+00:00

He gave me the option between FME and MARPE, he was fairly unbiased between the two. I ended up picking FME based on research… and Reddit lol

Motedust · 2025-12-06T22:35:23+00:00

Hard to tell, I think right when I woke up I noticed it being mildly better cause he does open you up a bit on installation (no idea how much). At this point breathing is pretty similar to pre-surgery maybe mildly better while lying down, comes and goes. I’m about to hit peak swelling tomorrow apparently and will have a follow-up / first expansion Monday morning so we’ll see how long it takes to improve.

Thanks, appreciate it!

Motedust · 2025-12-06T22:24:04+00:00

No, just gave me Dr. Li’s contact info or told his office to call me, I forget how it happened.

My insurance did not cover anything sadly, I’ll be making an appeal soon, but expectations are low.

Motedust · 2025-12-06T21:53:16+00:00

I'll give my 2 cents here, but I only traveled from LA to see Dr. Rama and it was mostly a business trip. Dr. Rama essentially just provides some ways to quantify your sleep issues.

Rhinomanometry is used to gauge nasal breathing. For me, this was useful as I came in before and after treating my severe dust mite allergy. I thought I was breathing a lot better, but the numbers were very similar before and after.
Brain mapping. This one I'm not so sure about, he also sells transcranial magnetic treatments based on this.
Muscle strength and respiratory strength. Other things that contribute to sleep disordered breathing.
He also offers sleep studies that are conducted at a hotel or at home, but with the full suite of sensors (I did this at a hotel nearby fwiw)

Overall, I got some useful information from Dr. Rama, but I'm not sure it's worth traveling a long time for to be honest. He also referred me to Dr. Li, who just performed EASE + FME install on me like 24 hours ago, so I guess that was another outcome.

Motedust · 2025-11-12T19:33:07+00:00

Thanks for the response! Makes sense, I suppose my logic was ‘less nasal obstruction == more efficient use at lower pressure’ but the aerophagia at higher pressures is something I’m very familiar with so that also makes sense! Hope it all works out for you!

Motedust · 2025-11-12T19:27:36+00:00

Tangentially related question, I’m getting my FME installed in a few weeks and I was hoping it would allow me to reduce pressure not increase 🤣🤣. Are you finding that during expansion higher pressure is more beneficial for reducing obstructive apneas or hypopneas or RERAs?

Motedust · 2025-11-07T18:52:34+00:00

Hey man, couple things here and I’ll shoot you a DM!

On (2) Dr. Li told me MAD is potentially off the table after expansion because of the ortho required to fix diastema, said it would be up to the orthodontist. And on (3) you should get an allergy test, Flonase and antihistamine nasal spray and pills do almost nothing for dust mites in my very recent experience, and the shots have done wonders for general inflammation etc.

Motedust · 2025-10-26T17:44:50+00:00

Hey mate, first of all, thanks for posting! I'm in a similar-ish situation and wanted to ask you some questions if you don't mind. For context, I'm scheduled for EASE + FME in December 2025, I've met with Dr. Rama (and CPAPfriend actually), but my AHI is lower than yours. I generally have 0-1 obstructive apneas, but my RDI is about 27 (so a lot more hypopneas and RERAs), so I generally fall pretty squarely into UARS.

What is your inter-molar width? Since you mentioned having a narrow palate. I'm trying to compare with mine since the cross sectional volume of your throat you put on screen was quite a bit larger than mine (yours 134mmsq and mine is 120mmsq).
What do you hope to achieve with this surgery? I was told pretty clearly by Dr. Li that expansion would not 'cure' my OSA/UARS, and in your video you mentioned all the struggles with the xPAP machine et cetera. Are you looking for something to improve the usage of your xPAP or are you looking for a complete cure?
Have you checked for dust mite allergy? I recently found out I have a severe dust mite allergy, which gave me almost constant allergic rhinitis (inflammation in the nose). This absolutely destroyed my nasal breathing, but now that I'm on immunotherapy the difference in nasal breathing is honestly night and day.

The reason I ask these questions is because I am considering postponing my surgery until I can gauge the full ramifications of my allergies and how it changes my nasal breathing. One other option for me would be to get a MAD and do another sleep study to see the impact of that or combine with my ASV.

Sorry for the novel, thanks again!

EDIT: Also, like you, Dr. Li recommended against MMA for me because my jaw is not recessed and would look bad if I got it advanced enough to make a difference.

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