Is Yaremchuk right that Sliding Genioplasty can be disfiguring?

[MrRochester]

He argues that it can create unnatural contours.

"Sagittal split and horizontal osteotomies (sliding genioplasties) of the mandible leave irregularities along the border of the mandible. In certain cases these can be disfiguring.

"

http://dryaremchuk.com/english/cbi.php

[overbiter]

The key phrase here is "In certain cases". Many people find that these osteotomies do not disfigure their face, and in fact improve facial aesthetics. Even this doctor, who spends his time working with cases where things have gone wrong, knows problems only occur sometimes.

You seem filled with trepidation about surgery. Just way up the pros and cons. Things can go wrong of course, but usually they don't. Most people get a decent outcome/improvement. Just decide whether you actually want this. If you do, then take the plunge.

[earl25]

depends on the advancement . the more mm the higher the chance

[geijutsu]

Some of the people who opt for a genioplasty are probably deficient not just around the chin but rather the entire lower jaw, so the surgeon over-augments the chin to compensate for the jaw deficiency. Too much genio augmentation can create a step off. As some of the folks said here, it all depends on how much mm were augmented.

[Optimistic]

Some of the people who opt for a genioplasty are probably deficient not just around the chin but rather the entire lower jaw, so the surgeon over-augments the chin to compensate for the jaw deficiency. Too much genio augmentation can create a step off. As some of the folks said here, it all depends on how much mm were augmented.

I'm pretty sure that's precisely why it's often combined with a BSSO, so that the following SG won't need to be too great and such as avoid that 'step off' everyone is talking about.

Regarding the irregularities I always thought that the bone just eventually healed over just like you'd been born that way. So wouldn't these irregularities simply be temporary?

[geijutsu]

I'm pretty sure that's precisely why it's often combined with a BSSO, so that the following SG won't need to be too great and such as avoid that 'step off' everyone is talking about.

Regarding the irregularities I always thought that the bone just eventually healed over just like you'd been born that way. So wouldn't these irregularities simply be temporary?

I'm not entirely sure, but I don't think that the step-off remodels to make a straight line, what I think happens is that the bone heals where both ends meet but there won't be much remodeling in areas that are not attached to another bone for lack of a better word. But the step-off issue isn't as disastrous as some make it out to be, you can fill it in either by using tiny custom implants, or HA.

[joesun]

The link is obviously bias from a plastic surgeon that prefers to do implants verses genioplasty.  However, any informed surgeon will tell you that genioplasty has more long term benefits

-no risk of implant infection
-implants are prone to shifting resulting in post-op asymmetry
-placing implants through intra-oral incision increases the chance of infection
-placing implants through an external excision reduces chance of infection, however may produce visible scars.

[earl25]

The link is obviously bias from a plastic surgeon that prefers to do implants verses genioplasty.  However, any informed surgeon will tell you that genioplasty has more long term benefits

-no risk of implant infection
-implants are prone to shifting resulting in post-op asymmetry
-placing implants through intra-oral incision increases the chance of infection
-placing implants through an external excision reduces chance of infection, however may produce visible scars.

also no bone resorbtion
the chance u will have to tell anyone about it

[Optimistic]

I'm not entirely sure, but I don't think that the step-off remodels to make a straight line, what I think happens is that the bone heals where both ends meet but there won't be much remodeling in areas that are not attached to another bone for lack of a better word. But the step-off issue isn't as disastrous as some make it out to be, you can fill it in either by using tiny custom implants, or HA.

Yeah, I'm pretty sure every surgeon finishes the operation with HA paste into the gaps. My understand is that this is the conventional usage of HA paste, whereas jaw augmentation is off-label if you will.

[earl25]

Implants and jaw surgery accomplish 2 different things imo. On his site he says full jaw/ chin implants can mimic the result of a bsso and genio.  On the old ytf board there were plenty of people who needed jaw surgery who opted for jaw,chin paranasal implants instead. post op they still looked "off".

[stravinsky]

I have a pretty bad step-off on one side only. Mostly visible when I smile... a strange looking line on my right side. I'm pretty sure my surgeon doesn't use HA paste at all, but he's just an average maxfac kind of deal.

[geijutsu]

Implants and jaw surgery accomplish 2 different things imo. On his site he says full jaw/ chin implants can mimic the result of a bsso and genio.  On the old ytf board there were plenty of people who needed jaw surgery who opted for jaw,chin paranasal implants instead. post op they still looked "off".

Yeah, I think it's a bit misleading. His claims apply only on borderline cases, and even then it will non-the-less achieve subpar results compared to jaw surgery. Things like short upper/lower jaw, steep occlusal plane and even narrow airways cannot be fixed with implants.

[Tiny]

I don't think combined chin and jaw implants will ever approximate the look of jaw surgery because it will not touch the lip position.  In a lot of class 2s, the bottom lip is significantly behind the top lip and this can only be fixed surgically

I think if the surgeon was doing quite a bit of rotation on the lower the chances of step off would be greater.  But I think for deecent jaw surgeons, the step off thing is not a significant issue.

The large majority of surgeons now fix implants with tiny screws so that they don't move.  This also means they're not shifting about and grinding down the bone (in theory)
As far as intra-oral incisions go, jaw surgery incisions are always intra-oral.  Most people do not remove their hardware either and this can get infected.

As far as implants go, I think they are good for
a) people who don't want to undergo a BSSO but for whom a standard genio would leave them with too pointy a chin
2) ramus augmentation

That's about it.  As more surgeons start to offer chin-wings then there will be less need for chin implants in particular

[Optimistic]

I don't think combined chin and jaw implants will ever approximate the look of jaw surgery because it will not touch the lip position.  In a lot of class 2s, the bottom lip is significantly behind the top lip and this can only be fixed surgically

I think if the surgeon was doing quite a bit of rotation on the lower the chances of step off would be greater.  But I think for deecent jaw surgeons, the step off thing is not a significant issue.

The large majority of surgeons now fix implants with tiny screws so that they don't move.  This also means they're not shifting about and grinding down the bone (in theory)
As far as intra-oral incisions go, jaw surgery incisions are always intra-oral.  Most people do not remove their hardware either and this can get infected.

As far as implants go, I think they are good for
a) people who don't want to undergo a BSSO but for whom a standard genio would leave them with too pointy a chin
2) ramus augmentation

That's about it.  As more surgeons start to offer chin-wings then there will be less need for chin implants in particular

Regarding lip position, what does this mean for people whose lips are already in the correct position? I wondered about this a bit the other day as I was jutting my jaw out. I realised that even a small advancement of my jaw my lips look weird. Is there a way to advance the jaw with BSSO without affecting the lips? Mind you my recession is mild so it won't be a big advancement.

[Tiny]

Regarding lip position, what does this mean for people whose lips are already in the correct position? I wondered about this a bit the other day as I was jutting my jaw out. I realised that even a small advancement of my jaw my lips look weird. Is there a way to advance the jaw with BSSO without affecting the lips? Mind you my recession is mild so it won't be a big advancement.

I don't think so?  However I don't think that a BSSO makes the lips look the same as jutting the jaw forward does. If I do that my lips look hella weird and my bottom lip is waaaaaay behind my top