Do I need surgery?

[Juliaaa]

Hello Everyone!

I am very new to jaw surgery. I`d like to get some insight from you guys, I know that a lot of you have been through the same; I would truly appreciate all your answers. I am 26 y/o female, and this is my story.....

I had braces when I was 12 for 3 years, and got 4 premolars extracted.  When I was 21, I discovered I could not breathe through my nose cause I had a severe deviated septum. I had a nose job to fix it and also a chin implant to improve my profile. By this time I found out about long face syndrome and mouth breathing. I thought the chin implant would fix it, but it did not.  It is really big like 13 mm. I don't feel comfortable smiling or yawning in public because it looks so long...

Now that I have got some money I decided to do something about it. I went to see 3 oral surgeons. One of them suggested lefort 1, 8 moths of braces and sliding genio. The other one is still checking my case but told me that I really need jaw surgery if I want to avoid future problems with TMJ, and improve my facial aesthetics.

Finally the last one told me that I don't need jaw surgery, that the orthodontist had done a great job and that my bite is fine.  He said that it is not worthy to go through all the pain and discomfort of jaw surgery. He only suggested a sliding genio...

So I don't know what to do... Should I say yes to jaw surgery...? Do you think the benefits outweigh the cost in my case?? What would you do??

Please any advice; tip, or idea would be really appreciated.

Thank you guys so much for reading my story... I am sorry for the English mistakes, Im not a native speaker.

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[overbiter]

You do look like you have long face syndrome, but at the same time your facial aesthetics don't look that bad to me. The chin implant seems to have improved your appearance overall. I wouldn't have thought that someone with long face syndrome getting a really big chin implant would have a good result, but in your case it seems to work.

It is possible that your appearance could be improved with jaw surgery. You would need to have some impaction. In the photo it doesn't look like you have a gummy smile so maybe you don't want this. Also, I think a big implant like you have might cause some problems long term. A genioplasty could be a good idea to prevent damage to the chin bone.

Judging by the images you don't necessarily need surgery, but I've seen other people like go through the process and be happy with the results. If you do have it you will look different, not necessarily better. I think it all depends on what you want. The only person who can make this decision is yourself.

[Optimistic]

You do look like you have long face syndrome, but at the same time your facial aesthetics don't look that bad to me. The chin implant seems to have improved your appearance overall. I wouldn't have thought that someone with long face syndrome getting a really big chin implant would have a good result, but in your case it seems to work.

It is possible that your appearance could be improved with jaw surgery. You would need to have some impaction. In the photo it doesn't look like you have a gummy smile so maybe you don't want this. Also, I think a big implant like you have might cause some problems long term. A genioplasty could be a good idea to prevent damage to the chin bone.

Judging by the images you don't necessarily need surgery, but I've seen other people like go through the process and be happy with the results. If you do have it you will look different, not necessarily better. I think it all depends on what you want. The only person who can make this decision is yourself.

You really think she has "long face syndrome"?? Maybe I misunderstand what it means but her face seems to have a very normal width and height to it with well balanced features.

[PloskoPlus]

Overall you look good, but I wonder I why the surgeon did not suggest advancing the lower jaw and removing the implant?  I think the fold between your lower lip and the chin is excessive.  Probably due to the implant.

[overbiter]

You really think she has "long face syndrome"?? Maybe I misunderstand what it means but her face seems to have a very normal width and height to it with well balanced features.

her lower jaw is rotated downwards, and her lower third is long, so technically she has a long face. She doesn't look as bad as some over people who have it. Not everyone who has a long face looks bad.

[notrain]

+1 to Long Face Syndrome because in addition to what has been said her palatal vault is also high and very narrow.

i don't know what to recommend, though. to fix the nose breathing issue, you would need SARPE first and later on Bimax Jaw Surgery with Counterclockwise Rotation and a genio.

Before all that, the implant would need to come out.

Since you aren't grotesque looking, I'd think long and hard if you want to start treatment.

[dantheman]

I'm going to have to disagree with notrain on this one. I don't think you have LFS though I do see where others are coming from. Do you resemble your parents? I wish I had a ruler to make some measurements. Of course the genio might be throwing me off too. I do see the palate observation by notrain. Did you have an expander? I personally don't see need for surgery, but you might benefit from it. I do also notice a degree of lip incompetence.

[dantheman]

When you mention mouth breathing, was this an issue since birth? Or did you injure your nose at some point?

[Juliaaa]

Thank you guys so much for all answers!! This is so helpful for me, I really appreciate it...

I always had issues breathing through my nose. I had asthma and allergies as a child. I was treated for that. The issue with my very badly broken septum is that it was way up, like kind of hidden, and all otolaryngologist did not notice it. I got an X ray done when I was 20 because of some random issue with my eye and that is when I found out. I know it sounds crazy, maybe that is why I do not blindly trust doctors.

The doctor said that I might have had an accident as a child. Looking at my pics I guess it happened when I was like 7 years old, cause I see pics from that age and  from that time on I always seem to have my mouth open..

For the orthodontics, I don't really know what did I get. I don't remember wearing anything special, only the 4 premolar extractions. 

So yeah, this is a very difficult decision.... Looking at different websites I saw this girls who looks a bit like me and had a double jaw surgery in Barcelona, so I don't know if I could expect the same, you guys have a much more educated eye for that..
 

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[ForeverDet]

LFS has a lot of variations however it almost always means a maxilla that's grown too long vertically causing the occlusal plane to rotate clockwise, creating a recessed mandible (occasionally class I and 3 bites result), steep occlusal/mandibular plane, lip incompetence, excess inscior exposure relaxed and usually a gummy smile.

Your case is interesting because your before pics definitely shows a retruded mandible and mandibular plane that's a bit steep (this isn't abnormal by itself) but you don't have lip incompetence or a gummy smile. This is primarily why a chin implant improved your facial aesthetics despite the implant being too big and causing a deep mental-labial fold (the area between your lower lip and chin).

An isolated sliding genioplasty or chin implant is usually insufficient to correct LFS because it doesn't address the vertical maxillary excess or occlusal steepness so the person is left with a stronger chin but no improvement in lip closure, bite or their mandibular abnormality. I had LFS and that's exactly what happened when I got a sliding genio and I required double jaw surgery to fix most of my issues.

In your case if your heart is set on doing something and your jaw joints are good (I think you look good now btw even with the prominent chin), I would recommenced removing the chin implant and getting a sliding genioplasty between 6-10mm, depending on how strong you still want your chin to be. That'll soften your mental-labial fold.

Overbiter - Her lower third was not so excessively long to diagnose her with LFS, even with her clockwise rotated jaws. Her issues were a mandibular deficiency and a weak chin button which causes the illusion of her lower third being long. A long lower third in the context of LFS must be accompanied by excess incisor exposure at rest and lip strain. It's normal variation for an individual have a longer than average chin length and by itself isn't abnormal at all.  It's like when someone has a huge amount of tooth display at rest like kristen stewart, you wouldn't diagnose her as LFS just because she shows way more incisors at rest than most people. And that's because she has lip competence, good bite and normal mandibular development.

[nrelax11]

Yea that chin implant seemed to really balance out your face. Honestly,  if you dont need to go through surgery, dont.

[PloskoPlus]

IMO @26, you're old enough to know what you need and young enough to recover from the surgery well.  The older you are, the tougher lower jaw surgeries are on the nerves.  Get a bunch of opinions from surgeons who do a lot of these surgeries.

[Juliaaa]

I'm going to have to disagree with notrain on this one. I don't think you have LFS though I do see where others are coming from. Do you resemble your parents? I wish I had a ruler to make some measurements. Of course the genio might be throwing me off too. I do see the palate observation by notrain. Did you have an expander? I personally don't see need for surgery, but you might benefit from it. I do also notice a degree of lip incompetence.

Oh I just checked and yes I did use a palatal expander prior to the braces.. I don't really remember for how long..
For the genetics, my mom has somehow a slight convex profile with perfect teeth no orthodontics whatsoever...

[Juliaaa]

LFS has a lot of variations however it almost always means a maxilla that's grown too long vertically causing the occlusal plane to rotate clockwise, creating a recessed mandible (occasionally class I and 3 bites result), steep occlusal/mandibular plane, lip incompetence, excess inscior exposure relaxed and usually a gummy smile.

Your case is interesting because your before pics definitely shows a retruded mandible and mandibular plane that's a bit steep (this isn't abnormal by itself) but you don't have lip incompetence or a gummy smile. This is primarily why a chin implant improved your facial aesthetics despite the implant being too big and causing a deep mental-labial fold (the area between your lower lip and chin).

An isolated sliding genioplasty or chin implant is usually insufficient to correct LFS because it doesn't address the vertical maxillary excess or occlusal steepness so the person is left with a stronger chin but no improvement in lip closure, bite or their mandibular abnormality. I had LFS and that's exactly what happened when I got a sliding genio and I required double jaw surgery to fix most of my issues.

In your case if your heart is set on doing something and your jaw joints are good (I think you look good now btw even with the prominent chin), I would recommenced removing the chin implant and getting a sliding genioplasty between 6-10mm, depending on how strong you still want your chin to be. That'll soften your mental-labial fold.

I do believe that I have a mild LFS. When I laugh I generally show my gums. But the main issue now for me is the chin. I can not smile because I am always conscious of my chin implant, it looks so long sometimes and makes my face look awful, check the attached pic.

I see that you had a sliding genio first, I thought that you had to have the whole surgery, cause you don't know how the jaw might end up looking.. I wonder if I could try with sliding genio first like you did, and if it could give me a more natural look, even if the profile is not perfect. I think that a slight convex profile does not look that bad on females.. I just want to look more natural, and I do hate the labiomental fold created by the implant



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[Dontknowwhattodo]

Thank you guys so much for all answers!! This is so helpful for me, I really appreciate it...

I always had issues breathing through my nose. I had asthma and allergies as a child. I was treated for that. The issue with my very badly broken septum is that it was way up, like kind of hidden, and all otolaryngologist did not notice it. I got an X ray done when I was 20 because of some random issue with my eye and that is when I found out. I know it sounds crazy, maybe that is why I do not blindly trust doctors.

The doctor said that I might have had an accident as a child. Looking at my pics I guess it happened when I was like 7 years old, cause I see pics from that age and  from that time on I always seem to have my mouth open..

For the orthodontics, I don't really know what did I get. I don't remember wearing anything special, only the 4 premolar extractions. 

So yeah, this is a very difficult decision.... Looking at different websites I saw this girls who looks a bit like me and had a double jaw surgery in Barcelona, so I don't know if I could expect the same, you guys have a much more educated eye for that..

What surgeries did she get? she got rhinoplasty too right?