Where to go from here

[tdawg]

So here are my issues:

Bite:
Anterior open bite that is mild
skeletal crossbite in the posterior region

The issues I have with my face are slight slight lip incompetence and my right side profile. My left side profile is OK.

My lip incompetence is kind of like this: Maybe A LITTLE bit less, but when I force my lips shut I get the dimpling of the chin.


Well so far every orthodontist I have seen has told me two things:

1)They dont think my problems warrant surgery
2)Insurance would not cover it

So I am thinking about "just" getting a genioplasty now along with invisalign(because invisalign can intrude the posterior teeth a few mm sort of mimicking a lefort impaction to a very slight degree). I will post pictures later, but the one thing that has me hesitant about that plan is the difference between my right and left side profile.

[tdawg]

Here are the pics

First one is the class 1 side that looks OK. Second one is the class 3 side that looks like a class 2. Its funny because to me the first picture almost looks like the after of the second.

It is obvious to me that a lefort impaction would be the best course of action. But this would be solely cosmetic and not only can I not afford that type of surgery, I am finding it difficult finding anybody that thinks it is worth operating on me. Do you think a genioplasty would be a decent compromise option?

[tdawg]

Mostly that it wouldnt be worth it, that people wouldnt really notice a difference, insurance wouldnt cover it and that there are no functional problems.


I am myself almost fine with how the first pic looks. Its the other side that bothers me.

Regardless of if I could find somebody to operate, cost is an issue and I am inclined to believe that insurance would not cover it. Im not looking for perfect, just improvement. I feel like if my chin was brought in line with my lower lip, that things would look significantly better.

[tdawg]

I think the first one looks slightly class 2 because of my weak chin. If my chin was advanced to my bottom lip it would be right on where it should be on the frankfort horizontal line. Thats what makes me think that its not so much the mandible, because my lips horizontally are around where they should be in relation to my forehead.

In fact the surgeons/orthos all said it would just be a maxillary impaction in the posterior region, if I were to surgically correct it. That combined with my molar relationships(no extractions) indicate to me that it isnt really my lower jaw that is the problem.


Imo it is a combination of a slightly long(3 mm) posterior region of the maxilla, and a long chin that is horizontally short.

But Im not a surgeon and getting them to explain things is hard.

That is what I am referring to. If you put that same line on me, my lower lip would be very slightly behind where it should be, while my chin is significantly behind. And its worse on the other side. That is what has me hung me up, I dont have noticeable asymmetry from the front, I dont want to have it if I get a genioplasty.

[angelstrings]

If a person is asymmetrical from one side to another, can they fix the chin during genioplasty to accomodate for that? How much asymmetry is noticable?

[CK]

If a person is asymmetrical from one side to another, can they fix the chin during genioplasty to accomodate for that? How much asymmetry is noticable?

i had an over bite, and before that an open bite, and also an overjet at some point. basically, my lower and upper law was elevated as part of the CCW, according to gunson, this projected my chin out, will seal my lips - eventually (but they're better than before) - and balanced that part of my face. the genio was critical but im not sure if the balance is predicated on that. the chin does nothing for the lip though, although i've seen before photos where people who needed lower jaw surgery instead got an implant and it makes their lips looked all mushy and crushed together. definitely not better than having an open mouth.