Bimax for only aesthetics?

[Perfectionist]

Hi all,

I'm a little unsure about what the most wise course of action is here, so I will summarize my situation below:

Chin:
-About 6 months ago I had Sliding Genioplasty with decent results. It widened my chin and strengthened my face. Overall if my only goal would have been to strengthen my face I would be happy.
-In a while I will have another sliding genioplasty because while my chin is much stronger, it is not "defined" (and therefore not as aesthetic as I'd like it to be). So the second will focus on that only
-My entire lower 3rd looks slightly more symmetrical after the operation

Jaw:
-My bite is fine, I don't have protrusion/retrusion/whatever. I don't mind my profile other than the chin.
-My jaw (upper+lower) is slightly asymmetric which causes my left gonial angle to be much more defined than my right
-Apart from the asymmetry on its own, I don't like the right side of my face mainly for this reason (from the front). I have to add that it is a small difference and that I don't want a wide, square jaw (AT ALL!) like you see on many before-afters of jaw angle implants. I want it to be slightly squared and more defined/refined only. So my surgeon is already finds it difficult to make the implant small and subtle enough not to make it over the top.

Intervention ideas:
-I'd like my right side jaw to be more defined. Therefore, it was my idea to have a small implant in the right side only. My surgeon doesn't really like this idea. He will do it, but seemed very reluctant. That makes me doubt whether it is a good idea (it probably isn't, then).
-My surgeon said that bimaxillary surgery after which implants could be placed on both sides to fill it out, would be the ideal solution. He didn't seem very giddy on actually doing it (but I think he would if I wanted him to).
-Given that my bite and profile (jaw-wise) are fine, I doubt whether it is a good idea.

So the questions are:
-What do you think about bimax in this situation?
-I don't understand how bimax is the exactly right solution because bimax doesn't address the gonial angles, so I don't understand how it would influence the type of implants that would have to be placed? (I will also ask my surgeon this, of course).
-Can you think of alternatives?
-One alternative would maybe be to find a surgeon that does HA paste isntead of implants.


By the way I am willing to bear the recovery and cost of all this. It's mostly the aesthetic cost-benefit analyses I'm contemplating (i.e. is the gain enough to warrant the costs).

[notrain]

if you have a class 1 jaw and no bite issues but want better gonial angles and better symmetry, then there is only one procedure to get:

Chin Wing Osteotomy.

[DrBirbe]

I would advise you to get a cone beam CT and analyse precisely where is the cause of this slight right/left asymmetry. If there is an asymmetric gonial angle and you don't address it properly, this asymmetry will subsist post op.
If you don't have any reason to change paranasal, naso-labial angle, upper lip support, or occlusal plane angle, there is not much space for a bimax.

[DrBirbe]

Hi there!
I have treated class I patient with good bites for aesthetics reasons. The issue is to exactly defined what we want to improve.
Gonial angle assimetries can be treated in different ways. One would be a surgical camouflage with some filler, like HA.
A more comprehensive, but also with more surgery, treatment is a bimax surgery with occlusal plane change. A counter clock wise rotation has the effects you would like in the gonial angle.
May be you could send me some pictures or , if you prefer skype me.

[PloskoPlus]

Hi there!
I have treated class I patient with good bites for aesthetics reasons. The issue is to exactly defined what we want to improve.
Gonial angle assimetries can be treated in different ways. One would be a surgical camouflage with some filler, like HA.
A more comprehensive, but also with more surgery, treatment is a bimax surgery with occlusal plane change. A counter clock wise rotation has the effects you would like in the gonial angle.
May be you could send me some pictures or , if you prefer skype me.

Dr,

Have you ever done CCW rotations on Class 3 patients?  Class 3 has the stereotype of "a big jaw", but to me a lot of class 3s looks like a normal jaw's worth of bone that was stretched out and placed at a steeper than normal angle.  They just don't look robust, just long.  A shorter, but more horizontal jaw looks better.  Is this even possible?  I've seen claims that IVRO does a better job at improving the gonial angles and making the jaw less steep, but few surgeons do it these days.

How stable is HA.  I hear all sorts of contradicting claims - that it can get reabsorbed by the body, it crumbles, it erodes the bones underneath, etc..