I'm currently halfway through the process of getting both Surgically Assisted Rapid Palatal Expansion (SARPE), which I completed 6 months ago, and Maxillomandib

I'm currently halfway through the process of getting both Surgically Assisted Rapid Palatal Expansion (SARPE), which I completed 6 months ago, and Maxillomandibular Advancement (MMA) which is happening in October. I'm in my early 30s. I never tolerated the mask well and couldn't fathom being strapped to it for the rest of my natural life. After reviewing the literature, it quickly became clear that soft tissue surgery was a poor option - surgical success rates are often less than 50%, and surgical cures are almost non-existent. At best you'd trade a lot of pain for a temporary, modest reduction in AHI. MMA, however, looked very different - in the hands of a skilled surgeon, surgical success rates are >90% and reduction of AHI to <5 is possible, though not guaranteed. A relevant paragraph: "Staged surgery protocols have been developed to address multilevel airway abnormalities that contribute to OSA. Generally, procedures that carry less severe risks and potential complications are performed initially. The Stanford group protocol reports a staged surgical success rate of 75 % in patients with mild-to-moderate OSA and 40 % in patients with severe OSA in phase I (palatal surgery alone or in combination with GA) to 95 % in phase II or facial skeletal surgery [53]. In some cases when soft tissue abnormalities are not considered to play a significant role, maxillomandibular advancement can be considered as the initial therapeutic option [45]." (source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3480570/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3480570/) Among leading surgeons the view these days is that MMA is the gold standard and there is no reason to do soft tissue surgery first unless your physiology specifically warrants it. MMA does, however, require a skilled surgeon - in the hands of an inexperienced one you'll see much lower success rates and more complications. I did a ton of research before picking the surgeon I've been working with. Dr. Kasey Li is probably the surgeon you're thinking of. I'm Canadian but paid to have a consult with him to make sure I was on the right path. My understanding is that many insurers will cover the surgery now, although in my case I'm having it done in Toronto by an excellent surgeon. Between the two surgeries and orthodontics it will come out to about $20k over two years. In Canada the hospital stay and most of the surgeries are covered by provincial insurance, so about 3/4 of that cost is actually for braces + expansion device for SARPE. It's a long and sometimes difficult process, but my own personal calculus lead me to believe it was the best available option given the circumstances. If all goes well I should come out the other end with minimal or no sleep apnea, and as a bonus straighter teeth too :-D There is some really interesting work being done on implantable hypoglossal nerve stimulation devices (https://www.inspiresleep.com/ https://www.inspiresleep.com/) but in my estimation the jury is still out on the long-term prospects of that modality.