Author Topic: Lower Jaw Surgery or Sliding Genio? [Pics]  (Read 957 times)

MyTimeIsNow

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Re: Lower Jaw Surgery or Sliding Genio? [Pics]
« Reply #15 on: September 12, 2017, 10:24:53 AM »
I'm yet to see a thread there a user named CCW does not recommend CCW bimax, so take his advice with a grain of salt.

Jilkster

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Re: Lower Jaw Surgery or Sliding Genio? [Pics]
« Reply #16 on: September 12, 2017, 11:00:09 AM »
I'm yet to see a thread there a user named CCW does not recommend CCW bimax, so take his advice with a grain of salt.

He didn't suggest it to me, lol.

kavan

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Re: Lower Jaw Surgery or Sliding Genio? [Pics]
« Reply #17 on: September 12, 2017, 01:57:14 PM »
Here is example of why my advice was so. The spaces suggest the chin drop. Fill them in visually and it's pretty close to what he's doing when he juts. Not exactly but close enough. Keep in mind when he juts his jaw forward, he's dropping his chin in the process. He's NOT advancing his maxilla and displacing the orientation of his nose.

I guess you could tell him to get the whole enchalada, bi-max with CCW. He might have money burning a hole in his pocket to revise his nose again if he doesn't like how it changes after that. But he's expressing nose changes are a concern of his and he shows a desire to get away with a lesser procedure which will give him the most bang for his buck. I think he can get away with it.

Sometimes, you just have to listen to what someone is telling you, check to see if he could 'aesthetically survive' with just that one thing and not just go into auto-pilot with the suggestions.
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Ezra

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Re: Lower Jaw Surgery or Sliding Genio? [Pics]
« Reply #18 on: September 12, 2017, 07:43:06 PM »
Hey guys! I'm still reading all your advice, thanks so much. Here is the ceph album (maybe?)

http://imgur.com/a/wDOsZ

Please let me know what you think.

Ezra

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Re: Lower Jaw Surgery or Sliding Genio? [Pics]
« Reply #19 on: September 12, 2017, 07:51:16 PM »
Here is example of why my advice was so. The spaces suggest the chin drop. Fill them in visually and it's pretty close to what he's doing when he juts. Not exactly but close enough. Keep in mind when he juts his jaw forward, he's dropping his chin in the process. He's NOT advancing his maxilla and displacing the orientation of his nose.

Thanks for putting it together visually. I'm wondering if the sliding genio won't cause too much of a "witches chin" as someone mentioned. I remember my surgeon telling me that isn't the case, because it moves all of the soft tissue toward, without stretching.

kavan

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Re: Lower Jaw Surgery or Sliding Genio? [Pics]
« Reply #20 on: September 12, 2017, 08:16:23 PM »
Thanks for putting it together visually. I'm wondering if the sliding genio won't cause too much of a "witches chin" as someone mentioned. I remember my surgeon telling me that isn't the case, because it moves all of the soft tissue toward, without stretching.

I'm thinking more in terms of a drop down to the chin with spacer block or graft ( but with some advancement).
Please. No PMs for private advice. Board issues only.

PloskoPlus

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Re: Lower Jaw Surgery or Sliding Genio? [Pics]
« Reply #21 on: September 12, 2017, 08:26:27 PM »
If you're in California, see Gunson.  Yes, his prices are astronomical, but his consultations are extremely thorough.  Also, if all you need is genioplasty, his fee is actually quite reasonable.  Frankel did an amazing job on your nose (and yet he has so many terrible reviews on realself... I guess rhinoplasty is a lottery).

ditterbo

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Re: Lower Jaw Surgery or Sliding Genio? [Pics]
« Reply #22 on: September 12, 2017, 09:08:18 PM »
Hey guys! I'm still reading all your advice, thanks so much. Here is the ceph album (maybe?)

http://imgur.com/a/wDOsZ

Please let me know what you think.

Welp now I see why my upper/lower palates are considered narrow, LOL. Borderline should be my new max facs forum nickname.  I agree with the SG drop-down recommendation, FWIW piling on.

Ezra

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Re: Lower Jaw Surgery or Sliding Genio? [Pics]
« Reply #23 on: September 13, 2017, 03:54:17 PM »
If you're in California, see Gunson.  Yes, his prices are astronomical, but his consultations are extremely thorough.  Also, if all you need is genioplasty, his fee is actually quite reasonable.  Frankel did an amazing job on your nose (and yet he has so many terrible reviews on realself... I guess rhinoplasty is a lottery).


I had no idea Frankel had those bad reviews. I've been reading them and while I'm surprised, it seems that any well known surgeon will have some bad reviews. We do take that risk with surgery. In Frankels defense, he is well know for being an expert in revisions, and is capable of creating that look he is known for.

I'll check out Gunson, but I'm much closer to Relle... he is good right ?

PloskoPlus

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Re: Lower Jaw Surgery or Sliding Genio? [Pics]
« Reply #24 on: September 13, 2017, 05:22:05 PM »

I had no idea Frankel had those bad reviews. I've been reading them and while I'm surprised, it seems that any well known surgeon will have some bad reviews. We do take that risk with surgery. In Frankels defense, he is well know for being an expert in revisions, and is capable of creating that look he is known for.

I'll check out Gunson, but I'm much closer to Relle... he is good right ?
Well, I've heard that the revision rate with rhinoplasties is very high no matter who does them, but on balance Frankel is one of the best.

Both Relle and Gunson are good. Relle is a bit more conservative and probably cheaper. You don't need anything radical.

Ezra

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Re: Lower Jaw Surgery or Sliding Genio? [Pics]
« Reply #25 on: September 13, 2017, 05:50:36 PM »
Well, I've heard that the revision rate with rhinoplasties is very high no matter who does them, but on balance Frankel is one of the best.

Both Relle and Gunson are good. Relle is a bit more conservative and probably cheaper. You don't need anything radical.

Is there anything known about Dr. Gilbert in Upland California? Or would that be considered a risky local surgery? Both my doctor and my orthodontist said he is a good surgeon.

PloskoPlus

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Re: Lower Jaw Surgery or Sliding Genio? [Pics]
« Reply #26 on: September 14, 2017, 02:44:08 AM »
Is there anything known about Dr. Gilbert in Upland California? Or would that be considered a risky local surgery? Both my doctor and my orthodontist said he is a good surgeon.
Never heard of him.  He could be great. Some say that no surgeon is 100 times better than another and that at the end of the day they all do the same osteotomies and surgeons like Gunson are simply overhyped.  I don't know what the truth is.  "The best local guy" did my surgery and I copped massive nerve damage and a ho-hum aesthetic result (functionally it's perfect, so he admits no fault).

Ask him how many orthognathic surgeries he does per year i.e. BSSOs, Le Forts, genioplasties. Not dental implants, not pulling wisdom teeth - for most oral surgeons this is the bulk of their business.  Ask him what are the chances of relapse of the maxillary down graft.  How many mms of down graft?  What materials does he use for the graft material?  If you do relapse, will he re-operate on you? (I heard that when revising his own work Gunson will drop his fee, but not that of the hospital or anaesthesiologist and his fee is the biggest part of the bill.  Other surgeons will revision "at a reduced rate".  Other surgeons will simply hide from you).  Also ask him if having an upper jaw down graft only puts you at a greater risk of relapse vs two jaw surgery, because AFAIK lower jaw surgery really weakens your bite strength for quite a while.

The problem with lengthening the maxilla is that it may lengthen your face and may make it more convex in profile as the lower jaw swings down.  I'm not sure if you're gonna like this.  The genioplasty is supposed to counteract this, but your mentolabial fold looks good.  Also genioplasties can thin the lower lip...

One option worth considering is a lip lift for tooth show.  There is a guy on the forum with full lips who did this (and a vermillion reduction at the same time) and he looks pretty good.  But personally I think one side effect that people overlook with lip lifts is that they may make the nose look longer.  This is a general issue with aesthetic surgery.  You take away from A, B look bigger.  You add to A, B looks smaller.  Also, I believe Frankel does them, and doing them at the same time as rhinoplasty is often a good idea, since you can hide the scar in the alar rim, so he would've mentioned this to you...

Arnett & Gunson published a paper some time ago where they downplay the importance of jaws period.  If you search for this paper you will find it.  They claim skin, hair, eyes, features are more important, unless there is a dentofacial deformity so significant that it takes away from those features.  For example, someone with such a recessive chin that you don't notice their great eyes.  I don't think anyone needs to tell you that you have great features.  Your dentofacialy deformities are so minor that they don't take away from your features.    They are not the first things that people notice about you (well, sane people).  IMO, you may go through a lot of trouble to end up looking no better than you do now.  You have to decide if any of this is worth it for you.  That's why I would definitely see someone like Gunson.  He has so much business, he will only suggest surgery if it's really worthwhile.

notrain

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Re: Lower Jaw Surgery or Sliding Genio? [Pics]
« Reply #27 on: September 14, 2017, 10:01:10 AM »
Hey guys! I'm still reading all your advice, thanks so much. Here is the ceph album (maybe?)

http://imgur.com/a/wDOsZ

Please let me know what you think.

You have a very similar growth pattern and starting position as I did before my surgery.
Dr. Choi's plan with premolar extractions is the way to go. You need as big of a lower jaw advancement as possible and no genioplasty.

You can opt in to upper jaw surgery as well, but not for the purpose of lowering the jaw vertically but rather advancing it as well. This isn't strictly necessary, but sliding the upper jaw forward gives the lower jaw additional room for advancement and would increase incisor show too. This approach would also massivley increase your airway volume, so if you have breathing problems or snore loudly it might be worth considering.

I don't think you need any kind of rotation, so if you are low on funds, you can get a very good improvement just doing lower jaw extractions followed by BSSO surgery.

kavan

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Re: Lower Jaw Surgery or Sliding Genio? [Pics]
« Reply #28 on: September 14, 2017, 12:19:09 PM »
I've looked at your cephs. The near 'flat' occlusal and mandibular plane angles are not in the direction of addressing via CCW. On the contrary---in direction of clockwise rotation. However, I still think you could get away WITHOUT bi-max, especially so if you are wanting to avoid any 'surprises' to your nose orientation..

The displacement I made is a drop down to the chin with minor advancement. Something where the gaps would need to be filled in with a 'bone buttress'. The chin drop with modest advancement, increases the angle of inclination of the mandibular plane with reference to the points used to assess the angle and of course, directly targets the the shortness of the chin relative to the rest of the mandibular body.
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Ezra

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Re: Lower Jaw Surgery or Sliding Genio? [Pics]
« Reply #29 on: September 16, 2017, 01:35:24 PM »
Never heard of him.  He could be great. Some say that no surgeon is 100 times better than another and that at the end of the day they all do the same osteotomies and surgeons like Gunson are simply overhyped.  I don't know what the truth is.  "The best local guy" did my surgery and I copped massive nerve damage and a ho-hum aesthetic result (functionally it's perfect, so he admits no fault).

Ask him how many orthognathic surgeries he does per year i.e. BSSOs, Le Forts, genioplasties. Not dental implants, not pulling wisdom teeth - for most oral surgeons this is the bulk of their business.  Ask him what are the chances of relapse of the maxillary down graft.  How many mms of down graft?  What materials does he use for the graft material?  If you do relapse, will he re-operate on you? (I heard that when revising his own work Gunson will drop his fee, but not that of the hospital or anaesthesiologist and his fee is the biggest part of the bill.  Other surgeons will revision "at a reduced rate".  Other surgeons will simply hide from you).  Also ask him if having an upper jaw down graft only puts you at a greater risk of relapse vs two jaw surgery, because AFAIK lower jaw surgery really weakens your bite strength for quite a while.

The problem with lengthening the maxilla is that it may lengthen your face and may make it more convex in profile as the lower jaw swings down.  I'm not sure if you're gonna like this.  The genioplasty is supposed to counteract this, but your mentolabial fold looks good.  Also genioplasties can thin the lower lip...

One option worth considering is a lip lift for tooth show.  There is a guy on the forum with full lips who did this (and a vermillion reduction at the same time) and he looks pretty good.  But personally I think one side effect that people overlook with lip lifts is that they may make the nose look longer.  This is a general issue with aesthetic surgery.  You take away from A, B look bigger.  You add to A, B looks smaller.  Also, I believe Frankel does them, and doing them at the same time as rhinoplasty is often a good idea, since you can hide the scar in the alar rim, so he would've mentioned this to you...

Arnett & Gunson published a paper some time ago where they downplay the importance of jaws period.  If you search for this paper you will find it.  They claim skin, hair, eyes, features are more important, unless there is a dentofacial deformity so significant that it takes away from those features.  For example, someone with such a recessive chin that you don't notice their great eyes.  I don't think anyone needs to tell you that you have great features.  Your dentofacialy deformities are so minor that they don't take away from your features.    They are not the first things that people notice about you (well, sane people).  IMO, you may go through a lot of trouble to end up looking no better than you do now.  You have to decide if any of this is worth it for you.  That's why I would definitely see someone like Gunson.  He has so much business, he will only suggest surgery if it's really worthwhile.


I am considering doing a minor lip lift instead of upper jaw surgery and I figured my facial hair would hide the scar well. Can you help me find the guy who had the lip lift on this forum? I'd like to check out his pictures or possibly message him if they aren't posted anymore.

Great idea on checking out Gunson to see what he thinks. I'll actually go to Arnett though, because it's driving distance, that is just as good, right?

Also, thanks for giving me some questions to ask Dr. Gilbert. I really appreciate it. I want to go into this extremely prepared.
« Last Edit: September 16, 2017, 02:13:23 PM by Ezra »