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General Category => Aesthetics => Topic started by: JigJaw_:/ on September 25, 2017, 05:45:56 AM

Title: What surgical technique do I need? Images included.
Post by: JigJaw_:/ on September 25, 2017, 05:45:56 AM
Hey everyone.
I've had a couple of different ortho appointments as of late. Trying to decide the best approach/plan for my outcome. I was on track for bimax surgery about 7-8 years ago, went through 2 years of adult braces, then fell through on the surgery. Since then I've had veneers put on my top 10 (big mistake), but I had chipping due to accident so it left me with an even worse vertical deficiency. I also had a chin implant placed, and was recently told by doctor it is absorbing the bone already (13 months in). Jesus, really?  I went back to my original oral surgeon , who went on to tell me that today the surgery would be "a lot of running for a little jump."  I have a very obvious shorter lower 1/3 and almost no chin, mixed with some asymmetry of the jaws and a long upper lip to go along. Now my smile is just all jacked up, and I'm left fitted with an implant that is highly annoying and has caused a ton of lower lip dysfunction. How hard would bimax surgery be for my case? I put some ceph xray images to help. Also, if I have a Class 1, is a surgery first plan all that uncommon...or are aesthetic/functionality best suited through braces first? I also have tmj pain, but my airway seems to be okay. Who are the best U.S. doctors that would focus more on aesthetics and a little functionality. I don't want to waste a bunch of time and money dishing out for consults that aren't going to benefit my long term goals. I had one ortho tell me that braces would fix my issues; was laughable. She then proceeded to offer me the most expensive plan/braces. Thanks for the help.

https://imgur.com/a/D7x8d
Title: Re: What surgical technique do I need? Images included.
Post by: kavan on September 25, 2017, 08:49:26 AM
You have GOOD bone structure with basic balance of bone planes and also balance of '1/3rds'. No 'obvious shorter lower 1/3rd' on full face photo. I measured.  Red arrow points to the chin implant. It's a different shade of grey, so you have to look for it on original.

Your asymmetry is minor. If you got bi-max, there would be no room for standard 'error' from perfection where as in people who really need bi-max, the improvement from it far EXCEEDS minor symmetry imperfections that could arise. Your good bone structure does not suggest 'need' for bi-max. However, if you wanted, you could have your (silicone?) implant removed and exchanged for a bone cut genio.

The rest of your issues are soft tissue ones where the bone ISN'T such as between the cheek bones and lower jaw. eg. Some Sculptra would help fill out somewhat. Long labial ledges are fine for male. But that too is in venue of soft tissue alterations such as lip lift.
Title: Re: What surgical technique do I need? Images included.
Post by: JigJaw_:/ on September 25, 2017, 10:02:17 AM
Appreciate your analysis.
I'm nearly 6'1 tall, so my face just doesn't match my body. I actually sent my X-rays/imaging over to Dr. Niamtu, he seems s to be fairly well versed on the genioplasty, he's the one who told me the implant was quite malpositioioned. If the red arrow is pointing to the implant, no wonder it's giving me so many lip issues/stiffness.
Is the room for error that small in my case? I guess I'm just extremely leeerie of pulling the trigger on another chin procedure;first one has caused issues and solved nothing. Seems my smile sits way too far back in my mouth, only lately have I also been researching lip procedures,  but again...I don't want to take a short cut down a path to further complication and basically regress in treatment.
Not sure I grasp what your describing in regards to cheek bones & lower jaw, sculpta etc. ; will have a o look that up. 
Title: Re: What surgical technique do I need? Images included.
Post by: GJ on September 25, 2017, 10:24:21 AM
Agree with Kavan I see no obvious deficiency in the lower 3rd.

Bones look good. Eyes are a bit close-set, so that might be giving a false illusion of the face being compact. I'd say remove the implant, go with a vertical genio if you really want to add length.

What went wrong with the veneers, by the way? I'm not a fan of those, but I like to collect mental notes/anecdotes on why.
Title: Re: What surgical technique do I need? Images included.
Post by: kavan on September 25, 2017, 10:25:56 AM
Appreciate your analysis.
I'm nearly 6'1 tall, so my face just doesn't match my body. I actually sent my X-rays/imaging over to Dr. Niamtu, he seems s to be fairly well versed on the genioplasty, he's the one who told me the implant was quite malpositioioned. If the red arrow is pointing to the implant, no wonder it's giving me so many lip issues/stiffness.
Is the room for error that small in my case? I guess I'm just extremely leeerie of pulling the trigger on another chin procedure;first one has caused issues and solved nothing. Seems my smile sits way too far back in my mouth, only lately have I also been researching lip procedures,  but again...I don't want to take a short cut down a path to further complication and basically regress in treatment.
Not sure I grasp what your describing in regards to cheek bones & lower jaw, sculpta etc. ; will have a o look that up.

Looks small for bi-max but not for isolated genio to replace chin implant. Looks like you have a 'button' implant which is easiest for most docs to put in.  Did a PS put that in? Sculptra is an injectable soft tissue 'filler'. But, yes, in matters of soft tissue issues, you will need to look those up simply because here, my focus is on the bone alterations. So, soft tissue 'things' or things more in venue of PS, I don't elaborate much on.
Title: Re: What surgical technique do I need? Images included.
Post by: JigJaw_:/ on September 25, 2017, 10:46:33 AM
I believe it's silicone. The doctor (Fred Hackney), PS, has since taken medical retirement...so he's not exactly available for the "bone" I'd like to pick with him. I was told pre procedure it would be fixed with screws, and that it wouldn't be a button implant...but now I honestly have no firm frame of reference with which to go on.
Yes, my eyes are a bit close. Have fractured my nose several times on the ridge, so that too has given the illusion of closer set (least I think).
As for the venders, they have just created a bigger overbite, i.e. the ortho who designed  them gave them a bit more length/size to give me more tooth display. Just feels disproportioned. Nothing so much categorically -(wrong) with them. Also, my teeth were grinded down, so, it's forever; perhaps I'm just little bitter about the entire outcome. It very well might be that the impant is creating more issues than I'm currently able to grasp. Seems like the implant is gripping real close to my teeth, its created an upward curling on my bottom lip; very strange.
Don't know about the sculpta, looks like a temporary procedure of considerable replacement intervals.
So, sliding genioplasty. How much chin bone does the doctor need to be able to create/construct a nice vertical improvement. Read a little about this chin wing osteotomy procedure that seems to be gaining popularity.
Title: Re: What surgical technique do I need? Images included.
Post by: kavan on September 25, 2017, 11:30:00 AM
I believe it's silicone. The doctor (Fred Hackney), PS, has since taken medical retirement...so he's not exactly available for the "bone" I'd like to pick with him. I was told pre procedure it would be fixed with screws, and that it wouldn't be a button implant...but now I honestly have no firm frame of reference with which to go on.
Yes, my eyes are a bit close. Have fractured my nose several times on the ridge, so that too has given the illusion of closer set (least I think).
As for the venders, they have just created a bigger overbite, i.e. the ortho who designed  them gave them a bit more length/size to give me more tooth display. Just feels disproportioned. Nothing so much categorically -(wrong) with them. Also, my teeth were grinded down, so, it's forever; perhaps I'm just little bitter about the entire outcome. It very well might be that the impant is creating more issues than I'm currently able to grasp. Seems like the implant is gripping real close to my teeth, its created an upward curling on my bottom lip; very strange.
Don't know about the sculpta, looks like a temporary procedure of considerable replacement intervals.
So, sliding genioplasty. How much chin bone does the doctor need to be able to create/construct a nice vertical improvement. Read a little about this chin wing osteotomy procedure that seems to be gaining popularity.

It looks like a silicone button implant placed kind of above the level of the pogonian or let's just say; not along the base border of the chin but higher than that and high enough to make the lip-chin fold less 'curvey' than it should be. Silicone buttons are often just sewn into a pocket. Screws usually show up as radio-opaque and i don't see any.

Sculptra is not 'perm' filler but it can plump out soft tissue where you could use it.

'how much' as to chin cuts and movements is a matter of MEASURE and planning. 

Now, this is not meant to be a personal 'rec' from me but I can tell you that in the Dallas area (where the PS who put in your chin implant is/was), Craig Hobar is a better PS who also can do genios.

As to 'popularity' of something, that is a function of MULTIPLE parties/patients--as opposed to ONE party making up a bunch of screen names to promote something. So for a chin wing, you better make damned sure you are looking at a number of unique individuals and not just promo content from one party (who has been banned here for deceptive promos).
Title: Re: What surgical technique do I need? Images included.
Post by: MyTimeIsNow on September 25, 2017, 01:51:00 PM
I don't see you aesthetically benefiting from bimax in non-trivial way.

Consider following procedures for aesthetics improvement:
Eyebrow transplant
Rhino for correcting asymmetric nose - I'm not knowledgeable about rhinos, so I'm not sure if you can actually achieve significant improvement and it's a procedure with high revision rates
Maybe some kind of ottoplasty as you do have weird shaped ears towards the top
Get a tan

There is no way I can advocate bimax for aesthetic reasons to you based on benefits: cost and risks ratio unless you have significant functional issues (sleep apnea, etc.).
Title: Re: What surgical technique do I need? Images included.
Post by: kavan on September 25, 2017, 02:29:55 PM
.....
the impant is creating more issues than I'm currently able to grasp. Seems like the implant is gripping real close to my teeth, its created an upward curling on my bottom lip; very strange. .....


Remember I mentioned it was placed high...well, it's  close to your tooth roots.
Title: Re: What surgical technique do I need? Images included.
Post by: ditterbo on September 25, 2017, 03:30:10 PM
Remember I mentioned it was placed high...well, it's  close to your tooth roots.

Was going to say this but yep.  That area's not supposed to house a chin implant, and is why you are getting such quick bone erosion.  Soon that may erode into your teeth roots and you'll have a much bigger problem (I don't know specifics anymore though, maybe risking extractions/infection; google it).  IMO get rid of that thing asap. It's pretty small from the looks of it too, maybe 3-4mm.  Shouldn't be too big a deal though I'm guessing he went through the mouth to place it that high. Only trade off is you'll get back to mostly the old labiomental fold you used to have, however acute that was.

Heck I think you can see the bone erosion pretty obviously in that x-ray.
Title: Re: What surgical technique do I need? Images included.
Post by: PloskoPlus on September 25, 2017, 03:43:05 PM
I don't think you have a short lower third, I think it's an illusion courtesy of the long midface. A couple of guys here have had lip lifts with very good results. Might be something for you to consider... But shortening the lip may make the nose look longer. It may also produce lip incompetence. You also appear to have a cant to your mouth. This may be hard to fix. You could get CW rotation (maxillary downgraft, lower jaw advancement) for more tooth show, longer lower third, but I think you won't like your face being longer. I wouldn't do it.
Title: Re: What surgical technique do I need? Images included.
Post by: ditterbo on September 25, 2017, 03:51:44 PM
I don't think you have a short lower third, I think it's an illusion courtesy of the long midface. A couple of guys here have had lip lifts with very good results. Might be something for you to consider... But shortening the lip may make the nose look longer. It may also produce lip incompetence. You also appear to have a cant to your mouth. This may be hard to fix. You could get CW rotation (maxillary downgraft, lower jaw advancement) for more tooth show, longer lower third, but I think you won't like your face being longer. I wouldn't do it.

I sense a bit of a fishbowl affect going on in most of his face shots, which make his mid-face appear even longer. The smile shot looks pretty good/balanced but it's still only ~3 feet from his face. Needs to be 5/6, IIRC, to avoid fishbowling.
Title: Re: What surgical technique do I need? Images included.
Post by: PloskoPlus on September 25, 2017, 04:13:33 PM
I sense a bit of a fishbowl affect going on in most of his face shots, which make his mid-face appear even longer. The smile shot looks pretty good/balanced but it's still only ~3 feet from his face. Needs to be 5/6, IIRC, to avoid fishbowling.
True. But I think these close shots don't make a compact midface look long, while they do make a long midface look even longer than it is... If that makes sense.
Title: Re: What surgical technique do I need? Images included.
Post by: kavan on September 25, 2017, 05:50:31 PM
I don't see fish bowling. You see that more in CONVEX profiles than balanced ones. He has the latter. His face can be divided into '1/3rds' so his bottom 1/3rd= his middle 1/3rd. However, he does have more length than width with respect to the yellow and red lines. But there is no balance for that. Nor is it really a cosmetic 'defect'.

Title: Re: What surgical technique do I need? Images included.
Post by: JigJaw_:/ on September 25, 2017, 06:53:32 PM
A lot to think about.
Haha, what the heck is an eyebrow transplant? I'm obviously being sarcastic, but...I wasn't even aware that existed. I see chicks get them painted on all the time, never really seems to pan-out; maybe I'll just trim for the time being....sit back and see if science brings anything new to the table.
Rhinoplasty is already on the radar, but will have to wait The chin-implant is certainly at the top of my concerns, not just the cosmetic aspect. To be quite honest, I was viewing the images (just had the ceph a week ago) thinking that the implant was placed correctly, and that I merely had some type of nerve issue going on coupled with the fact it was a button implant. Reason being, I figured the "step down" towards my teeth roots was created by the implant itself. Does that make any sense? However, certainly DOES NOT make sense for me to be experiencing pain near the roots. Suddenly extra concerned about more time elapsing. I was planning on taking a trip to Virginia to get a genioplasty consult (implant removal), but I went ahead today and scheduled with Dr. Sinn for a couple of weeks from now.
Really wish there was a way to get this PS doctor to pay (financially) for the work he DID NOT do.  The same doctor actually-also performed an open Rhinoplasty, hard to tell bc nothing changed bc my nose looks exactly the same only more inflammation remaining.
I'm not sure what a lip-can't  issue entails. I'm sure it's on the web. I'm planning to discuss lip lift possibilities with the same doctor but I have no idea if that's in his wheelhouse.
I appreciate all the ideas and/or analysis. Does definitely help me gain perspective.


Title: Re: What surgical technique do I need? Images included.
Post by: JigJaw_:/ on September 25, 2017, 08:04:02 PM
How did you know/hear about Dr. Hobar? He seems to be well established, esp. here in the Dallas metroplex. Checked out his website, he has a couple dozen genioplasty before/afters.  Looks like decent work. Some of his male patients seem to have definitely got that extra chin they were looking for.  A little standoffish from PS at the moment. The other guy was supposed to have also had a keen eye. I've talked with one already, but- the more I check in with my inner risk/reward evaluation...the more my brain is telling me to go with a max fax doctor bc they will have superior knowledge.
Title: Re: What surgical technique do I need? Images included.
Post by: kavan on September 25, 2017, 08:35:26 PM
How did you know/hear about Dr. Hobar? He seems to be well established, esp. here in the Dallas metroplex. Checked out his website, he has a couple dozen genioplasty before/afters.  Looks like decent work. Some of his male patients seem to have definitely got that extra chin they were looking for.  A little standoffish from PS at the moment. The other guy was supposed to have also had a keen eye. I've talked with one already, but- the more I check in with my inner risk/reward evaluation...the more my brain is telling me to go with a max fax doctor bc they will have superior knowledge.

Never mind 'how'. Please accept that I DO know who's who in the field. Your other PS was just a 'garden variety' type. Putting in a button implant is the easiest type to place and mark of run of the mill PS unless, it's the only thing that will work.
Title: Re: What surgical technique do I need? Images included.
Post by: JigJaw_:/ on September 25, 2017, 09:00:22 PM
Was only curious.
Title: Re: What surgical technique do I need? Images included.
Post by: PloskoPlus on September 26, 2017, 03:23:14 AM
I don't see fish bowling. You see that more in CONVEX profiles than balanced ones. He has the latter. His face can be divided into '1/3rds' so his bottom 1/3rd= his middle 1/3rd. However, he does have more length than width with respect to the yellow and red lines. But there is no balance for that. Nor is it really a cosmetic 'defect'.
So the "long midface" effect is due to the eyes being close set, which is a bit of a shame since the eye shape is nice.
Title: Re: What surgical technique do I need? Images included.
Post by: PloskoPlus on September 26, 2017, 03:25:25 AM
The cant may be hard to resolve - may need both jaw surgery and some kind of soft tissue work to resolve.
Title: Re: What surgical technique do I need? Images included.
Post by: JigJaw_:/ on September 26, 2017, 04:47:43 AM
Besides a couple ncbi articles...I can't find very much information covering lip "cant" issues/corrections. I don't really understand it all that well. My old oral surgeon never mentioned it; perhaps it was just part of the original game plan for evening things out. I'd relish the idea of being able to resolve the smile (lip issues) and chin w/out bimax surgery, if it can be done.  I've got to first get my chin situation resolved, so bi max would be down the road; at that time...who knows if docs would recommend it less perform it.
Title: Re: What surgical technique do I need? Images included.
Post by: kavan on September 26, 2017, 06:45:54 AM
So the "long midface" effect is due to the eyes being close set, which is a bit of a shame since the eye shape is nice.

But only relative to the vertical measure.
Title: Re: What surgical technique do I need? Images included.
Post by: PloskoPlus on September 26, 2017, 05:15:56 PM
But only relative to the vertical measure.
But does one eye width fit between the eyes?
Title: Re: What surgical technique do I need? Images included.
Post by: kavan on September 26, 2017, 07:33:10 PM
But does one eye width fit between the eyes?

YES and that's a good question. So, technically, he does not have 'close set' eyes. I think people might just be 'used to' seeing the (horizontally) 'long' eyes of male models where basically, the inter-pupil distance is longer than average, longer than the norm and with that the (vertical) distance from the the eyes to the corners of the lips is very close to being same.  They too have 'one eye between the eyes' but the inner to outer canthal distance is much LONGER than the norm. Hence, so will be the IPD. So, it's basically the 'off the charts' (positive) deviation from the NORM regarding the length of the eye and IPD that makes their midface look 'compact' even though their midfaces might be technically longer than the norm too.
Title: Re: What surgical technique do I need? Images included.
Post by: JigJaw_:/ on September 27, 2017, 10:35:36 AM
Kavlan,
Okay, then I have a stupid question: if I had a lip lift in combination with the genioplasty osteotomy, , theoreticaiiy would it help reduce that eye to lip corner ratio that is creating some of the visual distortion? I still see myself as having a shorter lower third, but it could just be subtle combinations of several factors that I've yet to completely accept. For years now I've created a narrative for the other.
I think if I had a bigger overall head size it would be less obvious.
I also made an appointment with the doc you suggested, but he isn't available until mid November.
Title: Re: What surgical technique do I need? Images included.
Post by: kavan on September 27, 2017, 12:28:22 PM
Kavlan,
Okay, then I have a stupid question: if I had a lip lift in combination with the genioplasty osteotomy, , theoreticaiiy would it help reduce that eye to lip corner ratio that is creating some of the visual distortion? I still see myself as having a shorter lower third, but it could just be subtle combinations of several factors that I've yet to completely accept. For years now I've created a narrative for the other.
I think if I had a bigger overall head size it would be less obvious.
I also made an appointment with the doc you suggested, but he isn't available until mid November.

There is really no 'distortion'. People are just used to looking at male MODELS who's eyes are very 'long' (inner to outer canthus) and longer than the NORM and DUE to that type of 'off the charts' length that is LONGER than the NORM for the eye, their midface looks 'compact'. They have a type of ratio where the distance from outer PUPIL to outer PUPIL=the vertical to either the corners of the lips or the 'part' between the lips. It's DUE to the EYES. They also have BIG HEADS. They also have an S-N plane that is either horizontal or tipped forward where S is higher than the N point. (Sorry but you will just have to familiarize yourself with ceph land marks) which is what gives them the nice 'shadowing' above the eye. Upper orbit is the FRONTAL bone of cranium and it's the forward tipping of the cranium that gives the models the type of 'shadowing' to the upper eye.

Point I'm making here is that IF you are doing things to look more like a male model which is a common motivation I see with guys who start with pretty good bone structure already and then pursue a bunch of bone cuts, teeth work--what ever--it ISN'T going to happen. You and countless others pursuing things where on some level, perhaps subconcious or in the back of your mind, want to see the relationships/ratios a male model has, ISN'T going to happen. Models usually have relationships, especially with the eyes that CAN'T be reproduced via surgeries.


So, a lip lift, along with a corner lip lift with it (LLs lift the central part mostly) will make the labial ledge (distance from sub-nasa to top of upper vermilion border) which would be something to do IF one wanted:

a MORE upper tooth show
b a SHORTER labial ledge

But it's not going to kick up the same kind of ratio that makes a male model's midface look 'compact'IF that is your motivation for having it.
Title: Re: What surgical technique do I need? Images included.
Post by: JigJaw_:/ on September 27, 2017, 01:43:30 PM
Roger that-
Thanks for the elaborate answer, really helps. And yes, I do need to up my facial anatomy I.Q. Facial structure is much more complex than I ever gave time to contemplate. Definitely interesting. It's crazy how alike yet how dissimilar we can all be with only mm's of difference.
I'm not on any kind of "model quest",  or GQ mission impossible. I'm really just looking to enhance/modify whats already on the table to level life's playing field. I think that's what most of us are seeking. No qualms with those seeking aesthetic perfection, I'm just not. This forum is definitely a nice short cut to information.
Right now I just want to be sure I walk into my consults with a firm understanding of what to ask and know the limitations, styles, fixation procedures  etc. Seems genioplasty can differ quite a bit.
Btw, good tip on the upper lip. Cause that area of augmentation is esp. new for me. 
Title: Re: What surgical technique do I need? Images included.
Post by: kavan on September 27, 2017, 03:09:32 PM
If you ask me, I think that part of the longer looking labial ledge is due to the vertically oriented central incisors and then the pile up of the THICKNESS of them (via veneers) to the TOP area. To demonstrate this, roll up a piece of wet tissue paper and place it HIGH on the teeth near the gums and see if your upper lip curls INWARD and looks longer. Then try at bottom of upper teeth and see that the upper lip curls OUTWARD and looks shorter.

Did you know that some people with OVER JETS--incisors that angle outward past the lower incisors, have shorter looking labial ledges or better looking lip prominence? The problem is that keeping (angled out) the over jet goes against the grain of standard dental practice where they want to push inwards for the teeth to meet better. With veneers, they always need to make it more thick towards the top.

So, although yours were made LONGER for more tooth show, the orientation of the central incisors is straight down and the thickness pile up of the veneers is close to top and that also contributes to the look of the longer lip.

LL would shorten the labial ledge and give MORE tooth show. But you would have to think about balancing that with the fact the guy made your veneers LONG to give more tooth show.
Title: Re: What surgical technique do I need? Images included.
Post by: Lazlo on September 27, 2017, 03:24:54 PM
You don't need anything. A rhino will look HORRIBLE on you. You have a very gaunt soft tissue structure and close set eyes. And you can't change your features without making you look messed up.

I think you should grow a beard. Jaw surgery its true would do basically nothing for you. You don't look bad, you look fine. (as in okay).

You'll never be a model, that's just the truth. But I'm sure many will find you attractive. Make peace with yourself.
Title: Re: What surgical technique do I need? Images included.
Post by: JigJaw_:/ on September 27, 2017, 04:58:12 PM
Well put, and true. Although the long upper lip was obviously around from the get-go, the veneers did add a little bit to the exaggeration. If I do decide to execute on any kind of procedure to that area I'll be sure and toss those aspects in. Thanks
Title: Re: What surgical technique do I need? Images included.
Post by: JigJaw_:/ on September 27, 2017, 05:08:21 PM
??
I've already had a rhinoplasty/septoplasty for a deviated septum....however my nose didn't change. The PS actually made my nose worse; left me with a pointy tip and failed to correct the fracture near the top of the bridge. So, I think it should be okay to correct the point as well as the fracture near the top of the bridge. Growing a beard doesn't work for me, no chin for it. 
I'm very in-tune with the fact I'll never be a model; I actually prefaced the fact I don't have any kind of ambition or motivation to be one.
Namaste    )
Title: Re: What surgical technique do I need? Images included.
Post by: PloskoPlus on September 27, 2017, 05:27:46 PM
Well kavan is right, a lot of these things are down to cranial shape which is impossible to change. There is a Photoshop plugin which allows you to mess around with your facial feature size and spacing. I'm guessing if you play around with that you'll find that increasing the spacing between your eyes would be the biggest win. Believe it or not there are craniofacial surgeons in the states who move eye sockets around. Many of them would be in Texas.
Title: Re: What surgical technique do I need? Images included.
Post by: JigJaw_:/ on September 27, 2017, 05:44:08 PM
I know.  It's all been great insight. I was actually just replying to Lazlo's comment. I think moving my eye sockets  around might be a touch aggressive; interesting to know they do that...sure they reserve that type of stuff for kiddos with supercharged deformities/injuries. I'm also sure any one of those surgeons would look at me like I'd lost my "cranium". Every pun intended.
Title: Re: What surgical technique do I need? Images included.
Post by: JigJaw_:/ on September 27, 2017, 05:49:29 PM
"What is involved is craniofacial surgery.  The bones that surround the eyes are cut taking take to protect the vital nerves that travel through these bones.  The brain is lifted because the bone roof above the eyes also makes the bony floor that supports the brain.  Then the orbits are repositioned relative to the rest of the facial skeleton.  I hope this description makes it clear that this is one of the most complex surgeries performed.  Due to the difficulty and inherent risks including blindness and death, this surgery is only performed when facial abnormalities are so severe that the individual can't interact with others.  This is not a cosmetic surgery in other words but a tremendously complex undertaking that is perform to give someone a more human appearance.
Having said that, occasionally individuals have this complain and the issue turns out to be body dysmorphic disorder, a self esteem issue, or even prominent epicanthal folds that make it look like the eyes are closer together than they are. "


(shea right) That sounds like the longest walk in the park, ever! Still freaking amazing.
Title: Re: What surgical technique do I need? Images included.
Post by: kavan on September 27, 2017, 06:19:56 PM
"What is involved is craniofacial surgery.  The bones that surround the eyes are cut taking take to protect the vital nerves that travel through these bones.  The brain is lifted because the bone roof above the eyes also makes the bony floor that supports the brain.  Then the orbits are repositioned relative to the rest of the facial skeleton.  I hope this description makes it clear that this is one of the most complex surgeries performed.  Due to the difficulty and inherent risks including blindness and death, this surgery is only performed when facial abnormalities are so severe that the individual can't interact with others.  This is not a cosmetic surgery in other words but a tremendously complex undertaking that is perform to give someone a more human appearance.
Having said that, occasionally individuals have this complain and the issue turns out to be body dysmorphic disorder, a self esteem issue, or even prominent epicanthal folds that make it look like the eyes are closer together than they are. "


(shea right) That sounds like the longest walk in the park, ever! Still freaking amazing.

If you ask me, the person getting that type of surgery to move a few mms to space eyes, should have the brain THROWN and TOSSED while they are lifting it. Because they are not using it anyway.
Title: Re: What surgical technique do I need? Images included.
Post by: JigJaw_:/ on September 27, 2017, 06:34:13 PM
lol
That, or...when it's lifted just throw that sucker on a weigh scale or brain scanner bc something is definitely suspect of malfunctioning.


Title: Re: What surgical technique do I need? Images included.
Post by: JigJaw_:/ on September 27, 2017, 06:37:37 PM
Now, on the other hand, if I go in for a chin osteotomy and wake up.  "Hey, wtf is going on? I came in for a genio-procedure, why is my brain on the table? Yeah, about that. We got the chin all fixed up, but, hell...we figured we'd move the eye sockets around a bit and see what panned out. By the way, Mr. Potato head sends his regards." . 
 Makes me nauseas just thinking of someone cutting that area of my skull.
Title: Re: What surgical technique do I need? Images included.
Post by: kavan on September 27, 2017, 07:46:31 PM
I know you didn't ask to look like a male model. But I just do a 'security check' just in case that's the motivation.

Don't even think of even asking a doctor to accommodate a request to 'look more like a male model'.  It just attracts predatory advice where they will NEVER tell the patient outright that there is no f*cking way they're going to be looking like a male model. They will just be looking for some 'employment opportunity' they can do.

Case in point. Check this out.
https://www.realself.com/question/chiseled-and-hollow-cheeks-like-male-model

 A photo is put up on real self where the person putting it up (probably someonejust f**king around with someone elses photo)  wants to know how he can get the chiseled cheeks that models have. Not even one of the doctors even tells him, there is NO WAY IN HELL he will ever look like a male model. They just DISREGARD the OBVIOUS and just tell him what cheek implants can do or suggest more things. None of which will EVER make the guy look like a model.

Moral of the story is that there are PREDETORS out there, especially going after the ones who want to look like models.  They can be doctors. They can be that little s**t banned from here duping people on 'Lookism' to buy services from his consulting biz.

Again, I know you did not say you wanted to look like a model. BUT that's why I ALWAYS check. It's because there are predators out ther preying on people that are getting stuff just to 'look like a model'.
Title: Re: What surgical technique do I need? Images included.
Post by: PloskoPlus on September 27, 2017, 08:16:18 PM
They aren't all bad all of the time.

https://www.realself.com/question/cheek-implants-create-masculine-cheekbones
Title: Re: What surgical technique do I need? Images included.
Post by: kavan on September 27, 2017, 08:30:04 PM
They aren't all bad all of the time.

https://www.realself.com/question/cheek-implants-create-masculine-cheekbones

They NEVER tell the person wanting implants or bi max or what ever 'to look like a male model' that what the male models have that no one else is going to BUY is the EYES.
Title: Re: What surgical technique do I need? Images included.
Post by: JigJaw_:/ on September 27, 2017, 08:39:52 PM
It's a good policy. 
Notice how the first 3 PS don't really even acknowledge him on a personal level. It's more just a check-off run down list of what "cheek implants" are/do, rather than what they might do for him.
Then the last PS swoops down like a vulture offering cheek, jaw, rhino, chin...surprised he didn't throw a boob job in for good measure.
Title: Re: What surgical technique do I need? Images included.
Post by: kavan on September 27, 2017, 08:54:42 PM
It's a good policy. 
Notice how the first 3 PS don't really even acknowledge him on a personal level. It's more just a check-off run down list of what "cheek implants" are/do, rather than what they might do for him.
Then the last PS swoops down like a vulture offering cheek, jaw, rhino, chin...surprised he didn't throw a boob job in for good measure.

BINGO.
Title: Re: What surgical technique do I need? Images included.
Post by: PloskoPlus on September 27, 2017, 09:00:23 PM
They NEVER tell the person wanting implants or bi max or what ever 'to look like a male model' that what the male models have that no one else is going to BUY is the EYES.
Well, it's a business. I do wonder how such busy experts have so much time to spend online. You're correct about the eyes. IMO the great jaw surgery before and afters are often just that - someone with great eyes which were overshadowed by their dentofacial deformity.
Fwiw, surgeons privately will tell you that they hate it when someone brings photos of models or other people to the consult - "these people are never happy".
Title: Re: What surgical technique do I need? Images included.
Post by: kavan on September 27, 2017, 09:11:22 PM
Well, it's a business. I do wonder how such busy experts have so much time to spend online. You're correct about the eyes. IMO the great jaw surgery before and afters are often just that - someone with great eyes which were overshadowed by their dentofacial deformity.
Fwiw, surgeons privately will tell you that they hate it when someone brings photos of models or other people to the consult - "these people are never happy".

Yes. It's a business  and they are looking for profit opportunities. I know the good ones hate it. It's a BRAIN INFARCTION to explain all the other bone relationships precluding them from looking like a male model.
Title: Re: What surgical technique do I need? Images included.
Post by: JigJaw_:/ on September 27, 2017, 09:22:29 PM
Yeah, would also be a waste of time for most perspective patients. They are just waiting for those magic words, "yes, you may have Angelina's nose". One moment while I get the Genie, I left her in exam room 4 next to my time machine.

I made the mistake of being TOO damn casual about my rhino consult, paid for it. I guess he was going for something aristocratic, have no idea. Guess it could have come out worse if I'd gone in there with a US weekly cutout of some A-lister.
I just wanna hand my profile pics to a team of docs the day of a surgery, blink my eyes with subtlety and mutter "do your worst". Or, "get creative".  Kidding 🤦‍♂️
Title: Re: What surgical technique do I need? Images included.
Post by: Lazlo on September 28, 2017, 12:00:44 AM
They NEVER tell the person wanting implants or bi max or what ever 'to look like a male model' that what the male models have that no one else is going to BUY is the EYES.

so true. or you get an idiot like my surgeon who did a buccal fat removal and it totally f**ked up one side of my face which i need to get revision on. f**king moron. oh and by the way, if you have flat cheeks no buccal fat removal does jack s**t.
Title: Re: What surgical technique do I need? Images included.
Post by: MyTimeIsNow on September 28, 2017, 09:24:24 AM
They NEVER tell the person wanting implants or bi max or what ever 'to look like a male model' that what the male models have that no one else is going to BUY is the EYES.

I laugh everytime I hear someone proclaim that good looking people in Hollywood are like that because of all plastic surgeries. The truth is even in 2017 it's impossible to buy good looking face and all the techniques available are very limited.
Title: Re: What surgical technique do I need? Images included.
Post by: kavan on September 28, 2017, 09:44:29 AM
I laugh everytime I hear someone proclaim that good looking people in Hollywood are like that because of all plastic surgeries. The truth is even in 2017 it's impossible to buy good looking face and all the techniques available are very limited.

Indeed. A lot of the Hollywood people were the really good looking ones in high school before any work. As for models, scouts go around looking for model material, often in out of the way 'corn fed' places in midwest where they discover 'fresh faces' of young people who have a look that they consider 'model material'. Also, the modeling agencies have a list of doctors if they feel some cosmetic work is needed. Then there is option for people who feel they could be models to just go to a modeling agency for some kind of evaluation.

Moral of story. For those wanting 'to look like a model', maybe go to a modeling agency FIRST and ask if that potential exists.
Title: Re: What surgical technique do I need? Images included.
Post by: kavan on September 28, 2017, 10:46:12 AM
so true. or you get an idiot like my surgeon who did a buccal fat removal and it totally f**ked up one side of my face which i need to get revision on. f**king moron. oh and by the way, if you have flat cheeks no buccal fat removal does jack s**t.

Did they remove more on one side than the other? Sometimes, they can pop out the part directly in the buccal space. But if they keep pulling on it, it's connected higher UP the side of face and to the temple. So, pulling too much to get all of it out can remove from places where it's needed and wanted and result in some 'collapse' because some of  it supports the face.

Also, they never really know the size of it or the extent of it with regard to all it's connections above buccal space until they make the incision and start pulling on it. It's very uncertain surgery in terms of the ODDs of it doing the trick.
Title: Re: What surgical technique do I need? Images included.
Post by: JigJaw_:/ on September 28, 2017, 08:18:40 PM
Nu uh, Kavan. Kaityln Jenner did NOT look like that in high school.  :)     

Speaking of fat, I'm hoping that little bit of pudge in the area under my neck tightens up just a bit from dropping my chin.
Title: Re: What surgical technique do I need? Images included.
Post by: kavan on September 29, 2017, 09:46:37 AM
Nu uh, Kavan. Kaityln Jenner did NOT look like that in high school.  :)     

Speaking of fat, I'm hoping that little bit of pudge in the area under my neck tightens up just a bit from dropping my chin.

He didn't look like a trans in high school but he was good looking.

http://static.celebuzz.com/uploads/2014/02/13/Bruce-Jenner-Young4.jpg
Title: Re: What surgical technique do I need? Images included.
Post by: JigJaw_:/ on October 04, 2017, 07:44:49 AM
I'm curious what other people have paid for genioplasty. I know it's going to differ. I had my first consult with a local max fax doctor. He wants 6,500, total.
2,100 (for vsp) planning, roughly 2,900 for the genioplasty, 800 for implant removal. The rest is anesthesia.
Maybe I'm being unreasonable, but why would the  surgeon charge me for implant removal? I would think since he's going to the same region (he's got to make the same incision in the lower lip to make the osteotomy on my chin. It's not screwed in, so, there's that to.
The virtual planning is definitely worth the bang for buck, but I couldn't find any comparative pricing on it. Thoughts? Concerns?
Title: Re: What surgical technique do I need? Images included.
Post by: David_D on October 04, 2017, 09:07:22 AM
I can understand charging for removal of an implant.  I can imagine that a surgeon in general might find working on "virgin" tissue easier that tissue that had been previously operated upon.

I did not pay for my genioplasty - my HMO covered it and it followed orthognathic surgery, which was also covered.  I don't think the price you mentioned is notably high or low.
Title: Re: What surgical technique do I need? Images included.
Post by: kavan on October 04, 2017, 11:14:43 AM
I'm curious what other people have paid for genioplasty. I know it's going to differ. I had my first consult with a local max fax doctor. He wants 6,500, total.
2,100 (for vsp) planning, roughly 2,900 for the genioplasty, 800 for implant removal. The rest is anesthesia.
Maybe I'm being unreasonable, but why would the  surgeon charge me for implant removal? I would think since he's going to the same region (he's got to make the same incision in the lower lip to make the osteotomy on my chin. It's not screwed in, so, there's that to.
The virtual planning is definitely worth the bang for buck, but I couldn't find any comparative pricing on it. Thoughts? Concerns?

It's pretty obvious to me why there would be an extra itemized charge for implant removal. But I would be more concerned as to why he's itemizing a separate charge for PLANNING the surgery. It's his obligation to plan a surgery. As to investments in VSP software to do so, that should be averaged out and factored into the cost of what ever he wants to charge for surgery he plans with the software.

I might be wrong but is it standard practice for a doc to itemize a separate charge for PLANNING a surgery???? I mean, I can understand that IF you are just going there to obtain a plan that you can have another carry out for you or just want another to evaluate. But can't wrap my head around his itemizing a separate charge for planning a surgery.

Ask him if there is an option tp purchase the PLAN so you can take it to another for evaluation and see what he says.


Title: Re: What surgical technique do I need? Images included.
Post by: JigJaw_:/ on October 04, 2017, 11:19:11 AM
Wish insurance was covering mine. Would much rather keep 7k in the bank! To me the price seemed about average. How did your surgery turn out, David? Happy you did it?
Title: Re: What surgical technique do I need? Images included.
Post by: JigJaw_:/ on October 04, 2017, 11:30:23 AM
Well....
I think he itemized iit in this way bc he essentially gave me the option for either the standardized planning method (i.e. , no VSP planning) or VSP.  He seemed to believe that since I had a malpositioned implant, plus an already asymettrcal chin to begin with, that the end result would be closer to expectation if I used the vsp. They send all my imaging off to some lab in Colorado, said company sends back cutting templates/molds etc. which have been specifically designed for my case. So, I ssentially I could forgo the planning...but I think it behooves me to pay it. I don't think it's the software I'm paying for..(maybe a small percentage), but I would imagine the majority is build in for surgical equipment/tools.
I see Dr. Sinn this Friday. Was gonna compare the two, see how different the pricing differs. Poke a little more regarding planning. Both doctors do it "in house", so there's no surgery center cost; which I like.
Title: Re: What surgical technique do I need? Images included.
Post by: kavan on October 04, 2017, 12:08:25 PM
So, you are saying he JOBS OUT the planning to a lab somewhere.  Yes. VSP is better than without it. But i would think a good maxfax  has these planning diagnostics IN HOUSE in addition to the skill set needed to plan the surgery.

Well....
I think he itemized iit in this way bc he essentially gave me the option for either the standardized planning method (i.e. , no VSP planning) or VSP.  He seemed to believe that since I had a malpositioned implant, plus an already asymettrcal chin to begin with, that the end result would be closer to expectation if I used the vsp. They send all my imaging off to some lab in Colorado, said company sends back cutting templates/molds etc. which have been specifically designed for my case. So, I ssentially I could forgo the planning...but I think it behooves me to pay it. I don't think it's the software I'm paying for..(maybe a small percentage), but I would imagine the majority is build in for surgical equipment/tools.
I see Dr. Sinn this Friday. Was gonna compare the two, see how different the pricing differs. Poke a little more regarding planning. Both doctors do it "in house", so there's no surgery center cost; which I like.
Title: Re: What surgical technique do I need? Images included.
Post by: PloskoPlus on October 04, 2017, 02:14:35 PM
So, you are saying he JOBS OUT the planning to a lab somewhere.  Yes. VSP is better than without it. But i would think a good maxfax  has these planning diagnostics IN HOUSE in addition to the skill set needed to plan the surgery.
I think the Colorado place does no VSP, just 3d prints cutting guides, skull models etc.. I think Sinn uses them for skull models for his mod lf3s.

FWIW, in Australia planning is a separate billable item for orthognathic surgery (not sure about genioplasty). It's not optional.
Title: Re: What surgical technique do I need? Images included.
Post by: David_D on October 04, 2017, 02:16:50 PM
I think the Colorado place does no VSP, just 3d prints cutting guides, skull models etc.. I think Sinn uses them for skull models for his mod lf3s.

FWIW, in Australia planning is a separate billable item for orthognathic surgery (not sure about genioplasty). It's not optional.

I've paid a fee for skull/jaw models to be developed previously to assist with surgical planning.  I see that as "providing data to facilitate surgical planning" rather than as surgical planning itself.
Title: Re: What surgical technique do I need? Images included.
Post by: David_D on October 04, 2017, 02:33:55 PM
Wish insurance was covering mine. Would much rather keep 7k in the bank! To me the price seemed about average. How did your surgery turn out, David? Happy you did it?

I think that it gave an improvement.  I had it done over a decade ago.  I had lack of forward projection and a lot of vertical length.  The change was significant from the genioplasty alone.
Title: Re: What surgical technique do I need? Images included.
Post by: kavan on October 04, 2017, 02:45:14 PM
I think the Colorado place does no VSP, just 3d prints cutting guides, skull models etc.. I think Sinn uses them for skull models for his mod lf3s.

FWIW, in Australia planning is a separate billable item for orthognathic surgery (not sure about genioplasty). It's not optional.

Then maybe I'm getting confused by the way the OP is describing it as he said the doc wanted [2,100 (for vsp) planning]. However, with your clarification as to the skull models, it's making more sense. thanx.
Title: Re: What surgical technique do I need? Images included.
Post by: Lazlo on October 04, 2017, 10:48:02 PM
Did they remove more on one side than the other? Sometimes, they can pop out the part directly in the buccal space. But if they keep pulling on it, it's connected higher UP the side of face and to the temple. So, pulling too much to get all of it out can remove from places where it's needed and wanted and result in some 'collapse' because some of  it supports the face.

Also, they never really know the size of it or the extent of it with regard to all it's connections above buccal space until they make the incision and start pulling on it. It's very uncertain surgery in terms of the ODDs of it doing the trick.

yeah one side looks completely different from the other side. one one side my cheek has collapsed up near the temple all the way down to the mid cheek. It just looks terrible and it was much better having fat there. People warned me it was a bad idea but Sinn kept insisting it was fine. As usual I exercised poor judgement. I'm beginning to realize we know much more than these surgeons.
Title: Re: What surgical technique do I need? Images included.
Post by: JigJaw_:/ on October 05, 2017, 06:44:50 AM
I think that it gave an improvement.  I had it done over a decade ago.  I had lack of forward projection and a lot of vertical length.  The change was significant from the genioplasty alone.

I'm hoping that the genioplasty will do the same for me. If it's done right, I think it will probably give the result I'm seeking. Vertical aspect is probably going to offer the most change, but I need projection, too.

Title: Re: What surgical technique do I need? Images included.
Post by: JigJaw_:/ on October 05, 2017, 06:47:38 AM
I think the Colorado place does no VSP, just 3d prints cutting guides, skull models etc.. I think Sinn uses them for skull models for his mod lf3s.

I think they are 3D cutting guides, but not sure about skull models. Gonna ask him today.
Title: Re: What surgical technique do I need? Images included.
Post by: kavan on October 05, 2017, 09:41:37 AM
yeah one side looks completely different from the other side. one one side my cheek has collapsed up near the temple all the way down to the mid cheek. It just looks terrible and it was much better having fat there. People warned me it was a bad idea but Sinn kept insisting it was fine. As usual I exercised poor judgement. I'm beginning to realize we know much more than these surgeons.

Tbh, if he's offering cosmetic surgery like facelifts, botox fillers, etc. and pulling out buccal fat pads while he's at it, it could reflect that despite his very impressive CV and his academic recognition for specialized bone cutting surgeries, he's not getting much of a demand for the specialty his reputation revolves around.

Sure, a maxfax can do plastic surgeries or also offer 'cosmetic surgery' if they want to but to keep up with the advances (techniques, pitfalls, etc), membership in specialized academic societies is where those advances are learned about. I don't see that in his CV.

Was this a thing where you narrowed him down for his specialty, for example his being able to do a modified L3 that earl isolated him for and then HE suggested buccal fat removal or did you you request that from him?
Title: Re: What surgical technique do I need? Images included.
Post by: lamb on October 05, 2017, 12:08:06 PM
Las, didn't you have double jaw surgery with Sinn?  Are you happy with that aspect?
Title: Re: What surgical technique do I need? Images included.
Post by: JigJaw_:/ on October 06, 2017, 06:17:57 PM
Had my consult with Dr. Sinn today. Went well. He said he actually prefers doing a free hand 3D sketch over computer image planning; regardless of the implant or asymmetry. He didn't really blink an eye on that. He offered me 3 options...all 3 of which include extraction of the implant. 1) Genioplasty, alone. 2) Genioplasty along with internal lip lift. 3) Leforte 1 (no forward movement, just down), and genioplasty. No braces!
He was pretty thorough with explanation, also easy to talk to. I might have been last patient of the day, but I don't think that really mattered. He didn't hurry. Easily the most skilled and knowledgeable I've talked with.
Looks like he makes a pretty broad cut of the chin for his genioplasty.
Title: Re: What surgical technique do I need? Images included.
Post by: Lazlo on October 07, 2017, 12:50:17 AM
Las, didn't you have double jaw surgery with Sinn?  Are you happy with that aspect?

yeah you know i am relatively happy right now. i feel what messed up my result was my ortho not Sinn's surgery so much. I don't really have any problems with the surgery except bottom lip is slightly numb. The profile is "okay" given I have a very thick upper lip. I would say I'd give my result a B-. He could have done some CCW but didn't. And yeah he is pretty confident in doing some extreme things. I'm sure he knows how to do things like an internal lip lift (which is news to me frankly!). But what I'm most disappointed about is the buccal fat removal which was a HUGE mistake and totally asymmetric on me. SO I would say just proceed with caution.
Title: Re: What surgical technique do I need? Images included.
Post by: JigJaw_:/ on October 07, 2017, 09:43:00 AM
yeah you know i am relatively happy right now. i feel what messed up my result was my ortho not Sinn's surgery so much. I don't really have any problems with the surgery except bottom lip is slightly numb. The profile is "okay" given I have a very thick upper lip. I would say I'd give my result a B-. He could have done some CCW but didn't. And yeah he is pretty confident in doing some extreme things. I'm sure he knows how to do things like an internal lip lift (which is news to me frankly!). But what I'm most disappointed about is the buccal fat removal which was a HUGE mistake and totally asymmetric on me. SO I would say just proceed with caution.


Hey Lazlo,
Mind me asking what your total price tag with Sinn was? You had both Jaws + Genio, right? Was yours straight out of pocket? Was your surgery at his office/facility, in Mansfield?
I feel pretty good about him doing the chin. Have to ask more questions about the lip; from what I found on web, it only removes tissue from inside the lip (as it obviously states), thereby allowing more tooth show.
Leforte is a possibility. Don't know what stability looks like long term, though. Seems to be one of the less stable procedures. He said my bite was good enough. Just wondering what it would cost. He's emailing quote next week.
Title: Re: What surgical technique do I need? Images included.
Post by: GJ on October 07, 2017, 10:51:31 AM
Don't talk prices in public.
Title: Re: What surgical technique do I need? Images included.
Post by: Adonia on October 18, 2017, 02:13:14 PM
lYou look like you would really benefit from more chin height
Title: Re: What surgical technique do I need? Images included.
Post by: Framboise on October 18, 2017, 11:10:33 PM
I think  a Clockwise rotation of your jaws will be beneficial for you.
Title: Re: What surgical technique do I need? Images included.
Post by: JigJaw_:/ on October 19, 2017, 08:08:32 AM
I think  a Clockwise rotation of your jaws will be beneficial for you.

I once thought so too, now...I don't know. I think cc rotation would benefit me the most, but not sure. Most recent surgeon I saw didn't seem to think I needed any forward movement. Maybe I was just hearing what my mind thought was the easiest solution. He suggested a Leforte1 downgraft and geniplasty. Going to have AT LEAST one more consult.
Title: Re: What surgical technique do I need? Images included.
Post by: JigJaw_:/ on October 19, 2017, 08:12:45 AM
lYou look like you would really benefit from more chin height

Agreed. My facial height gets WAY skewed when you get to my chin area. I think adding vertical to the chin (even if that's all I do) should solve most of the vertical issues.
Title: Re: What surgical technique do I need? Images included.
Post by: JigJaw_:/ on October 19, 2017, 09:28:01 AM
I know that Leforte with CCR changes the nasal base.. What about Leforte with dowgraft, but no forward rotation/movement?
What happens with the nose with no rotation? What changes manifest?
Title: Re: What surgical technique do I need? Images included.
Post by: Framboise on October 19, 2017, 10:28:26 AM
Some surgeons do not clockwise rotation but mimic the movement with anterior extrusion with less extrusion at the back or even a posterior impaction. Thus, the nose is not ruined.
Title: Re: What surgical technique do I need? Images included.
Post by: JigJaw_:/ on October 19, 2017, 11:18:46 AM
Some surgeons do not clockwise rotation but mimic the movement with anterior extrusion with less extrusion at the back or even a posterior impaction. Thus, the nose is not ruined.

Interesting.
Surely it-too also changes the nose on some level?
Is one technique less stable than the other?
I'm afraid that doing the Leforte without also moving the mandible will possibly create a more sunkin' look for me (increased soft tissue problems). Even with a genioplasty, when the maxilla comes down...both jaws will rotate inward. Maybe I'm wrong, but, still...I'd really like to not move my mandible.
Title: Re: What surgical technique do I need? Images included.
Post by: JigJaw_:/ on December 05, 2017, 04:02:46 PM
Okay, would appreciate opinions on my imaging. Below is a link to 4 different outcomes to my Genioplasty, all are side by side lateral of current/after. In my case, the current (before) already includes a mal positioned implant which is riding high close to the tooth roots. I was told that 2 of the images would involve about  10 mm forward and 4 mm vertical, except for the first image which will get a little less vertical and the third image a little more vertical. I'm between image 2 and image 4. Which one would you pick?



https://imgur.com/a/LvwMm
Title: Re: What surgical technique do I need? Images included.
Post by: kavan on December 06, 2017, 10:41:18 AM
If the surgery you are getting is a bone cutting genio to advance forward and also to elongate then, the same 'technique' would be used. A choice amoung the varied displacements that can be made does not change the 'technique'.

As to the morphs, the first one is sufficient.