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General Category => Aesthetics => Topic started by: Purist on September 20, 2017, 10:41:48 AM

Title: Genioplasty date confirmed but unsure about expected outcome.
Post by: Purist on September 20, 2017, 10:41:48 AM

I'm about to undergo a genioplasty in the first week of October but due to the angle of the mandible and narrow profile of the chin the expected outcome is difficult to gauge with my surgeon stating I should expect some recession after the surgery. My chin is very retruded, i.e no chin.

The first hospital I went to, turned me down stating that I would end up with a pointy chin which would not be to my liking. So, I've resorted to Photoshopping to decide if "pointy" is acceptable. Right now, I'm considering not continuing with the surgery.

Do you think the attached x-rays are a realistic stab at the outcome?  It's a tiered genioplasty and I'm not great at editing.

Please note I cannot have jaw surgery before anyone asks ;)
Title: Re: Genioplasty date confirmed but unsure about expected outcome.
Post by: kavan on September 20, 2017, 12:00:12 PM
This is an approximation. It is done ONLY to relay the cut is usually a diagonal one for the chin slide. If tiered, then 2 cuts. It's also done to confirm you won't be getting a lot of augmentation or not to expect it.

For chin augment, one usually does not want to go past the blue drop vertical. Norms for chins are slightly behind the drop. It is to demonstrate not to expect getting even too close to it.
Title: Re: Genioplasty date confirmed but unsure about expected outcome.
Post by: GJ on September 20, 2017, 12:10:40 PM
Unfortunately, that mandible angle is too steep for genio to be much use. It might improve your situation, but it might also result in a deep, unnatural labiomental fold. What you truly need is a pretty significant CCW rotation. At least that's what I see. Did you see an orthognatic surgeon for opinion?
Title: Re: Genioplasty date confirmed but unsure about expected outcome.
Post by: Purist on September 20, 2017, 12:23:06 PM
So based on what Kavan is saying, it would look like this, which unfortunately wouldn't be acceptable to me. That's a shame.
Title: Re: Genioplasty date confirmed but unsure about expected outcome.
Post by: kavan on September 20, 2017, 12:29:42 PM
Unfortunately, that mandible angle is too steep for genio to be much use. It might improve your situation, but it might also result in a deep, unnatural labiomental fold. What you truly need is a pretty significant CCW rotation. At least that's what I see. Did you see an orthognatic surgeon for opinion?

If any genio, it would most likely be the kind where a bone buttress material is between the cut sections for more augment. It's not the sliding genio though.
Title: Re: Genioplasty date confirmed but unsure about expected outcome.
Post by: kavan on September 20, 2017, 12:41:00 PM
So based on what Kavan is saying, it would look like this, which unfortunately wouldn't be acceptable to me. That's a shame.

Can't make a prediction of exactly how it would look. More of a matter of saying not a whole lot can be expected from the SLIDING procedure. You would need to look for docs who could advance more but fill the SPACE left from doing that with a material to support the cut bone segments.
Title: Re: Genioplasty date confirmed but unsure about expected outcome.
Post by: girl on September 20, 2017, 07:09:12 PM
Agree, absolutely don't get a genioplasty on its own.

Edit - Reading back through your posts, it seems that you're from the UK. Given what you've been told, this doesn't surprise me. You won't get the surgery you need here I don't think. Have you expanded your search to Europe? You deserve the best outcome.

Also, 40s is not too old for jaw surgery!  :o There are 70 year olds who get it done. Don't take those remarks as the absolute truth. These surgeons aren't comfortable in handling your case and are making excuses
 ("long roots?")

I had a SG with a long, retruded face and it worsened my situation substantially. It just doesn't work when the occlusal plane is so steep.

(PS - I don't know what it is about UK society but I think we're rather ageist compared to others).

Unfortunately, that mandible angle is too steep for genio to be much use. It might improve your situation, but it might also result in a deep, unnatural labiomental fold. What you truly need is a pretty significant CCW rotation. At least that's what I see. Did you see an orthognatic surgeon for opinion?
Title: Re: Genioplasty date confirmed but unsure about expected outcome.
Post by: kavan on September 20, 2017, 07:24:05 PM
Agree, absolutely don't get a genioplasty on its own.

Edit - Reading back through your posts, it seems that you're from the UK. Given what you've been told, this doesn't surprise me. You won't get the surgery you need here I don't think. Have you expanded your search to Europe? You deserve the best outcome.

Also, 40s is not too old for jaw surgery!  :o There are 70 year olds who get it done. Don't take those remarks as the absolute truth. These surgeons aren't comfortable in handling your case and are making excuses
 ("long roots?")

I had a SG with a long, retruded face and it worsened my situation substantially. It just doesn't work when the occlusal plane is so steep.

(PS - I don't know what it is about UK society but I think we're rather ageist compared to others).

You would need more basic knowledge in reading ceph x rays to say that. They are not making excuses. his roots are quite close to the edge of his jaw. It's obvious from the X ray.
Title: Re: Genioplasty date confirmed but unsure about expected outcome.
Post by: GJ on September 20, 2017, 08:17:40 PM
Also, 40s is not too old for jaw surgery!  :o

More than age it's health. If you're 60s and like an avid swimmer or cyclist you can probably get it no problem. That's why they do pre-op physicals, though.

Eat well, exercise, sleep, and you'll have more options for much longer.
Title: Re: Genioplasty date confirmed but unsure about expected outcome.
Post by: kavan on September 20, 2017, 08:59:33 PM
More than age it's health. If you're 60s and like an avid swimmer or cyclist you can probably get it no problem. That's why they do pre-op physicals, though.

Eat well, exercise, sleep, and you'll have more options for much longer.

Health they use for GENERAL surgical risks. But for max fax , they also look at the jaw bones to see if there is enough 'room' to make the cuts, bone density, distance away from mandibular nerve, condition of the teeth, etc.  Some people just have very diminutive jaws, too small to make the cuts or too fragile. Others have jaws like pit bulls even when older.
Title: Re: Genioplasty date confirmed but unsure about expected outcome.
Post by: ditterbo on September 20, 2017, 09:04:05 PM
Couldn't he/she be considered for the inverted L osteotomy then, instead of the standard BSSO?
Title: Re: Genioplasty date confirmed but unsure about expected outcome.
Post by: girl on September 20, 2017, 09:36:38 PM
If they're in the UK, they won't be equipped to deal with complex cases though, so their opinions on the matter aren't to be trusted. That's why I encouraged him to get opinions from abroad from well-known leaders in the field.

Not sure if he had a health check, I just think there's an assumption that a 40+ person is "old" here. I once saw a healthy guy who was 40 or so on a forum. He said that a UK doctor gave him the impression that jaw surgery was a "young person's thing" and that he was over the hill for it.
 
Title: Re: Genioplasty date confirmed but unsure about expected outcome.
Post by: kavan on September 20, 2017, 10:04:52 PM
If they're in the UK, they won't be equipped to deal with complex cases though, so their opinions on the matter aren't to be trusted. That's why I encouraged him to get opinions from abroad from well-known leaders in the field.

Not sure if he had a health check, I just think there's an assumption that a 40+ person is "old" here. I once saw a healthy guy who was 40 or so on a forum. He said that a UK doctor gave him the impression that jaw surgery was a "young person's thing" and that he was over the hill for it.

There's no 'assumption'. He has NO room in his jaw and his tooth roots are too close (deep). They told him right. Risk with little reward is evident in the X ray. Doesn't matter what his age is. His ceph x ray gives the info=HIGH risk.
Title: Re: Genioplasty date confirmed but unsure about expected outcome.
Post by: girl on September 20, 2017, 11:21:23 PM
The "assumption" was me referring to the age aspect - not the tooth roots.
Title: Re: Genioplasty date confirmed but unsure about expected outcome.
Post by: Purist on September 21, 2017, 12:04:19 AM
girl, I made that age comment last year after visiting a third NHS hospital.  They remarked that recovery from jaw surgery is much harder in your forties and for that reason (as well as others Kavan has stated), they would be reluctant to perform surgery.

I'm fortunate that I can postpone the surgery for 12 months which I'm now going to do.

I am also getting braces in the next 6-8 weeks from one of the best UK orthodontists. I have a lot of protrusion, just to add to the messed up jaw. Even this will be tricky with multiple extractions to push the teeth back before retroclining them. So the roots don't come out of my jaw.

The orthodontist did ask me to consider postponing the surgery for at least nine months, as I may be so happy with the result I may not want surgery.  That's the second orthodontist that has said that. I'm sure it will be a huge boost to my self esteem but we all know the chin will still be severely retruded.




Title: Re: Genioplasty date confirmed but unsure about expected outcome.
Post by: girl on September 25, 2017, 05:32:06 AM
Well, the NHS's job is to tightly screen patients for suitability (free surgery). They don't routinely offer IVF to women in their early 40s. So maybe there's a certain cut-off point for jaw surgeries too.

Have you looked into a custom wraparound implant? This guy is very receded and the after is dramatic (too long, mind you) - but it does give a sense of what can be achieved with that method. If you could get something similar without so much excessive drop, I think it would be good. But I don't know what's really possible with these implants myself. Just posting this here for your reference:

(https://fi.realself.com/full/4011b49654a339b81cab1ce8062ff763/4/f/d/userimage-1947642.jpg)
Title: Re: Genioplasty date confirmed but unsure about expected outcome.
Post by: tdawg on September 25, 2017, 11:11:36 AM
Unfortunately, that mandible angle is too steep for genio to be much use. It might improve your situation, but it might also result in a deep, unnatural labiomental fold. What you truly need is a pretty significant CCW rotation. At least that's what I see. Did you see an orthognatic surgeon for opinion?

So I talked to Dr. Francq about my situation via email and he said he thinks a vertical shortening, horizontal advancement genioplasty with "bony filling of the labiomental fold" is all I need. This may be an option for OP as I imagine the bony filling he refers to is to counter the deep labiomental fold you warn of.
Title: Re: Genioplasty date confirmed but unsure about expected outcome.
Post by: kavan on September 25, 2017, 11:37:13 AM
So I talked to Dr. Francq about my situation via email and he said he thinks a vertical shortening, horizontal advancement genioplasty with "bony filling of the labiomental fold" is all I need. This may be an option for OP as I imagine the bony filling he refers to is to counter the deep labiomental fold you warn of.

It might be all YOU need. But info for you might not apply to the OP who has extensive chin retrusion.
Title: Re: Genioplasty date confirmed but unsure about expected outcome.
Post by: GJ on September 25, 2017, 11:41:53 AM
So I talked to Dr. Francq about my situation via email and he said he thinks a vertical shortening, horizontal advancement genioplasty with "bony filling of the labiomental fold" is all I need. This may be an option for OP as I imagine the bony filling he refers to is to counter the deep labiomental fold you warn of.

In your emails to him, did you or he mention filling the fold first? If him, cool, but if you mentioned you know that it needs to be filled to prevent a large groove, then you basically biased his answer.
Title: Re: Genioplasty date confirmed but unsure about expected outcome.
Post by: tdawg on September 25, 2017, 12:04:57 PM
In your emails to him, did you or he mention filling the fold first? If him, cool, but if you mentioned you know that it needs to be filled to prevent a large groove, then you basically biased his answer.

He mentioned it, I had no idea that was even something that was done.
Title: Re: Genioplasty date confirmed but unsure about expected outcome.
Post by: tdawg on September 25, 2017, 12:05:55 PM
It might be all YOU need. But info for you might not apply to the OP who has extensive chin retrusion.

Agreed but OP is short on alternatives since jaw surgery isnt an option. Its something worth looking into.
Title: Re: Genioplasty date confirmed but unsure about expected outcome.
Post by: kavan on September 25, 2017, 12:13:07 PM
Agreed but OP is short on alternatives since jaw surgery isnt an option. Its something worth looking into.

Sliding genio doesn't look like it will do much for him either given the extent of retrusion. He would probably need a bone block buttress between separation of chin cuts.

It sounds like in your case, you want to address what you feel is some residual 'longness' to the face?  If so, the sliding genio advancing forward and up on a diagonal cut to give some projection and to shorten but where the bone paste fill in would be modest.

Did you not get that with your initial VME max fax surgery?
Title: Re: Genioplasty date confirmed but unsure about expected outcome.
Post by: tdawg on September 25, 2017, 12:22:27 PM
Sliding genio doesn't look like it will do much for him either given the extent of retrusion. He would probably need a bone block buttress between separation of chin cuts.

It sounds like in your case, you want to address what you feel is some residual 'longness' to the face?  If so, the sliding genio advancing forward and up on a diagonal cut to give some projection and to shorten but where the bone paste fill in would be modest.

Did you not get that with your initial VME max fax surgery?

No the chin wasnt touched at all. Let me ask you since you seem to know about this. I feel like I still have some lip incompetence, mostly from the lower not coming up far enough to cover my lower teeth(I still show some upper teeth at rest but according to my orthodontist that is normal and a good thing given that the upper lip droops with age) . Do you think that genioplasty plan would help with that? To be honest, I am hesitant and want to wait until I see Gunson in June before I do anything that would complicate things further but it does seem like most long face syndrome patients have a genioplasty performed. In my case the surgeon never mentioned it.
Title: Re: Genioplasty date confirmed but unsure about expected outcome.
Post by: kavan on September 25, 2017, 12:42:31 PM
No the chin wasnt touched at all. Let me ask you since you seem to know about this. I feel like I still have some lip incompetence, mostly from the lower not coming up far enough to cover my lower teeth(I still show some upper teeth at rest but according to my orthodontist that is normal and a good thing given that the upper lip droops with age) . Do you think that genioplasty plan would help with that? To be honest, I am hesitant and want to wait until I see Gunson in June before I do anything that would complicate things further but it does seem like most long face syndrome patients have a genioplasty performed. In my case the surgeon never mentioned it.

Well, in general, lip incompetence is from chin muscle (mentalis strain). The strain is made less when the movement of the muscle is more on a VERTICAL plane and not on a diagonal. If the chin is too backwards, then the orientation is backwards diagonal. Think of a right angle where the distance of the hypotenuse is longer than the distance of the vertical leg. So, one drops a vertical line from the lower lip and advances the chin 'somewhat to slightly' posterior to the line so the mentalis orientation is more vertically aligned which makes less the strain associated with lip incompetence.

This is from a mechanical geometric perspective. I'm not a doctor. However, the mechanics or geometry of it pretty much explains why chin advancement is done to ease that type of strain. However, IF someone has a very recessive chin, there's also a mechanical 'limit' as to how far it can be advanced without stretching the mentalis muscle which is yet another strain on it.