Can I Skip MARPE and Go Right to Double Jaw Surgery?

[@JawHacks]

Heads-up people!! This video is just for information and isn’t medical or dental advice-I’m not a doctor, dentist or licensed healthcare provider of any kind. Always check with a qualified professional for your health questions. Use this info at your own risk-it’s not meant to diagnose, treat, or recommend specific providers, products or procedures.

[@ravipuralena7747]

I spent so long trying to make sense of this question and all its nuance. Such a great distillation of it all into an easy 5min answer!

[@JawHacks]

What did you ultimately decide on? Thanks for the kind feedback.

[@ravipuralena7747]

@@JawHacks Pretty sure I'm going to go with Ease+non-segmental. As a bonus I happen to live 10 min from Li; his ortho wants me to get my wisdom teeth out so I just have to wrap my head around that before finally going for it all. But I met with lots of people trying to tell me to go for the one-and-done 3 (or 5) piece segmental. Took many weeks of having your videos on repeat over and over to come to the understandings you cover in this 5 minute version and realize ease is what I really want.

[@connorford7402]

@@ravipuralena7747don’t get your wsidom teeth removed. It’s the worst thing you can do for your face as a man and will destroy your facial bones and aesthetics

[@natural_law_nutrition]

​@@ravipuralena7747so you are going for the wisdom teeth extractions?

[@RobbyBrookss]

So glad i spent several months thinking about what to do before making a choice on expansion or just going straight to MMA (many thanks to you Ron). Im an impatient guy, but i know i wouldnt be completely satisfied if i didnt have that Hollywood smile at the end of this whole process. Dr. Yousefian also highly encouraged me to be thorough and transversely expand the mandible first despite the longer treatment time.

[@lm4363]

Damn dude, if you look at you now compared to your older videos your jawline continues to improve. I wonder if the mewing ability unlocked by the mse has further improved your aesthetics over time.

[@JawHacks]

Thanks for the compliment bro, I'm flattered. I do have a working hypothesis that the face doesn't reach full maturity until 3-4 years after MARPE. I think in my case the mandible gained some bone mass simply biting into the larger maxilla during that time, which may explain some of my continued (subtle) facial changes.

[@Benovald]

Just the massetar muscles growing bigger from chewing so much gum and maybe even harder diet food. No magic bullet or any skeletal change. In some cases it isn’t safe cuz they are so tense that they might cause clenching.

[@harrykinnear2592]

Was also thinking this

[@leoramos9821]

@@JawHacksbiobloc vs mse?

[@abirhasankhan9327]

How ​long do you have to keep the titanium plates for after recovery? For life? @JawHacks

[@anilramamd2222]

If you think of the maxilla as as box, it is rarely small in one dimension. Expansion and advancement both help.

[@RobbyBrookss]

i think this is a great analogy

[@tHYRR3N]

You probably know about Dr. Hérnadez Alfaro from Instituto Maxilofacial in Barcelona, one of europe's most prominent maxillofacial surgeons. Would love to see you talk with him.

[@blastdrome829]

Man, I’m so excited to talk to you tomorrow Ron!!!!!

[@JawHacks]

Awesome bro me too.

[@eauth_login_system]

what do you mean you will talk to him?

[@singha__]

you just glow up my brother ✨✨ thank you for spreading this knowledge 🙏🙏

[@ardodaniel32]

Hey ron im little far behind on latest updates i wanted to ask , do you know if someone found a way to expand one side of the maxilla intentionally basically trying to fix asymmetry like was caused in your mse expansion like many others i saw and heard about? Meaning if one got one side of his maxilla wider than the other did they found a way to fix it intentionally by now expanding the side which lacks expansion? Best regards

[@DDDarray]

I got the marpe in April, Olde Oakville, the dentist you told me about, and nasal breathing is already slightly better. I'm quite over age 40, and it's actually working. I used to often bite my lip while chewing due to the class III, and once this and the ortho is done I should enjoy relief. The nasal side effect is great, and I'm sleeping a bit better already.

[@christinal434]

That's great! Thinking of going to him

[@christinal434]

how are you doing now? are you using the face mask?

[@DDDarray]

not ATM. Consulting soon re. pterygomaxillary suture release, since I think only one side shifted, and need both sides for symmetry and posterior expansion. Might also need zygomatic suture released. Nasal bone may end up stuck at the narrower side of maxillary ridge, but that's something to work on later. I've also lost as much weight as is safe, to try and maintain sleep with the metal in my mouth, and it's helped reduce but didn't cure the sleep apnea.

[@christinal434]

​@@DDDarrayoh ok who would you go sult with about releasing those sutures? Have you had major problems with having it expand only on one side? That seems not good

[@DDDarray]

@@christinal434 It did seem to move most on one side, the side where the pterygoid process looked thinner on cbct. The expander actually reached its force limit after only a couple mm, so I had to stop turning. I'm booked with the omf surgeon the dentist works with, for the corticotomy and to pry them open a little. Gonna make sure everything goes by the plan, whatever it takes, measuring at each step. I still feel my nose working a little better, and a few times this year I've actually stayed in bed all night. Are you at this point also for better breathing/sleep? It's taken me so long to find this path, I can barely believe I'm here. edit for sep 28: had the surgery 5 days ago. Pterygomaxillary and zygomatic sutures release, so four spots. Face still swollen and sore, but it seems my nose works better even though I haven't resumed expanding. Looks like those were the bones holding things back. I'll know for sure in a bit once I'm able to expand more, if the screw is easier to turn. One adverse effect was nasal bleeding, which is very common when a ventilation tube has to go in the nose for the surgeon to work in the mouth. I don't know if they had the C-T imaging of my messy nasal passages right there to guide them. It'll heal. It's been hard to sleep on the couch upright this week, but things are ok so far, and swelling is finally starting to fade.

[@RobbyBrookss]

i think it's worth mentioning that even with MARPE, you will never get the kind of acute pronunciation of the zygomas like you would with implants. Most of the time, the change will be marginal, aside from cases like that which you mentioned in the video

[@TalesFromTheSlumsOfMumbai]

im definitely getting a consultation with you bro, you know your stuff very well and I need to ascend asap, it's costing me my life being ugly.

[@jeffrman777]

If it's nasal breathing you're trying to address, always do expansion first. Just advancing the maxilla alone in a purely linear fashion doesn't do much in terms of opening up your nasal passage UNLESS you're doing something like a 2-piece or 3-piece le fort 1 that involves transversely expanding your maxilla.

[@teethree141]

how much transverse expansion can you get with a lefort cut?

[@jeffrman777]

@@teethree141 5-7 mm is the limit, without imposing vascular risks to the palatal mucosa.

[@austinzizzi1142]

That question about Alfi and where the Laforte 1 cut occurs and what that does for the rest of the face is what I wanted to ask you in our last talk

[@SashaOrwell]

Sup Ron, sup y'all. I'm getting MMA with segmented lefort because I'm too asymmetrical for a MARPE. Could also do MARPE after the MMA, but as Ron said it's sub-optimal and will extend your treatment for 2 years I think for people with significant assymetries this is the way to go

[@darren3851]

Does ease provide as much aesthetic benefits compared to a marpe?

[@ericweingarden4898]

I got mma surgery without marpe. The Nasal breathing is night and day and I basically no longer have sleep apnea. my apnea was a severe case. However, since I was recessed and had previous orthodontics as a child I didn’t realize how narrow my upper jaw was compared to my lower and now I am going to wait 5 more months to get all the gear out and get sarpe. I am getting sarpe instead of marpe because I’m 34 years old and there can be a ton of complications with marpe, which can be negated by getting the sarpe surgery. I don’t care as much about the cheekbones if it means avoiding severe asymmetrical complications or other issues that can occur at my age. I have seen results from sarpe and it looks to me that there is still an improvement on midface aesthetics even with sarpe. I think it is because the bones and tissues are sitting on a wider frame so they slightly adapt to it. Sorry for the long story but I wanted to let people know how marpe can come with a ton of complications if you are a male and getting into your mid 30s or above and might not be the best option. What I should have done was get a sarpe first then mma but I spoke to 2 orthodontists who didn’t want to do it so I threw my hands up a little too soon and just got the mma hopping that would be all I needed. I’m getting the sarpe purely because I don’t like the idea that my jaw is basically anatomically incorrect and my lower jaw is wider than my upper, and for aesthetic reasons, but as far as nasal breathing is concerned mma completely fixed that issue. An orthodontist initially wanted to just tip teeth to fix my new bite but I didn’t like that idea. I strongly doubt marpe sarpe or any other expansion would have an effect that would have been anywhere even close to an improvement as the mma did. I’m in Canada btw and convincing doctors and orthodontists to consider doing any kind of surgery for sleep apnea is very difficult. We are very behind here and these treatments are not known by most people in this country. The nurses at the hospital couldn’t wrap their head around why I would get such an invasive surgery “just” for sleep apnea. Over here they basically throw a cpap at you and wish you good luck.

[@ParaLellor]

who was your srugeon in canada and are you satisfied with the results?

[@christinal434]

Yep. Where in Canada are you? I'm near Toronto. It's so hopeless here. Who was your surgeon?

[@abennett]

Doesn’t jaw surgery affect the airflow in the throat too? Would a MARPE affect anything down there?

[@10splayerluv]

Thank you so much for this! Does MARPE significantly improve OSA?

[@MrAmbrosse]

You didn’t mention one more important point. TMJ stability. I expect it’s easier to achieve a good TMJ position with the surgery, whereas marpe is a bit more random.

[@JawHacks]

Potentially, but on the flipside, a long orthodontic phase that includes MARPE allows a skilled orthodontist (the only kind I would ever recommend) to create a TMJ-optimized bite. At least the orthodontist, slowly and steadily, can find a bite that is guaranteed to be symptom free before the surgeon makes it totally permanent.

[@galaxyroll7053]

@@JawHacksdoes Newaz deal with this well? I plan on getting a MARPE with him.

[@bezwong]

When i got invisalign done, i made the choice to abandon my retainers after learning about orthotropics. It always felt weird that the teeth would feel tight after not having worn retainers for a couple of days. When I noticed that the teeth would be moving out outside the restrictive position of retainers, i knew there must be another force at play and that the outward pressure from the tongue acts as a natural retainer. It's been like 8 years since I've had to use retainers, my teeth aren't crowded, and there have been no relapse with proper tongue posture.

[@rx0102]

Isn't it a big risk though? If you don't get the exact right posture, you may relapse, and the pro is...no minor inconvenience of a retainer?

[@bezwong]

@rx0102 some people can't get the right tongue posture no matter what. Their arch is too small to even suction their tongue up to their top palate. Luckily mine isn't too narrow. It's more of a risk for me when my teeth are artificially placed in a position that isn't natural for my mouth. My tongue wants the arch a bit wider than what the retainer wants, If i had seen some drastic changes over the year, i'd probably go back to retainers. But i didn't have to thankfully.

[@cameronsterls7983]

hi ron, i have an appointment with you in june, is it ok to send you comparison photos which i want to discuss prior to our meeting or would i just send to you when we are on the meeting? thanks

[@YasinAbshir2]

Hi Ron, I’ve been trying to get in touch with you. Is there a possibility of doing a IRL consult with you? Your website doesn’t have that option. I’m in state and I talked to you before about your willingness to do that, but I’m not sure if that changed yet

[@Korrosiv_]

Hey Ron, I'm considering booking an appointment with you on June. But before that, i wanted to know, do you have any insight about chronic sinusitis improvement with any nasal surgery? (IE: EASE). No need to explain in detail, just the assurance that you know about the subject. Thanks.

[@JawHacks]

Hi friend I would refer you to my interview with Coral Tieu. It might be helpful to you.

[@lena990]

I’m a perfect candidate for marpe and my ortho wanted to do it before MMA. However with my surgeon and ortho planning, they decided we’re going to do the split during surgery instead of marpe before. So now I have aligners and we are making 2 small side gaps to make room for the split. And honestly I like that way better than the unpredictability with marpe

[@selfimprovementb6]

Wow that’s really interesting. Who is your surgeon?

[@lena990]

@@selfimprovementb6 surgeon is Dr. Alfi In TX

[@bloomp7999]

you do great job of raising awarness on this subject. Anyway condiering your own face, you're looking good !

[@ISOGONIC]

Nice bro tnx so much Btw how old are u??

[@davidsz.8618]

I didnt watch your videos for some time and what a jaw performance man.

[@sparkignite6073]

will marpe work after double jaw surgery

[@Artolink97]

Hello Ronald, I was wondering how much forward growth did you achieve with your MSE treatment? Correct me if I'm wrong but in case of overjets (I have one) MSE is useless, because the whole face is tilted downwards, so MSE can't fix the overjet as the chin will always remain back in relation to the maxilla, even if the mandible comes a little bit forward after the forward growth of the maxilla. So, since MSE only splits the suture without counter rotating the bone, it does not address all the problems and in case of overjets the only real solution for adults is jaw surgery, am I right?

[@ChloeReiter]

I’m confused if I need a mse because I do have a narrow palate (it’s V shaped instead of U shaped. I also have the classic teeth mark on the sides of my tongue. However, I have gapped teeth and a good bite. I don’t know if getting a palate expander would ruin the good bite that I already have and cause other issues?

[@mattb728]

Expansion is typically followed with orthodontics to correct the bite

[@reginaldchow6976]

chances of success for marpe with male in 40s? any rec's on East Coast Orthos with highest succes rate? thx for vid

[@natural_law_nutrition]

so who should i visit first if i don't know if i need MARPE? the maxillofacial surgeon or the orthodontist?

[@abennett]

How can you get jaw surgery and have it relapse? I thought it’s permanent.

[@דודישראלי-ל1ל]

I did and it relapse after a week if the surgery was bad you Fucked

[@marcoantoniobr153]

And when your dental arches are compensated but are small? Is it silly to put the expander ?, I want to do the expansion to have the strongest zygomatic bone, but the lower arch will remain small, I intend to do the surgery for advancement later, so that the face does not look like an alligator.

[@SilverGeFer]

I don’t know if you have the answer to this, but I’ve had braces at 14, that was 8 years ago, and 6 extractions total (wish I never got two of my wisdom teeth removed because it was completely unnecessary considering my other ones grew perfectly fine). I still hate my side profile since I have a big nose and recessed jaw. My maxilla and mandible completely failed to grow because of mouth breathing habits that were never fixed back when I was a child. Would I have to wear braces again if I get double jaw surgery or does the fact my teeth have already been straightened save the need for additional braces?

[@ocoro174]

hey Ron, I am missing a bottom incisor (extracted..), what do you think is the best course of action?

[@Farrusco91]

So Marpe should always be the first line of treatment? if it fails then one must consider MSE or double Jaw surgery or MMA right?

[@Thaizinho0]

Yes! marpe is the first option, always.

[@HHindsight]

Dr Joel told me had good facial advancement in women with his expander + facemask, but always none in men so he's experimenting with getting a maxillofacial surgeon to break the Zyglomatic suture to be able to pull forward with facemask and the expander. He said that that was the strongest suture holding the face back and that the other facial sutures would be flexible under the pressure of the expander and facemask. I'll ask him if he's tried this and how it's going next time I see him, but if this works I'd say it's a better alternative to every other facial advancement option out there,

[@christinal434]

how is that going and which surgeon does he use?

[@HHindsight]

@@christinal434 he says they`re doing it now but idk the progress, surgeon wise I think it`s pretty rudimentary as far as that type of surgery goes

[@christinal434]

Ok well my friend got good results with fm and marpe with him. 35 male ​@@HHindsight

[@GibsonFender-z3g]

What do u think of thumb pulling? Can it be almost as effective as mewing if done like 10min w breaks daily?

[@necronecrow1826]

If I got my wisdom teeth extracted when i was a younger person is it possible to get back that lost correct primary level of jaw development using any available options?

[@n8rock1]

Hi Ron , I live in San Diego do you know have any good surgeons out this way? I was thinking about driving to LA to see Dr. Yoon but if you know of anybody closer please let me know .

[@kichki777]

Hi bro do you know any mse provider in the middle east? Specificaly lebanon?

[@67maxfield]

dude can you help me lol. ive followed you on and off but havent really committed to truly understanding all this stuff. ive had somewhat debilitating tmj and over facial structure probs since i was a kid and especially after my shitty ortho messed my braces up. i'm thirty now and have like no money to make a dent in anything, as my insurance is pretty basic. so what exactly should i try to do? i had one myofunctional therapist tell me if i dont try to fix my situation it could literally decrease my life expetancy significantly. i didnt really try to get him to elaborate much, but it scares me. and im sick of my jaws popping everytime i open my mouth past like an inch.

[@maxaffe3195]

EASE also allows for midface expansion right? he doesnt do cuts that prevent the midface from expanding right?

[@JawHacks]

That’s correct.

[@Smile-rd5fn]

If you have composite bonding on tooth is it OK to expand the palate?

[@bluecresc5804]

Here to say you sound like keith gill aka DFV but stayed for the video ty

[@JawHacks]

We are both from the same neck of the woods.

[@carloscueva7492]

Great video… since double jaw surgery or facial surgery makes nasal cavity longer.. Y could t surgery Also widen the nasal cavity ?? I thought it has the ability to do both 🤔

[@unknown15690]

hi sir as you told in previous videos due to my wrong exercises i got lumps under the eye(zygomatic bones came out on either sides which were never there before exercises) how do i reduce them plzzzz help me get ot of this❤

[@carlosmengs]

Should I get them both done on the same clinic or is it fine to go to a regular orthodontist for the marpe?

[@JawHacks]

Regular orthodontists don't offer MARPE. Furthermore, among the providers who do offer it, only a small percentage are experienced and deliberate enough to ensure that you don't suffer from one of the common pitfalls of MARPE such as overexpansion, asymmetry or failure to split.

[@XtergoBlue]

I have some interesting points i want to debate with you esp after I met with Prof John, can we make an arrangement?

[@NadaOmar-be1uo]

Please can you help me and recommend me experts who provides SFOT procedure and MARPE in Europe or in UAE? And if you don’t know can you ask the doctors you know in the US if they know anyone who provides them abroad. Because I can’t travel to the US to get them done and I need them as soon as possible

[@gtaboyrocks]

You forgot the most important point of them all. That is, can the tongue comfortably fit in the roof of the mouth with proper tongue posture before MMA? If not, one will be at risk of recession even after mma due to inadequate forces applied to the maxilla. Also, if the patient's tongue is collapsing due to a narrow maxilla, advancing the jaws is only a bandaid, compensatory solution for it. Low tongue posture is a risk factor for OSA even after MMA.

[@rickrobinson8417]

He actually mentioned that

[@teethree141]

so if you have low tongue posture due to tongue tie, what do you do first? tongue tie release before mma or mma before tongue tie release

[@gtaboyrocks]

@@teethree141 tongue tie beforehand

[@Alex-tg2uj]

SICK JAWLINE BRO. DO YOU CHEW A LOT MORE THAN BEFORE ??

[@giova3182]

can i get fixed of my receesed lower jaw with msdo

[@maxaffe3195]

i am sorry but can u tell the difference between mse and marpe? sorry if the question is stupid

[@maxaffe3195]

its the same right?

[@JawHacks]

MSE is a brand of MARPE. MARPE = any nasomaxillary expander (splits the suture)

[@rayeesramzan8690]

Iam indian my cbct narrow airway class 1 occulation whats plan ?

[@truman3.0]

Sorry for maybe sounding like a noob; MARPE Vs MSE Similar procedure?

[@truman3.0]

Also are you planning / still planning to get the double jaw surgery on yourself ?

[@ravipuralena7747]

MARPE is a more evolved, customized and complex system. MSE is a simpler mass-market system

[@nemonemo8430]

What do you think about a reverse cone custom marpe?

[@JawHacks]

I think the more posterior the MARPE, and the more reverse conical the expansion, the better for nasal breathing. It's a big ask though.

[@Chriskitesurfer]

​@@JawHacks Hello Ron, the solution to your doubts is much more effective than with rhinomanometry, evaluating the results of the flow (flow rates, pressures and velocities) in each meatus, applying an exhaustive CFD analysis with Sinuflow from Flowgy, After a virtual surgery planned with Nemotec (Cephalometric Analysis Software of the entire Maxilla), applying the MARPE, SAMARPE or MSE technique according to each case and the type of patient, the Virtual Surgery planned in Sinuflow (CFD software) is then evaluated. ) to analyze the flow. Keep in mind that excess transverse expansion of the palate could develop ENS and consequently lose the necessary Venturi Effect in both lower meatuses. The pressures and velocities in the 6 meatuses must be balanced and balanced to be able to have the required pressure in each meatus to be able to expel nasal secretions (mucus) from the sinuses (frontal, ethmoidal, sphenoidal and maxillary), Otherwise, dry mucus will remain trapped in the upper and middle meatuses, turning into scabs that will obstruct normal breathing, reducing the respiratory rate and the required oxygen flow rate. As consequences of ENS. I know Fluid Mechanics, learned in Engineering. I recommend that you watch the videos of M.D.Orl.🇩🇪 Fabián Sommer, from SCONA (Society for Computational Fluid Dynamics of the Nose & Airway) 2018.

[@rainashroff11]

ok I'll make sure to get my KPOP haircut before everything else!

[@Rin-xy4tt]

Gotta love the bro science

[@PhysicsBallArt]

Better then diet bro science, atleast

[@RobbyBrookss]

elaborate? It's easy to say "bro science" without actually refuting any of the points made

[@r3sault792]

Hi, if i got 2 molars teeth extracted when i was almost 12 now im (17.5) do i normally need to get 2 implant after i do mse?

[@rickrobinson8417]

Chad.

[@JawHacks]

My guy 🙌🏼

[@MaartenVaanThomm]

There is no way MARPE will significantly impact bizygomatic width, besides some extreme cases. With MARPE, the cut is only on the palate and the shift is totally on the dental arch, while what you can get on the zygomas is a marginal amount of some sort of a rotation. It's negligable in terms of aesthetics.

[@JawHacks]

Haha clearly you haven't seen many before/afters of MARPE. The expansion goes all the way up, basically to the bottoms of the eyes. This shows in the CBCT images too. Maybe you are thinking of SARPE? In which case I agree, the Lefort cuts prevent any midfacial expansion beyond the palate.

[@MaartenVaanThomm]

@@JawHacks Haha okay, let's talk facts - would you be able to provide any clear before and after CT scans that shows significant expansion in bizygomatic width?

[@yulia7191]

There's an expansion Facebook support group where real people get MARPE (like even people in your area) and when people post before and after photos, you can usually clearly see the difference in their facial structure. It may not be a giant difference but it's usually enough to cause a positive change in aesthetics. At least it's those who post, but it does prove significant differences are possible. Also people talk about noticing a difference in their cheekbones.

[@grimartificial]

Looking w i d e

[@kichki777]

What about mse or ease after surgery?

[@rickrobinson8417]

He talked about that in the video

[@mrchromo872]

just get bimax

[@Ojj2002]

Lefort 3 😮

[@דודישראלי-ל1ל]

Yes go to MMA surgery And end this nightmare. MSE is hard and long.

[@benjaminmarin9404]

Why don't you ever grow a beard Ron?

[@joedimaggio3146]

Do you think we should get plates and screws removed after double jaw surgery to help facilitate further mewing benefits in the long term?

[@jeffrman777]

Why would that help? If anything leaving them in helps stabilize the surgical outcome in the long run.

[@joedimaggio3146]

@@jeffrman777 Because bones move throughout our life (very slowly). If we keep mewing, then hopefully bones will move into better, more functional positions over time. If there is metal hardware fixing bones in place, it cannot move. Also, there is a chance of infection from the hardware.

[@jeffrman777]

@@joedimaggio3146 Or you can just get the surgery to move your jaws into their ideal positions, then practice proper tongue posture to try your best to maintain that surgical outcome for as long as possible.

[@RobbyBrookss]

you cant do this. 99% of the time the cuts made in the jaws will be significant enough that those plates will be there for the rest of your lifetime, as bone grafting wouldnt be enough to facilitate holding the jaws in place by itself.

[@stayontrack]

@@RobbyBrookss nah people get them taken out for various reasons like infection all the time

[@abennett]

Doesn’t jaw surgery affect the airflow in the throat too? Would a MARPE affect anything down there?