Please Advise: LeFort 1 Should Have Been Double Jaw Surgery; LeFort 1 "Revision" Caused Other Issues.

Three years ago, I had an open bite and crossbite, which had always caused problems in speech and made me a messy eater. I'm interested to know if any doctors can evaluate what the best way would be to proceed from here after these surgeries. I am 48.

My surgeon opted for LeFort 1 surgery without (as I learned later) doing sufficient scans, rotating my upper teeth downward to meet the lower and kind of keeping them back (sometimes I would jut out my lower jaw to relax those muscles that were kept in a strained-back position), even though my lower jaw had already been slightly recessive. The result was a VERY gummy, rat-tooth smile, as well as an increased philtrum length *look* because of the nose being pushed upward. The nostril was also slightly raised on one side, giving more of a sneering expression with the more prominent nostril show. I looked like the Grinch, or at the very best, like British actresses (Celia Imrie or Imelda Staunton) who capitalize on this look to play sprites and elves. My nose was also measurably wider (superimposing before and after photos) and showing more nostril. After a year of assuring me that healing/dropping tissue would fix the excess gum show, my surgeon agreed that it wouldn't, and offered to send away for 3-D scans (should have been done before the first surgery, apparently) in order to do a revised surgery to bring the upper teeth up about 3 mm. He said he would also do a genioplasty, moving part of the chin upward/forward to increase "lip competence"--otherwise, the lower jaw would keep the bottom lip back and it would be hard for me to close my lips. I consulted with another surgeon at this time, who advised me that this should have been a double-jaw surgery, bringing the lower jaw into symmetry and avoiding the rotation of my upper jaw (avoiding the nose issues). She said a double-jaw revision surgery, doing the double-jaw surgery, would involve braces again for up to 1.5 years. Since I had already done this braces-time for the first surgery, I was *hoping* the first surgeon's offer of a lessened braces-time as well as a more minor surgery (at a reduced price) would fix things sufficiently. A double-jaw surgery would have also been very costly, no longer covered at all by insurance. After consulting with friends, husband, relatives, even a third surgeon (that visit ended up being a little hurried, and he expressed understanding of both other surgeons' points of view), I hoped for the best and went apprehensively with the first surgeon's revision.

It has been a year since that second surgery result is that yes, now I do not have the gummy, "rat-tooth" smile and weirdly lowered teeth, so that helps with the mouth-to-nose ratio. However, the chin is too prominent, pointy, and asymmetric, and, without the tooth support that a double-jaw surgery would have provided, my mouth suddenly has an elderly, "punched-in" look which it did not have a week prior to the surgery. My sister noticed this change immediately even while praising other aspects of the surgery. After a year, the lips are still rolled inward and the lips corners are severely turned downward, a look that even my 84-year-old mom does not have. Our 80-something neighbor also noticed the drastic change. The lips also pucker above and below as they try to meet from the protruding chin and nose positions. It is a witchy look, similar to Mrs. Bailey in "It's a Wonderful Life," when she doesn't have her dentures in and is refusing him at the door of her boarding house.

Additional complications from the surgeries include a blocked tear duct after the second surgery (runny, goopy eye, where I could push out pus at any time of day, now fixed with eye surgery), and scans examined by a specialized radiographer indicate that there has been severe bone loss in my upper next-to-front tooth since the surgeries. There is also numbness of the upper teeth and gums dating from the first surgery--this lack of sensation does not bother me, but does possibly indicate that the first surgery, done without proper scans, may have severed the upper front-row teeth from their nourishing bone and that I will lose at least one, or perhaps all, of those teeth.

I have consulted again with the "second opinion" surgery, who has graciously gone through all my records and scans and found that the asymmetry in my chin is in fact visible in an (x-ray? ultrasound?) scan--the chin has been attached askew, and instead of using plates, long screws were used. These are extremely hard to remove as bone grows around them. As this sweet surgeon consulted with other doctors, another offered to remove them with her in a revision surgery, but this is no longer advised because of the bone loss. Larger screws seem to have been used throughout, and I can feel the ones by my affected eye with a finger touch. Scans also report severe sinusitis and air in the uninfected tear duct, neither of which feel different from my previous normal so far.

A dentist has advised me against further orthodontia because of the severe bone loss visible in the scans. The "second opinion" surgeon, who has been so kind and thorough in helping me understand what has produced these results, also felt she could not do much at this point. Some chin contouring was a possible option she brought up, but said this would be kind of "winging it." She suggested I talk to a plastic surgeon about nose surgery and lip filler options. However, after going through my charts more thoroughly, she is more alarmed about the lack of pre-surgical scans and the possibility of my losing my front row of teeth along with some of these invisible complications. I am scheduling appointments with periodontists and other specialists now to address those issues, though the visible issues currently concern me more.

I am a busy mom of four children and never intended to make these appointments my life--I wanted to correct a functional problem in an aesthetically pleasing way, and instead have caused a myriad of other asethetic problems, surgeries and appointments, and may possibly lose the teeth I set out to save, $10K out of our pockets later.

Notes on the photos: my orthodontist was an angel and did the second round of braces/appointments absolutely for free. I am very pleased with my straighter, wider-smile teeth, and in the photos my smiling face looks really not bad, overall better than my "before" face (though with the thinner lips and turning corners still somewhat visible).
I never considered myself a shallow or looks-obsessed person (hence the lack of focused "before" photos!, but this has turned my face from rather kindly-looking to unhappy, sneering and elderly-looking. It has caused me many tears and made me shy of meeting up with old friends. My husband, who was so patient with the braces process and surgery recovery, is really ready for me to stop grieving and move on and wishes I'd never done anything. Please, if you have any knowledge or perspective on this, I would appreciate it.