jawsurgeryforums.com
General Category => Aesthetics => Topic started by: Ezra on September 11, 2017, 11:15:33 AM
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Hi guys. I really need some help. I'm pursuing surgery for aesthetics reasons. I don't have any pain or bite problems. I have an slight overbite, deep bite, my teeth are starting to flair but that can be fixed with braces. I just hate how small and recessed my chin looks and how short my face I'm not jutting my jaw forward.
I've seen two reputable jaw surgeons.
Dr. Gilbert wants to do:
-Sliding Genioplasty (instead of lower jaw surgery, to build a better chin area)
-Upper Jaw lowering (to give add facial length, show more teeth when smiling and resting)
Dr Choi wants to:
-Lower Jaw Surgery only ( to fix recessive lower jaw appearance. No sliding genio )
-Remove 2 molars to make room for this.
-Willing to do upper jaw as well after I asked. Doing both these surgeries is very expensive for me, tough.
All options include braces obviously. My orthodontist said both options will achieve a good result cosmetically and he didn't recommend one surgeon over the other. He said they are both great surgeons.
I'm hesitant to do upper jaw after reading about nose changes. I had a botched nose surgery that I fixed with an expensive revision from Dr. Frankel. I will not do something that changes my nose. Dr. Gilbert never mentioned nose changes but I just noticed people talking about it on this forum. If I only lowered the upper jaw, without moving it forward, would that change the nose? I'm considering just doing a Sliding Genio and no jaw surgeries. Would a Sliding Genio be good enough, by itself?
TLDR - I'm deciding between 1.) Sliding Genio only, 2.) Sliding Genio+Upper Jaw, or 3.) Lower Jaw only.
my real bite:
https://imgur.com/tq2lnYh
http://imgur.com/LN0tdjD
http://imgur.com/ReyqcIH
https://imgur.com/n1qXOqc
jutting forward (close to what I want to achieve, hopefully will be better):
http://imgur.com/UTdIOxa
http://imgur.com/wYLGLW4
http://imgur.com/CuDKLPU
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slide down genio to elongate the chin.
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Wouldn't your relaxed jaw look pretty decent? The biting down makes it a lot worse than in daily life.
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I think you'd get a nicer aesthetic result with jaw surgery + genio versus only a sliding genio, but if you do go the jaw surgery route: for heaven's sake go to the best surgeon and stop the surgery thereafter.
Since you probably don't want to hear this, but it is a shame what happened to your nose. As you have damn good features (I'm envious bro!)
You have a great projected browridge, fantastic jawline with good drop down (albeit the jawline/angle seems covered a bit by fatty tissue), nice eyes, good inferior orbital rim projection, fantastic hairline, great brows (just a tiny bit too groomed for my personal taste), nice shaped lips albeit your bite currently seems to affect the way they look in resting pose, which is one of the reasons why I feel you'd look better after jaw surgery (aside the fact the lower jaw looks retruded). Good skin and skin tone. Good temple projection, nice lateral width of your face, nice cheekbones. Good forehead shape. Good fat distribution, albeit losing a bit of weight may make your features pop out more, and posteriorly along the jawline there seems a bit of excess fatty tissue.
Seriously dude: you're really lucky. Now don't mess that up with more surgery, so if you do go the route of jaw surgery, aim high, go to the best surgeon, and for heaven's sake: NO MORE SURGERY TO NEW FEATURES. You seriously risk ruining those good features. Surgically enhanced features are not better than the naturally handsome features you have: it's not going to get better than that. Remember that! If you're born with bad looking features you can possibly improve them with surgery, but if you have such naturally great features as you have: you're never ever going to get such completely naturally appearing goodlooking features through surgeries. So don't try!
What did your nose look like before any surgery? I hate to say it but it is still the other feature to me that stands out.
When you say a nicer aesthetic result with jaw surgery + genio, are you referring to lowering the upper jaw and a genio? That is what the first surgeon offered me.
And thank you for the compliment. It does mean something to me as I'm here obviously because I'm not feeling too secure with my appearance. It really is just the jaw thing that bothers me though. I'll have to take your advice on avoiding cosmetic surgeries in the future. Its so costly ($$ and emotionally) and in my case, apparently not necessary.
Yeah, so about my nose, I was really young and wanted to a nose that wouldn't project so far out. I went to the first surgeon I (mistakenly) liked. He really just made it crooked/upturned/thin and not closer to my face. Dr. Frankel fixed the crookedness, fixed the upturned angle, and de-projected it. He is really is a master at this.
here is my original nose:
https://imgur.com/zcZn8vC
http://imgur.com/zWZVNug
http://imgur.com/Xbzxal9
http://imgur.com/em992nV
http://imgur.com/Oj7jSh5
I didn't understand that I have recessive jaw/chin. This added to the reason I thought my nose was overprotected. However, I don't dislike the nose Dr. Frankel gave me. He did the best with what he had to work with.
What about my current nose stood out to you?
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Both of these plans are wrong for you. You clearly have bimax recession and need double jaw surgery with counterclockwise rotation. Your chin looks adequate to me and you may not even need a genio if your jaws are rotated enough. Don't get an isolated genio because it'll probably give you a witch's chin appearance due to the amount of advancement needed to give you enough projection.
You need to get more opinions. Don't settle for the cheapest local surgeon who really is a glorified dentist, especially if you're doing this for aesthetics. In this business, you really get what you pay for.
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Ok so that last picture (that I quoted above as some of the other pics don't show your face as well, but I can remove it for you, just lemme know), shows your frontal face before your rhinoplasty. Some exceptional features, be careful there and don't mess with it as said.
I think Frankel did a good job on the profile of your nose, it looks much better than before since that 'sweep' was straightened. However (but this is my personal opinion): the front view doesn't look onoperated on to me. If I see your original nose I can comprehend why you wanted a bit of refinement in the tip/the 'sweep' in the side view gone, since the tip of the nose was a little bit bulbuous perhaps in some views. However, the problem is as you've seen yourself: once rhino goes wrong it is s**t difficult to fix. And everyone can see on Realself: it goes wrong more often than it goes right. So I'm sure Frankel gave you a good improvement. But my personal opinion is it does still not look completely onoperated on. The nose seems too short from the front view, the tip not completely natural shaped and should point further downwards, and ideally have a more natural shape/be better streamlined. To get a stronger, more masculine nose that complements your other features such as your masculine jawline. Very very few surgeons can do such revision worldwide. I know Lazlo always mentions Toriumi, and for females Toriumi may be over-the-top, but for such a revision case that needs a masculine result as you have: I think he may be one of the only surgeons that could pull this off. But he's very expensive. And I don't want to make you feel worse as I'm sure your nose was a good improvement. This is just my opinion.
Getting other surgery to other features is not just "not necessary" as you say: you have splendid features that would make most guys (me included) envious. You can only f*** them up if you get surgery to them; they are not going to get better. I repeat myself but surgery can only enhance features that could use enhancement, and in such a case there may be a nice improvement. But no surgery result is going to look as nice as naturally goodlooking features. You're never going to get that through surgery. This is a mistake many make (also many that get rhinoplasty). Naturally goodlooking features have good/even skintone, good/even fat coverage, complete unlimited mobility (scar tissue will affect that, even if only a little bit). Getting jaw surgery is a different story since you'd be getting osteotomies to the bone, but more soft tissue/cartilage work and you can mess up those features. It would be damn pity to see you try that out to such good features as you naturally have.
As to the jaw surgery, certainly lower jaw surgery + genio in my opinion, but we'd need to see cephs to have an idea about your bite/the upper jaw.
Well thank you and I'll keep that particular surgeon in mind. As of now, I mostly like my nose. Dr. Frankel is going to add some cartilage (from behind my ear) to the deep nasal indent on my right. This will help fill in the gash and it can be done while I'm awake. It is very minor and can only improve things. You're right though, it could definitely be much more natural looking, but the cons tend to outweigh the risks for me. All the morphs I do only make things look worse, even slight milometers to the tip tend don't really help. If I see a good morph, it could change my mind. Plus, altering the tip would change the profile view, which is pretty great right now. The only morph that looked good was when I made the bridge wider, but I can live without that for now.
As for the jaw, no surgeon has yet to offer me both a sliding-genio combined with lower jaw surgery.
One surgeon said just lower jaw by itself. The other surgeon wants to move the upper jaw downwards, combined with sliding genio.
Not sure what to do.
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Very true. OP should not just get a genio: he would get a deep sulcus that way too, if he'd want to get all the advancement with a genio.
As to the upper jaw: I think you're right too. Would still be good to first see a ceph though.
What is a ceph?
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Both of these plans are wrong for you. You clearly have bimax recession and need double jaw surgery with counterclockwise rotation. Your chin looks adequate to me and you may not even need a genio if your jaws are rotated enough. Don't get an isolated genio because it'll probably give you a witch's chin appearance due to the amount of advancement needed to give you enough projection.
You need to get more opinions. Don't settle for the cheapest local surgeon who really is a glorified dentist, especially if you're doing this for aesthetics. In this business, you really get what you pay for.
What are some good surgeons in Southern California / Los Angeles area?
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Both of these plans are wrong for you. You clearly have bimax recession and need double jaw surgery with counterclockwise rotation. Your chin looks adequate to me and you may not even need a genio if your jaws are rotated enough. Don't get an isolated genio because it'll probably give you a witch's chin appearance due to the amount of advancement needed to give you enough projection.
You need to get more opinions. Don't settle for the cheapest local surgeon who really is a glorified dentist, especially if you're doing this for aesthetics. In this business, you really get what you pay for.
Looks like he has somewhat of a deep bite to me (and he said that). Deep bite shows as short chin and often associated with flatter occlusal plane not needing CCW. Also, the act of his jutting out his jaw is act of clockwise rotation which makes the chin look longer. I think a drop down genio, perhaps with a chin implant overlay would give him the biggest bang for his buck.
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Doing just one jaw is almost always a compromise. Dentofacial deformities aren't usually limited to just one jaw and if you're going through with jaw surgery and all the risks associated with it, you shouldn't settle for a compromise. You want to get it right the first time.
Are you in California? You should consult with Dr. Gunson and Dr. Relle.
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Looks like he has somewhat of a deep bite to me (and he said that). Deep bite shows as short chin and often associated with flatter occlusal plane not needing CCW. Also, the act of his jutting out his jaw is act of clockwise rotation which makes the chin look longer. I think a drop down genio, perhaps with a chin implant overlay would give him the biggest bang for his buck.
I think his entire maxilla needs to be lowered, but more in the posterior part, so that it results in CCW. It's not rare for a deep bite patient to need CCW. He doesn't have the typical "too flat occlusal plane" look. His profile is too convex. His chin has a decent shape to it, so he may get away with not needing a genio at all or a small one if it's necessary. It's not a good idea to camouflage jaw recession with a genio.
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I think his entire maxilla needs to be lowered, but more in the posterior part, so that it results in CCW. It's not rare for a deep bite patient to need CCW. He doesn't have the typical "too flat occlusal plane" look. His profile is too convex. His chin has a decent shape to it, so he may get away with not needing a genio at all or a small one if it's necessary. It's not a good idea to camouflage jaw recession with a genio.
There could be an indication for that. But, I would not say that in absence of seeing ceph. His go-go distance is nice and wide and his jaw angles look nice and low which is why I think he could mask with drop down genio to elongate chin. This is in reference to his facial topography.
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A deep bite can mask a steep occlusal plane.... I don't think genioplasty is a good idea - the chin bone looks fine to me.
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What is a ceph?
An X ray that shows your dental relationships, facial bones and soft tissue contour outline.
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A deep bite can mask a steep occlusal plane.... I don't think genioplasty is a good idea - the chin bone looks fine to me.
It's short when he closes in on his bite. When he advances out his jaw it's longer. That's why I say a chin elongation would mask things for him. He does not need much advancement there either. With bi-max (keep in mind CCW entails surgery to the maxilla), his nose relationship can change. So, my response takes into consideration his concerns about a potential change in the nose relationship. Also, i think the short chin is the main aesthetic deviance he has from looking great. That's why I think he could get away with 'masking'. Keep in mind drop down genios don't make the chin sulcus more visible. They tend towards making it less visible.
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I'm yet to see a thread there a user named CCW does not recommend CCW bimax, so take his advice with a grain of salt.
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I'm yet to see a thread there a user named CCW does not recommend CCW bimax, so take his advice with a grain of salt.
He didn't suggest it to me, lol.
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Here is example of why my advice was so. The spaces suggest the chin drop. Fill them in visually and it's pretty close to what he's doing when he juts. Not exactly but close enough. Keep in mind when he juts his jaw forward, he's dropping his chin in the process. He's NOT advancing his maxilla and displacing the orientation of his nose.
I guess you could tell him to get the whole enchalada, bi-max with CCW. He might have money burning a hole in his pocket to revise his nose again if he doesn't like how it changes after that. But he's expressing nose changes are a concern of his and he shows a desire to get away with a lesser procedure which will give him the most bang for his buck. I think he can get away with it.
Sometimes, you just have to listen to what someone is telling you, check to see if he could 'aesthetically survive' with just that one thing and not just go into auto-pilot with the suggestions.
[attachment deleted by admin]
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Hey guys! I'm still reading all your advice, thanks so much. Here is the ceph album (maybe?)
http://imgur.com/a/wDOsZ
Please let me know what you think.
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Here is example of why my advice was so. The spaces suggest the chin drop. Fill them in visually and it's pretty close to what he's doing when he juts. Not exactly but close enough. Keep in mind when he juts his jaw forward, he's dropping his chin in the process. He's NOT advancing his maxilla and displacing the orientation of his nose.
Thanks for putting it together visually. I'm wondering if the sliding genio won't cause too much of a "witches chin" as someone mentioned. I remember my surgeon telling me that isn't the case, because it moves all of the soft tissue toward, without stretching.
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Thanks for putting it together visually. I'm wondering if the sliding genio won't cause too much of a "witches chin" as someone mentioned. I remember my surgeon telling me that isn't the case, because it moves all of the soft tissue toward, without stretching.
I'm thinking more in terms of a drop down to the chin with spacer block or graft ( but with some advancement).
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If you're in California, see Gunson. Yes, his prices are astronomical, but his consultations are extremely thorough. Also, if all you need is genioplasty, his fee is actually quite reasonable. Frankel did an amazing job on your nose (and yet he has so many terrible reviews on realself... I guess rhinoplasty is a lottery).
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Hey guys! I'm still reading all your advice, thanks so much. Here is the ceph album (maybe?)
http://imgur.com/a/wDOsZ
Please let me know what you think.
Welp now I see why my upper/lower palates are considered narrow, LOL. Borderline should be my new max facs forum nickname. I agree with the SG drop-down recommendation, FWIW piling on.
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If you're in California, see Gunson. Yes, his prices are astronomical, but his consultations are extremely thorough. Also, if all you need is genioplasty, his fee is actually quite reasonable. Frankel did an amazing job on your nose (and yet he has so many terrible reviews on realself... I guess rhinoplasty is a lottery).
I had no idea Frankel had those bad reviews. I've been reading them and while I'm surprised, it seems that any well known surgeon will have some bad reviews. We do take that risk with surgery. In Frankels defense, he is well know for being an expert in revisions, and is capable of creating that look he is known for.
I'll check out Gunson, but I'm much closer to Relle... he is good right ?
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I had no idea Frankel had those bad reviews. I've been reading them and while I'm surprised, it seems that any well known surgeon will have some bad reviews. We do take that risk with surgery. In Frankels defense, he is well know for being an expert in revisions, and is capable of creating that look he is known for.
I'll check out Gunson, but I'm much closer to Relle... he is good right ?
Well, I've heard that the revision rate with rhinoplasties is very high no matter who does them, but on balance Frankel is one of the best.
Both Relle and Gunson are good. Relle is a bit more conservative and probably cheaper. You don't need anything radical.
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Well, I've heard that the revision rate with rhinoplasties is very high no matter who does them, but on balance Frankel is one of the best.
Both Relle and Gunson are good. Relle is a bit more conservative and probably cheaper. You don't need anything radical.
Is there anything known about Dr. Gilbert in Upland California? Or would that be considered a risky local surgery? Both my doctor and my orthodontist said he is a good surgeon.
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Is there anything known about Dr. Gilbert in Upland California? Or would that be considered a risky local surgery? Both my doctor and my orthodontist said he is a good surgeon.
Never heard of him. He could be great. Some say that no surgeon is 100 times better than another and that at the end of the day they all do the same osteotomies and surgeons like Gunson are simply overhyped. I don't know what the truth is. "The best local guy" did my surgery and I copped massive nerve damage and a ho-hum aesthetic result (functionally it's perfect, so he admits no fault).
Ask him how many orthognathic surgeries he does per year i.e. BSSOs, Le Forts, genioplasties. Not dental implants, not pulling wisdom teeth - for most oral surgeons this is the bulk of their business. Ask him what are the chances of relapse of the maxillary down graft. How many mms of down graft? What materials does he use for the graft material? If you do relapse, will he re-operate on you? (I heard that when revising his own work Gunson will drop his fee, but not that of the hospital or anaesthesiologist and his fee is the biggest part of the bill. Other surgeons will revision "at a reduced rate". Other surgeons will simply hide from you). Also ask him if having an upper jaw down graft only puts you at a greater risk of relapse vs two jaw surgery, because AFAIK lower jaw surgery really weakens your bite strength for quite a while.
The problem with lengthening the maxilla is that it may lengthen your face and may make it more convex in profile as the lower jaw swings down. I'm not sure if you're gonna like this. The genioplasty is supposed to counteract this, but your mentolabial fold looks good. Also genioplasties can thin the lower lip...
One option worth considering is a lip lift for tooth show. There is a guy on the forum with full lips who did this (and a vermillion reduction at the same time) and he looks pretty good. But personally I think one side effect that people overlook with lip lifts is that they may make the nose look longer. This is a general issue with aesthetic surgery. You take away from A, B look bigger. You add to A, B looks smaller. Also, I believe Frankel does them, and doing them at the same time as rhinoplasty is often a good idea, since you can hide the scar in the alar rim, so he would've mentioned this to you...
Arnett & Gunson published a paper some time ago where they downplay the importance of jaws period. If you search for this paper you will find it. They claim skin, hair, eyes, features are more important, unless there is a dentofacial deformity so significant that it takes away from those features. For example, someone with such a recessive chin that you don't notice their great eyes. I don't think anyone needs to tell you that you have great features. Your dentofacialy deformities are so minor that they don't take away from your features. They are not the first things that people notice about you (well, sane people). IMO, you may go through a lot of trouble to end up looking no better than you do now. You have to decide if any of this is worth it for you. That's why I would definitely see someone like Gunson. He has so much business, he will only suggest surgery if it's really worthwhile.
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Hey guys! I'm still reading all your advice, thanks so much. Here is the ceph album (maybe?)
http://imgur.com/a/wDOsZ
Please let me know what you think.
You have a very similar growth pattern and starting position as I did before my surgery.
Dr. Choi's plan with premolar extractions is the way to go. You need as big of a lower jaw advancement as possible and no genioplasty.
You can opt in to upper jaw surgery as well, but not for the purpose of lowering the jaw vertically but rather advancing it as well. This isn't strictly necessary, but sliding the upper jaw forward gives the lower jaw additional room for advancement and would increase incisor show too. This approach would also massivley increase your airway volume, so if you have breathing problems or snore loudly it might be worth considering.
I don't think you need any kind of rotation, so if you are low on funds, you can get a very good improvement just doing lower jaw extractions followed by BSSO surgery.
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I've looked at your cephs. The near 'flat' occlusal and mandibular plane angles are not in the direction of addressing via CCW. On the contrary---in direction of clockwise rotation. However, I still think you could get away WITHOUT bi-max, especially so if you are wanting to avoid any 'surprises' to your nose orientation..
The displacement I made is a drop down to the chin with minor advancement. Something where the gaps would need to be filled in with a 'bone buttress'. The chin drop with modest advancement, increases the angle of inclination of the mandibular plane with reference to the points used to assess the angle and of course, directly targets the the shortness of the chin relative to the rest of the mandibular body.
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Never heard of him. He could be great. Some say that no surgeon is 100 times better than another and that at the end of the day they all do the same osteotomies and surgeons like Gunson are simply overhyped. I don't know what the truth is. "The best local guy" did my surgery and I copped massive nerve damage and a ho-hum aesthetic result (functionally it's perfect, so he admits no fault).
Ask him how many orthognathic surgeries he does per year i.e. BSSOs, Le Forts, genioplasties. Not dental implants, not pulling wisdom teeth - for most oral surgeons this is the bulk of their business. Ask him what are the chances of relapse of the maxillary down graft. How many mms of down graft? What materials does he use for the graft material? If you do relapse, will he re-operate on you? (I heard that when revising his own work Gunson will drop his fee, but not that of the hospital or anaesthesiologist and his fee is the biggest part of the bill. Other surgeons will revision "at a reduced rate". Other surgeons will simply hide from you). Also ask him if having an upper jaw down graft only puts you at a greater risk of relapse vs two jaw surgery, because AFAIK lower jaw surgery really weakens your bite strength for quite a while.
The problem with lengthening the maxilla is that it may lengthen your face and may make it more convex in profile as the lower jaw swings down. I'm not sure if you're gonna like this. The genioplasty is supposed to counteract this, but your mentolabial fold looks good. Also genioplasties can thin the lower lip...
One option worth considering is a lip lift for tooth show. There is a guy on the forum with full lips who did this (and a vermillion reduction at the same time) and he looks pretty good. But personally I think one side effect that people overlook with lip lifts is that they may make the nose look longer. This is a general issue with aesthetic surgery. You take away from A, B look bigger. You add to A, B looks smaller. Also, I believe Frankel does them, and doing them at the same time as rhinoplasty is often a good idea, since you can hide the scar in the alar rim, so he would've mentioned this to you...
Arnett & Gunson published a paper some time ago where they downplay the importance of jaws period. If you search for this paper you will find it. They claim skin, hair, eyes, features are more important, unless there is a dentofacial deformity so significant that it takes away from those features. For example, someone with such a recessive chin that you don't notice their great eyes. I don't think anyone needs to tell you that you have great features. Your dentofacialy deformities are so minor that they don't take away from your features. They are not the first things that people notice about you (well, sane people). IMO, you may go through a lot of trouble to end up looking no better than you do now. You have to decide if any of this is worth it for you. That's why I would definitely see someone like Gunson. He has so much business, he will only suggest surgery if it's really worthwhile.
I am considering doing a minor lip lift instead of upper jaw surgery and I figured my facial hair would hide the scar well. Can you help me find the guy who had the lip lift on this forum? I'd like to check out his pictures or possibly message him if they aren't posted anymore.
Great idea on checking out Gunson to see what he thinks. I'll actually go to Arnett though, because it's driving distance, that is just as good, right?
Also, thanks for giving me some questions to ask Dr. Gilbert. I really appreciate it. I want to go into this extremely prepared.
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I've looked at your cephs. The near 'flat' occlusal and mandibular plane angles are not in the direction of addressing via CCW. On the contrary---in direction of clockwise rotation. However, I still think you could get away WITHOUT bi-max, especially so if you are wanting to avoid any 'surprises' to your nose orientation..
The displacement I made is a drop down to the chin with minor advancement. Something where the gaps would need to be filled in with a 'bone buttress'. The chin drop with modest advancement, increases the angle of inclination of the mandibular plane with reference to the points used to assess the angle and of course, directly targets the the shortness of the chin relative to the rest of the mandibular body.
So with this edit, it looks like a sliding genio alone would possibly be sufficient? According to one surgeon I consulted with, it is possible to fill in gaps using bovine cartilage grafts. Any thoughts on this?
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Here is example of why my advice was so. The spaces suggest the chin drop. Fill them in visually and it's pretty close to what he's doing when he juts. Not exactly but close enough. Keep in mind when he juts his jaw forward, he's dropping his chin in the process. He's NOT advancing his maxilla and displacing the orientation of his nose.
I notice in this picture you edited, I could possibly see a "witches chin" look. I'm wondering if is true with sliding genios? The surgeon told me it actually moves the soft tissue forward enough and the "chin indent" (forgive me for not remembering the actual term) moves forward with it.
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I notice in these picture you edited, I could possible see a "witches chin" look. I'm wondering if is true with sliding genios? The surgeon told me it actually moves the soft tissue forward enough and the "chin indent" (forgive me for not remembering the actual term) moves forward with it.
I'm not talking about a 'sliding' genio, I'm referring to a drop down with a buttress between the cuts. I'm talking about something aimed at increasing the angle of the mandibular plane and also making the chin look longer in frontal.
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I'm not talking about a 'sliding' genio, I'm referring to a drop down with a buttress between the cuts. I'm talking about something aimed at increasing the angle of the mandibular plane and also making the chin look longer in frontal.
I'm trying to understand what the difference is. Isn't that just a type of sliding genio procedure?
Edit: It's called a drop down genio. I get it now.
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Someone else mentioned a deep bite resulting in a short lower face.
How does it look when you test a "spacer" like a pencil eraser between the top and bottom molars for more height?
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I'm trying to understand what the difference is. Isn't that just a type of sliding genio procedure?
A slide is usually an angled cut where the bone is slid onto itself and some bone contact remains. There is some shortening of the chin with a 'forward' slide to project outwards. There is some elongation to the chin with backward slide BUT with loss of forward projection.
Although one can still make an angled cut to DROP DOWN the chin, as to not actually slide it BACKWARDS a spacer block or graft needs to be buttressed between where it was cut. Buttress materials can vary, eg. bone from spine of pelvis, calcium hydroxy appatite blocks, sometimes porex...something where the cut and SEPARATED bone segments have contact with something else.
However, some docs might elect to do the sliding (backwards) genio to elongate and then compensate with lost forward projection with a chin implant overlay.
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Someone else mentioned a deep bite resulting in a short lower face.
How does it look when you test a "spacer" like a pencil eraser between the top and bottom molars for more height?
I just tried it. My face was slightly longer, but my chin was still badly recessed, bad lip posture.
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I think you'd be fine with the chin osteotomy alone, plus the lip lift...if you are really hankering for more tooth show. You seem to have pretty good bone structure, really just the chin that needs a little push. Definitely don't want to keep having to mess with your nose, cause that will change with bimax. I need some of my upper lift knocked off as well, but you show more teeth than I do.
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kavan, is there a more preferred "buttress" for drop-down as far as stability?
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kavan, is there a more preferred "buttress" for drop-down as far as stability?
It can be hydroxy appetite, harvest bone from pelvic spine, maybe porex block or other materials.
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So if I want to stay away from an implant overlay with drop-down, they will definitely be making an angled cut? If I'm understanding correctly, the only way to get the desired forward projection... How does the stabilization differ in a drop-down slide forward than a drop down? Please feel free to cyber smack me if I'm asking dumb questions.
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So if I want to stay away from an implant overlay with drop-down, they will definitely be making an angled cut? If I'm understanding correctly, the only way to get the desired forward projection... How does the stabilization differ in a drop-down slide forward than a drop down? Please feel free to cyber smack me if I'm asking dumb questions.
This is someone else's thread where the info I gave was meant to apply to them.
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yo dude, your rhino looks amazing. i love the new nose. frankl really is that good huh?
can i see a pic of the scar on your columnella? I want to see what it looks like when its healed.