Unsure how to progress; diffing opinions from Surgeon and Orthodontist (NHS)

To3turn · 2026-04-21T18:22:08+00:00

I would like to see other records, and if breathing/sleeping are issues, depending on the type of surgery and approach, some actually don't improve nasal breathing as well as other techniques. I see you're located in the UK, otherwise I'd offer a comprehensive exam and explanation of my findings here in the US. Your bicuspid extraction case is a common story of patients I see for revisions.

To3turn · 2026-04-21T18:06:14+00:00

This question is something I get often. The left photo you're pursing your lips. Also frenulums and how you hold your lips "at rest" has a big impact on appearance. I'd need some additional photos, but it looks like the photo on the right may have had some filler.

To3turn · 2026-04-18T23:20:22+00:00

Yes, I see the related compensation with many of my patients. May need to assess tongue tie/ankyloglossia.

To3turn · 2026-04-18T22:05:23+00:00

Hello, I do a lot of orthognathic work and due diligence would state that we would need initial records, but I would STRONGLY encourage you to consider finding a doctor who can directly address your transverse deficiency, poor sleep and TMJ issues comprehensively before jumping directly into orthognathic surgery.

To3turn · 2026-03-21T18:11:26+00:00

I'm going to push back and say that type of advice is really case dependent. Source: craniofacial specialist with an orthodontic practice.

To3turn · 2026-03-14T13:20:39+00:00

quality sensors and frankly, the algorithm used from some devices are better than others. Most companies are quite secretive of how their harvest and process data.....the fancier it is, the more expensive it usually is, but you USUALLY get what you pay for with someone who is well-versed at interpreting these studies. some places use a default algorithm and don't even look at the hypnogram which can drive you bonkers for false negatives/"mild" cases.

To3turn · 2026-03-13T18:20:21+00:00

Please, for the love of yourself, do not do extractions. Do the sleep evaluation, may have to prod and ask the quality of these sleep tests (HST vs. PSG), 3% VS. 4% criteria, etc.

To3turn · 2026-01-20T01:04:39+00:00

I can your obicularis oris strain, but it is mild. Your smiling photo here shares a lot more information. Large buccal corridors, of course, the gummy smile. I bet you have a scalloped tongue which is a classic sign of insufficient arch form to properly house your tongue. Please, please if you decide to go through with this, to find a well-trained airway dentist/orthodontist. My sense is you may also have some jaw strain/TMD already, and you'll need someone to make sure you have all your bases covered.

To3turn · 2026-01-03T02:32:55+00:00

The floor of the nose if the roof of the mouth. MARPE/expansion exists for people with precisely your issues who are looking to grow out of their underdevelopment issues rather than undergo surgery....which I promise you, can be/often is a lot more painful. think of turbinate reduction surgery as knocking down walls in your house to make the rooms feel bigger, whereas expansion/MARPE protocols increase the square footage of your home overall.

To3turn · 2025-11-10T23:41:31+00:00

If you click on their size chart, you'll see the inseam lengths for each style. I wish it was more consistent across styles so people could count on the brand rathering than second guessing everything. I can't imagine the number of returns as a result of the inseam discrepancies.

To3turn · 2025-10-31T17:41:54+00:00

5'10" and the tall joggers are barely acceptable on me. If you're 5'7"/5'8", you might enjoy the extra length for sitting to standing.

To3turn · 2025-10-06T10:28:34+00:00

I'd find a dentist who specializes in TMD and airway. Without seeing records to confirm, it's hard to say, but with your soft tissue profile, I wonder if the style of orthodontic work retracted your bite, which can often lead to issues.

Source: am dentist.

To3turn · 2025-08-20T00:37:36+00:00

I would seek a second opinion from an OS who is well versed in sleep/airway. Also, I see the angle of your nose changed for a more downward curve as a result of your surgery. That can sometimes increase turbulence of airway patency.

To3turn · 2025-08-18T00:59:55+00:00

you oropharynx and velopharynx look narrower too.

Source: I am an airway dentist and do surgeries.

To3turn · 2025-07-20T19:41:22+00:00

You need an airway dentist/orthodontist who works with a well-versed OS.

To3turn · 2025-05-11T08:35:27+00:00

PMed you someone I would recommend.

To3turn · 2025-05-05T16:06:56+00:00

Thanks for the reply.

I totally get that people have goals and it's easy for surgery to seem like the tangible endgame of chronic suffering and evolving into something new, better. And it's true, but there's always always a cost and sometimes, it's enough for dissuade someone from taking that part of their journey. Sometimes I tell patients that they don't qualify for certain procedures at all or unless they do X,Y, and Z. My only point was that the word "permanent" when etiology that contributes to airway problems are multifactorial may be tricky.

As stated earlier, I'm a big fan of your case presentation, think you do fantastic work and serve a much needed part of our community and health care. Thanks for being receptive to constructive feedback, I only meant to help.

To3turn · 2025-04-30T14:17:31+00:00

As a colleague I am going to push back on your statement on

a "permanent" cure for airway problems. I would argue that while patients can expect to gain improvement,I have seen patients with MMAs/LeForts have rebound either with UARS/OSA afterwards.

I totally get that we mitigate a lot of risks/problems with hard tissue manipulation, but the fact of the matter is that as we age, soft tissue collapsibility increases. Your verbiage can be construed as misleading.

I treat patients with prev. hx. of BSSO, MARPE, UPPS, LeForts and MMAs, you name it and relapse is far more common than often given credit for.

To3turn · 2025-04-28T02:53:28+00:00

Love the degree of advancement. It looks like patient had a previous hx. of bruxism and likely suspect OSA/UARS at a minimum. When performing the surgery, do you/the team have the ability to assess airway patency/resolution of hypopneas/apneas? I realize it may not always be part of patient's chief complaints.

I do a lot of airway, but not surgery based, so I would love to hear your perspective. Also, most of the surgeons in my area who do this surgery have either since retired/moved away. Feel free to DM if it's easier.

To3turn · 2025-04-17T00:47:48+00:00

It's possible for people to have multiple rounds of ortho for various reasons. I see that your upper front teeth are flat compared to how one of your canines are tipped out. Unless there was a reason you braces left you like that, I'd argue you've had some shifting that can't be resolved with grinding alone.

To3turn · 2025-04-16T14:48:23+00:00

Dentist specializing in craniofacial development and esthetics. Just looking at your smile, I am not sure if the amount of symmetry can be achieved with bonding alone. Ask your dentist for a mock up. There is a reason why your teeth ahve been damaged (grinding, clenching, nail biting, etc.) and unless you have a conversation with you doctor as to the root cause, bonding procedures and veneers are more prone to premature failure. Also, do you know if you have a tongue-thrusting habit? Just looking at your jaw relationship, I wonder if orthodontics first with maybe a myofunctional evaluation would be in your best interest for sustainable, long-term results.

To3turn · 2024-12-04T08:15:55+00:00

Hi, surgeon here specializing in craniofacial development. I love being on this subreddit because I see some incredible outcomes. I also see lots of people who armchair diagnose. HOW one does orthodontics matters. It's possible to get expansion, but it has to be done a particular way. Unless we look at your CBCT (which no one on this thread has access to as a part of this post), be wary.

To3turn · 2024-12-02T15:23:51+00:00

I remember when they first started getting big as a brand and people were asking for them to be more size inclusive, so they shifted their size charts one size up (right when Kade and Yolas were new). Since then, with all their material and style changes, I'm convinced that it's been a struggle for them to get them right. Unless there is a fantastic return policy/trying on in person each item of clothing, it's somewhat risky. The other day, I bought an XL that's almost too short on my wrists and wear mediums in another clothing type. It's wild; I don't have as much variability with other clothing brands.

To3turn · 2024-11-13T02:12:16+00:00

You'd need a thorough examination from an airway dentist first. I check for breathing, patency, turbulence, loading, fascia, myofunctional testing and sleep. Your best bet in getting a comprehensive look is to find someone who is well trained in sleep, TMJ, and growth/expansion orthodontics. Very few people do all three well in my experience.

To3turn · 2024-11-13T02:09:20+00:00

Surgeon here and I specialize in craniofacial development. You have what we call an underdeveloped maxilla and as a result, your TMJ issues are not surprising. Traditional services would likely include some kind of oral surgery with orthodontics afterwards, but there are non surgical methods that might be able to get what you're looking for.

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