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General Category => Aesthetics => Topic started by: tim06 on October 26, 2017, 10:30:54 AM

Title: Sliding Genioplasty lost projection after swelling was gone, using filler?
Post by: tim06 on October 26, 2017, 10:30:54 AM
I had a sliding genioplasty and two weeks after the procedure it looked perfect! Due to the swelling my lower third had the perfect proportions and projection for my face. But since the hefty swelling went away it looks now really not good.

Is there any way to get back to the 2 weeks post surgery swelling with filler? I was so happy with the result, it had the correct volume from all angles and now it just went away :(

2 weeks post op:
(https://i.imgur.com/oF3Oy8n.jpg)

18 months post op:
(https://i.imgur.com/j4anKR0.jpg)
Title: Re: Sliding Genioplasty lost projection after swelling was gone, using filler?
Post by: kavan on October 26, 2017, 11:41:45 AM
The chin is actually in line with the lower lip and pretty much where the chin should be 'in it's own right'. Aside from the fact that there is more BULK in the swelling photo and filler RARELY mimics the look of DIFFUSE even swelling, it's still about the same projection. However, in both photos your upper lip is too far forward to the lower lip which is an indicator that genio ALONE was not the entire solution to your profile imbalance.

Via my displacement changes, the visual info I'm getting suggests a Lefort 2 type set back for a protrusive area above the Lefort 1 area in addition to a BSSO. It looks like you have a protrusive Lefort 2 area in addition to a slightly retrusive lower jaw.

You probably could get away with a bi-max with lefort 1 set back and BSSO advance and spare yourself from pursuing any Lefort 2, a rhinoplasty would be needed in addition for better overall balance.

Although I try to AVOID suggestions towards the more complex and involved leforts, (usually because the next person reading it THINKS he/she also needs same when they don't), in this case, I'm seeing protrusion in the Lefort 2 area.
Title: Re: Sliding Genioplasty lost projection after swelling was gone, using filler?
Post by: needadvancement on October 26, 2017, 12:01:00 PM
I went through the same disappointing thing bud. Good thing you posted pictures, anybody considering SG and going through post-surgery needs to see them.

The look of the initial swelling is not achievable with jaw augmentation alone because it adds size in areas all around the critical points which of course are only there temporarily.
Title: Re: Sliding Genioplasty lost projection after swelling was gone, using filler?
Post by: tim06 on October 26, 2017, 12:47:16 PM
The chin is actually in line with the lower lip and pretty much where the chin should be 'in it's own right'. Aside from the fact that there is more BULK in the swelling photo and filler RARELY mimics the look of DIFFUSE even swelling, it's still about the same projection. However, in both photos your upper lip is too far forward to the lower lip which is an indicator that genio ALONE was not the entire solution to your profile imbalance.

Via my displacement changes, the visual info I'm getting suggests a Lefort 2 type set back for a protrusive area above the Lefort 1 area in addition to a BSSO. It looks like you have a protrusive Lefort 2 area in addition to a slightly retrusive lower jaw.

You probably could get away with a bi-max with lefort 1 set back and BSSO advance and spare yourself from pursuing any Lefort 2, a rhinoplasty would be needed in addition for better overall balance.

Although I try to AVOID suggestions towards the more complex and involved leforts, (usually because the next person reading it THINKS he/she also needs same when they don't), in this case, I'm seeing protrusion in the Lefort 2 area.

I asked for a BSSO and the doctor told me it is not possible since my bite is fine. No doctor will do a lefort 1 or 2 for aesthetic reasons. The only options left are Chin Wing, Implant, or Fillers.
A chin wing is too dangerous and would most likely just result in an even pointer chin, and a visible plate that stands forward.

During my SG the chin was moved by 11 mm.
Title: Re: Sliding Genioplasty lost projection after swelling was gone, using filler?
Post by: tdawg on October 26, 2017, 12:55:29 PM
I asked for a BSSO and the doctor told me it is not possible since my bite is fine. No doctor will do a lefort 1 or 2 for aesthetic reasons. The only options left are Chin Wing, Implant, or Fillers.
A chin wing is too dangerous and would most likely just result in an even pointer chin, and a visible plate that stands forward.

During my SG the chin was moved by 11 mm.

Can you post a picture of your teeth biting down, from the side? From the way your upper lip sticks out I would be pretty surprised if you didnt have a significant overjet.
Title: Re: Sliding Genioplasty lost projection after swelling was gone, using filler?
Post by: kavan on October 26, 2017, 01:03:56 PM
I asked for a BSSO and the doctor told me it is not possible since my bite is fine. No doctor will do a lefort 1 or 2 for aesthetic reasons. The only options left are Chin Wing, Implant, or Fillers.
A chin wing is too dangerous and would most likely just result in an even pointer chin, and a visible plate that stands forward.

During my SG the chin was moved by 11 mm.

None of the options you mentioned, (alone) would address what looks like excess protrusion to the area I showed. I guess you could get an implant to bulk up your chin more if you feel more bulk there would please you.  I'm just telling you where I see excess protrusion to the face which is in the lefort 2 area.
Title: Re: Sliding Genioplasty lost projection after swelling was gone, using filler?
Post by: tim06 on October 26, 2017, 01:07:30 PM
None of the options you mentioned, (alone) would address what looks like excess protrusion to the area I showed. I guess you could get an implant to bulk up your chin more if you feel more bulk there would please you.  I'm just telling you where I see excess protrusion to the face which is in the lefort 2 area.

Yes, but it is simply not possible to address this. I asked this multiple maxillofacial surgeons and they refused to do it.
Title: Re: Sliding Genioplasty lost projection after swelling was gone, using filler?
Post by: tim06 on October 26, 2017, 01:08:42 PM
Can you post a picture of your teeth biting down, from the side? From the way your upper lip sticks out I would be pretty surprised if you didnt have a significant overjet.

No, none of my doctors ever mentioned that. It was checked before I got the SG and ruled out.
Title: Re: Sliding Genioplasty lost projection after swelling was gone, using filler?
Post by: kavan on October 26, 2017, 01:24:54 PM
Yes, but it is simply not possible to address this. I asked this multiple maxillofacial surgeons and they refused to do it.

Ya, I can see that it would be difficult for many max fax docs and also to find the few who could do. Member= 'Brazilian Jaw' shared an article of this nature. https://zeze.sci-hub.cc/135c43ccde4fa76fe829841dcca29c62/konopnicki2016.pdf
if you're interested.
Title: Re: Sliding Genioplasty lost projection after swelling was gone, using filler?
Post by: tim06 on October 26, 2017, 01:41:57 PM
Ya, I can see that it would be difficult for many max fax docs and also to find the few who could do. Member= 'Brazilian Jaw' shared an article of this nature. https://zeze.sci-hub.cc/135c43ccde4fa76fe829841dcca29c62/konopnicki2016.pdf
if you're interested.

No you understood me wrong, they can do it, but will not do it for me. It is like amputing a healthy arm. If something goes wrong during the procedure they could loose their licence.
Also my upper jaw is already very wide forward, moving it even more forward with a BSSO would not result in a good aesthetic face.
Title: Re: Sliding Genioplasty lost projection after swelling was gone, using filler?
Post by: kavan on October 26, 2017, 02:35:40 PM
No you understood me wrong, they can do it, but will not do it for me. It is like amputing a healthy arm. If something goes wrong during the procedure they could loose their licence.
Also my upper jaw is already very wide forward, moving it even more forward with a BSSO would not result in a good aesthetic face.

You may have misunderstood me too. I was not suggesting to move your upper jaw forward. The suggestion was for a set back to it.
Title: Re: Sliding Genioplasty lost projection after swelling was gone, using filler?
Post by: tdawg on October 26, 2017, 02:52:42 PM
No, none of my doctors ever mentioned that. It was checked before I got the SG and ruled out.

Could you post a photo anyway? Just for the sake of curiosity.
Title: Re: Sliding Genioplasty lost projection after swelling was gone, using filler?
Post by: ditterbo on October 26, 2017, 03:29:24 PM
There's no guarantee your lower lip will meet your upper after lower jaw surgery advancement.  I think some others here can attest to that from their own experience.  But that would be the way to try to correct that discrepancy.  Yeah as kavan said, if you want more heft in your chin area then consider a custom type of chin implant with no advancement but bulk to the jowls and area left and right of the chin b point/apex.  I don't mind the supposed protrusive upper face at all. Looks good even.
Title: Re: Sliding Genioplasty lost projection after swelling was gone, using filler?
Post by: girl on October 26, 2017, 03:36:13 PM
I asked for a BSSO and the doctor told me it is not possible since my bite is fine. No doctor will do a lefort 1 or 2 for aesthetic reasons. The only options left are Chin Wing, Implant, or Fillers.
A chin wing is too dangerous and would most likely just result in an even pointer chin, and a visible plate that stands forward.

During my SG the chin was moved by 11 mm.

Jaw surgery isn't just a "bite only" thing, or at least it shouldn't be - it's about correcting skeletal imbalances. For e.g., traditional orthodontics (like I and many others have had) "corrects" a class II bite but does not deal with the resulting skeletal problems, which is where jaw surgery comes in. 

If you're from the UK (I'm guessing) then you'll need to contact surgeons in Europe for the correct diagnosis.

To counter the 'healthy limb' argument, you had an involved surgery that was not really right for you, which IMO is worse than having a slightly more involved surgery that is aimed at correcting the actual problem.

 
Title: Re: Sliding Genioplasty lost projection after swelling was gone, using filler?
Post by: kavan on October 26, 2017, 04:05:18 PM
Jaw surgery isn't just a "bite only" thing, or at least it shouldn't be - it's about correcting skeletal imbalances. For e.g., traditional orthodontics (like I and many others have had) "corrects" a class II bite but does not deal with the resulting skeletal problems, which is where jaw surgery comes in. 

If you're from the UK (I'm guessing) then you'll need to contact surgeons in Europe for the correct diagnosis.

To counter the 'healthy limb' argument, you had an involved surgery that was not really right for you, which IMO is worse than having a slightly more involved surgery that is aimed at correcting the actual problem.

I think he's already in Europe as he (or maybe someone else) mentioned they knew him from a German board. Anyway, something like a Lefort2 set back would be more in venue of doctor who also has CRANIO-facial expertise underbelt. It's very common for many of the max fax guys to to just want to stick to the lefort 1s since that's the most kind of common Lefort done. Not to mention the other Leforts are much more challenging. So, would basically take an 'uncommon' MOTIVATION to hunt down the guy for the job. What he has does not look like an easy fix (protrusion to the L2 area). But I guess it's  a good thing that just some more chin bulk would bring him more happiness. Maybe a silicone pre-jowl implant or some deeply placed MACRO-lane. Both can be taken out or down if they don't do the trick.
Title: Re: Sliding Genioplasty lost projection after swelling was gone, using filler?
Post by: tim06 on November 08, 2017, 02:14:22 PM
I think he's already in Europe as he (or maybe someone else) mentioned they knew him from a German board. Anyway, something like a Lefort2 set back would be more in venue of doctor who also has CRANIO-facial expertise underbelt. It's very common for many of the max fax guys to to just want to stick to the lefort 1s since that's the most kind of common Lefort done. Not to mention the other Leforts are much more challenging. So, would basically take an 'uncommon' MOTIVATION to hunt down the guy for the job. What he has does not look like an easy fix (protrusion to the L2 area). But I guess it's  a good thing that just some more chin bulk would bring him more happiness. Maybe a silicone pre-jowl implant or some deeply placed MACRO-lane. Both can be taken out or down if they don't do the trick.

Yes correct I am from Germany. I agree that a Lefort 2 with BSSO would be the perfect procedure but it is just unrealistic. It would require years of completely unnecessary orthodontic work to prepare for the surgery. And like mentioned I don't believe that there are any doctors who would do a Lefort 1 or 2 just for aesthetic reasons.

At the moment I really consider getting a custom made silicon implant. The big advantage would be a very short recovery time and much less pain since no bones need to be cut. And it would also give me a much greater opportunity to be able to influence the aesthetic result.
Title: Re: Sliding Genioplasty lost projection after swelling was gone, using filler?
Post by: kavan on November 08, 2017, 02:33:55 PM
Yes correct I am from Germany. I agree that a Lefort 2 with BSSO would be the perfect procedure but it is just unrealistic. It would require years of completely unnecessary orthodontic work to prepare for the surgery. And like mentioned I don't believe that there are any doctors who would do a Lefort 1 or 2 just for aesthetic reasons.

At the moment I really consider getting a custom made silicon implant. The big advantage would be a very short recovery time and much less pain since no bones need to be cut. And it would also give me a much greater opportunity to be able to influence the aesthetic result.

Well, as long as you don't expect your lower lip to line up with the top. Keep in mind a vertical dropped from your lower lip has your chin lining up with it and if you go too much beyond that it can give look of crescent moon chin. (https://i.pinimg.com/736x/9e/fc/e2/9efce22f8f30b0c94f3ce5dce02e28da--moon-pictures-luna-moon.jpg)
Title: Re: Sliding Genioplasty lost projection after swelling was gone, using filler?
Post by: tim06 on November 08, 2017, 10:48:05 PM
Well, as long as you don't expect your lower lip to line up with the top. Keep in mind a vertical dropped from your lower lip has your chin lining up with it and if you go too much beyond that it can give look of crescent moon chin.

Yes sure, but what would you recommend in my situation?
Title: Re: Sliding Genioplasty lost projection after swelling was gone, using filler?
Post by: kavan on November 09, 2017, 08:06:26 AM
Yes sure, but what would you recommend in my situation?

When the solution (L2 set back) to the asthetic problem (protrusive leftort area) can't be done because the doctors you've asked to do it say 'no', other suggestions are just MAYBEs and not substitutes for the solution.

Maybe a silicone  implant or some deeply placed MACRO-lane. Both can be taken out or down if they don't do the trick. You would have to be cautious about going too far with the implant as I mentioned above and be aware that it is hard to reproduce the type of even over all favorable swelling you are wanting to reproduce. Those are just maybes for the CHIN as in maybe they will volumize the chin more in the way you liked it soon after the SWELLING.

The 'maybes' for the CHIN are limited to maybe they will given you the look of post op swelling to the chin area. But there is no 'maybe' about that compensating for the protrusive L2 area.
Title: Re: Sliding Genioplasty lost projection after swelling was gone, using filler?
Post by: Jilkster on November 09, 2017, 08:08:42 AM
When the solution (L2 set back) to the asthetic problem (protrusive leftort area) can't be done because the doctors you've asked to do it say 'no', other suggestions are just MAYBEs and not substitutes for the solution.

Maybe a silicone  implant or some deeply placed MACRO-lane. Both can be taken out or down if they don't do the trick. You would have to be cautious about going too far with the implant as I mentioned above and be aware that it is hard to reproduce the type of even over all favorable swelling you are wanting to reproduce. Those are just maybes for the CHIN as in maybe they will volumize the chin more in the way you liked it soon after the SWELLING.

The 'maybes' for the CHIN are limited to maybe they will given you the look of post op swelling to the chin area. But there is no 'maybe' about that compensating for the protrusive L2 area.

I see you suggesting macrolane a lot, do you have any context for its use in the face? My dermatologist considered it unsafe.
Title: Re: Sliding Genioplasty lost projection after swelling was gone, using filler?
Post by: kavan on November 09, 2017, 09:38:25 AM
I see you suggesting macrolane a lot, do you have any context for its use in the face? My dermatologist considered it unsafe.

I could give the generic term which would be; high viscosity filler ('thick' filler), a type of filler meant to be injected very DEEP to areas where there is already some thick tissue coverage for them which can be used 'off label' for areas like to the lower jaw and chin. But if someone then asked for an example of one (you know a trade name for one), I could say; 'macrolane is an example of one.'

Maybe from now on I'll just say: 'High viscosity filler. Ask your derm.'
Title: Re: Sliding Genioplasty lost projection after swelling was gone, using filler?
Post by: Jilkster on November 11, 2017, 06:09:15 AM
I could give the generic term which would be; high viscosity filler ('thick' filler), a type of filler meant to be injected very DEEP to areas where there is already some thick tissue coverage for them which can be used 'off label' for areas like to the lower jaw and chin. But if someone then asked for an example of one (you know a trade name for one), I could say; 'macrolane is an example of one.'

Maybe from now on I'll just say: 'High viscosity filler. Ask your derm.'

Is macrolane even regularly used in the face though?
Title: Re: Sliding Genioplasty lost projection after swelling was gone, using filler?
Post by: kavan on November 11, 2017, 06:32:22 AM
Is macrolane even regularly used in the face though?

It's OFF LABEL use.  On label is body filler. Very 'thick' filler that can be used off label to jaw area. But not used regularly for that.
Title: Re: Sliding Genioplasty lost projection after swelling was gone, using filler?
Post by: tim06 on November 13, 2017, 04:49:54 AM
It's OFF LABEL use.  On label is body filler. Very 'thick' filler that can be used off label to jaw area. But not used regularly for that.

In Europe the producer stopped selling it completely.
Title: Re: Sliding Genioplasty lost projection after swelling was gone, using filler?
Post by: kavan on November 13, 2017, 09:27:53 AM
In Europe the producer stopped selling it completely.

Well, that definitely makes it 'off label' use. lol

Thanks folks for the feedback on this product. In retrospect, I should have just said; 'High viscosity' or 'thick filler' and not mentioned the trade name of the thickest one I could think of.
Title: Re: Sliding Genioplasty lost projection after swelling was gone, using filler?
Post by: BrazilianJaw on November 13, 2017, 10:21:27 AM
Really looks like a maxilary protusion. Perhaps a BSSO with lower extractions could bring some improvement.

In cases like these, would be possible in the same surgery to perform a lefort 2 set back and in the same procedure a lefort1 + bsso with a big maxilomandibular advancement to creates a very strong lower third?
Title: Re: Sliding Genioplasty lost projection after swelling was gone, using filler?
Post by: kavan on November 13, 2017, 11:07:42 AM
Really looks like a maxilary protusion. Perhaps a BSSO with lower extractions could bring some improvement.

In cases like these, would be possible in the same surgery to perform a lefort 2 set back and in the same procedure a lefort1 + bsso with a big maxilomandibular advancement to creates a very strong lower third?

(https://img.medscapestatic.com/pi/meds/ckb/73/23373tn.jpg)
The Lefort2 area includes the Lefort 1 area.
Title: Re: Sliding Genioplasty lost projection after swelling was gone, using filler?
Post by: tim06 on November 13, 2017, 01:41:43 PM
(https://img.medscapestatic.com/pi/meds/ckb/73/23373tn.jpg)
The Lefort2 area includes the Lefort 1 area.

I am thinking about visiting Dr. Brusco in Zurich or at least making a 3d scan of my skull and sending him an email with pictures and asking for advice. Do you know any talented surgeons in Germany for such a case?
I know about dr. Z but I guess he would just offer me a chin-wing and this is not a good solution without chin-visor osteotomy or other procedures.
Title: Re: Sliding Genioplasty lost projection after swelling was gone, using filler?
Post by: kavan on November 13, 2017, 02:38:49 PM
I am thinking about visiting Dr. Brusco in Zurich or at least making a 3d scan of my skull and sending him an email with pictures and asking for advice. Do you know any talented surgeons in Germany for such a case?
I know about dr. Z but I guess he would just offer me a chin-wing and this is not a good solution without chin-visor osteotomy or other procedures.

Here's the deal. I just stick to helping with conceptual stuff like showing/explaining where the problem is. On you, it looks like you have excess protrusion to the Lefort 2 area and that you could use some advancement to the BSSO area. The other concept is that chin alterations won't compensate for that.

The only thing I can suggest as far as doctors are concerned is to take note of the doctors who wrote the paper about L2 set back (included here. Brazil jaw tracked it down) and research from there.
Title: Re: Sliding Genioplasty lost projection after swelling was gone, using filler?
Post by: ditterbo on November 13, 2017, 09:16:21 PM
Curious if a lefort 2 that actually brings his center face backwards instead of forwards is really a smart move long term? Isn't he going to age better with this extra midface surface area? It doesn't look disfiguring at all as it is now either.  Not included in this decision making so far I think is the state of his airway, and how that can be impacted from any of these set backs we're talking about - lefort 1 or 2.
Title: Re: Sliding Genioplasty lost projection after swelling was gone, using filler?
Post by: Lazlo on November 13, 2017, 09:22:39 PM
Curious if a lefort 2 that actually brings his center face backwards instead of forwards is really a smart move long term? Isn't he going to age better with this extra midface surface area? It doesn't look disfiguring at all as it is now either.  Not included in this decision making so far I think is the state of his airway, and how that can be impacted from any of these set backs we're talking about - lefort 1 or 2.


listen you guys are insane for even discussing having a lefort 2 setback in this case. do you think the face is like a lego sculpture that you can so easy move blocks around without significant risk to nerves, soft tissue and function. His profile and chin are "fine".  If he wants a bit more augmentation there get some filler, end of story. If his bite is fine a bsso advancement won't really help this case unless he got a very aggressive CCW which only a few guys know how to do well. Honestly, only one I really know of (Gunson). And do you really want to go through a 2 plus year fuck up of your face to achieve what will only be a minimal difference? Just get some filler.
Title: Re: Sliding Genioplasty lost projection after swelling was gone, using filler?
Post by: kavan on November 13, 2017, 10:12:00 PM
I'm just saying his protrusion is to the Lefort 2 area because that's where his protrusion is. Not really advocating he get that type of surgery. Just that he knows where the imbalance issue is so he doesn't expect chin implants and fillers to fix that.
He's on his own to research it further if he likes.
Title: Re: Sliding Genioplasty lost projection after swelling was gone, using filler?
Post by: tim06 on November 14, 2017, 11:01:08 AM

listen you guys are insane for even discussing having a lefort 2 setback in this case. do you think the face is like a lego sculpture that you can so easy move blocks around without significant risk to nerves, soft tissue and function. His profile and chin are "fine".  If he wants a bit more augmentation there get some filler, end of story. If his bite is fine a bsso advancement won't really help this case unless he got a very aggressive CCW which only a few guys know how to do well. Honestly, only one I really know of (Gunson). And do you really want to go through a 2 plus year fuck up of your face to achieve what will only be a minimal difference? Just get some filler.

While I value the opinion of the other users really much, I think that this is true. Even Dr. Brusco would most likely not offer a lefort 2 setback but I will ask him in the next weeks and can post his answer here.
Title: Re: Sliding Genioplasty lost projection after swelling was gone, using filler?
Post by: kavan on November 14, 2017, 12:51:32 PM
I've talked about it in a responsible way which was show and tell  where I isolated the profile imbalance and gave link to an academic paper. That's sufficient info to research this further.

This looks to be a highly ESOTERIC surgery. I don't  know all about details of it such as, medical minutia involved, risk profile, doctor referrals etc. just because I isolated where the profile imbalance was and cited a paper where the authors of it were listed.

Did it ever occur to you to consider consulting with the authors of the paper?
Title: Re: Sliding Genioplasty lost projection after swelling was gone, using filler?
Post by: tim06 on November 17, 2017, 06:09:46 AM
I've talked about it in a responsible way which was show and tell  where I isolated the profile imbalance and gave link to an academic paper. That's sufficient info to research this further.

This looks to be a highly ESOTERIC surgery. I don't  know all about details of it such as, medical minutia involved, risk profile, doctor referrals etc. just because I isolated where the profile imbalance was and cited a paper where the authors of it were listed.

Did it ever occur to you to consider consulting with the authors of the paper?

That my middle-face is protruding was also mentioned by my surgeon who did the sliding genioplasty. He said this is one of the reasons why a bsso wouldn't make sense in my case since the upper jaw would have to be moved forward even more.