x-rays/pics- advice on SG/chin augmentation

[needadvancement]

Hey there, I posted here before but I got some x-rays after my orthodontist visit. Basicely my problems are aesthetic(I nose breathe, chew, sleep etc. normally. only some crowding on my lower palate thats difficult to clean but that's all) my issues are with my protruding mouth and my short nonexistent chin. I was told that my jaw is a bit recessed both upper and lower are narrow which I'm confused by. Maybe my width is all due to the muscles attached to the jaw?

here's some pictures of the outside look:
https://imgur.com/a/dy0J9#0
and the x-rays and teeth:
https://imgur.com/a/jjB1Q#0
never realised how prominent my brow ridge is and thats what makes my mandible look even more recessed. am I correct in this?

Anyway they told me that they are gonna be able to fix the look of my mouth without extractions(a relief for me). I am thinking about getting a sliding genioplasty after that in the future. I was told here that a SG would not work for me though because I have a deep m. fold  above the chin already. I am not sure what the effects would be if I did get a SG but with mostly lengthening and some projection. That's the most invasive surgery I'm willing to get, I don't wanna do a whole jaw surgery+2years braces type of thing, I don't seem to have functional problems associated with recessed jaws. I just want a chin..

So what would be your advice, and also more comments on the x-rays and the rest of my face development would be interesting too. I'd appriciate it.

[sean89]

Your case is very difficult.

Hip graft or distraction of the alveolar crest isn't suitable for you, nor is BSSO. Fillers are more suitable, but are expensive and temporary.

You need to address both the sublabial fold and chin at the same time.

As far as I can see, your best option is a custom made chin implant. Second best option is an osteotomised chin advancement/chin implant with an implant for sublabial fold. I don't think you can avoid implants because your sublabial fold is quite severe and autologous solutions are probably inadequate.

[PloskoPlus]

Your case is very difficult.

Hip graft or distraction of the alveolar crest isn't suitable for you, nor is BSSO. Fillers are more suitable, but are expensive and temporary.

You need to address both the sublabial fold and chin at the same time.

As far as I can see, your best option is a custom made chin implant. Second best option is an osteotomised chin advancement/chin implant with an implant for sublabial fold. I don't think you can avoid implants because your sublabial fold is quite severe and autologous solutions are probably inadequate.

What about "chin visor"?

[sean89]

What about "chin visor"?

Yeah, I forgot about that. Good shout.

[needadvancement]

^I can't find anything on google, or actually the chin wing surgery comes up for that term. Could you elaborate on chin visor?

Your case is very difficult.

Hip graft or distraction of the alveolar crest isn't suitable for you, nor is BSSO. Fillers are more suitable, but are expensive and temporary.

You need to address both the sublabial fold and chin at the same time.

As far as I can see, your best option is a custom made chin implant. Second best option is an osteotomised chin advancement/chin implant with an implant for sublabial fold. I don't think you can avoid implants because your sublabial fold is quite severe and autologous solutions are probably inadequate.

I see, kind of what I was dreading. The thing with implants is what I've read about the risks and how it can move/damage and I have a certain lifestyle where I worry that things could go wrong there. That's why I like the idea of sliding genio since eventually I'll have my own bone grow and form a new chin.
I'm just wondering, I still don't quite understand about the sublabial fold and the effects of it after an augmentation. Would it look terrible or is it a functional thing?
Thanks.

[sean89]

^I can't find anything on google, or actually the chin wing surgery comes up for that term. Could you elaborate on chin visor?

I see, kind of what I was dreading. The thing with implants is what I've read about the risks and how it can move/damage and I have a certain lifestyle where I worry that things could go wrong there. That's why I like the idea of sliding genio since eventually I'll have my own bone grow and form a new chin.
I'm just wondering, I still don't quite understand about the sublabial fold and the effects of it after an augmentation. Would it look terrible or is it a functional thing?
Thanks.

I don't know much on chin visor, but it would address your fold, which needs addressing because of aesthetics not function. Any more chin advancement would look terrible imo, especially when smiling.

I saw a guy who had surgery in Italy on lookyourbestuk forum and had genio with sublabial implant and looked very good. Implants in the chin area are supposed to be more immovable than jaw implants fwihh.

[needadvancement]

I've read that with this fold, a SG would not make it worse if most of the advancement is done vertically (and I need downward chin length a lot more than forward projection imo) is this accurate?

Also I've been looking on google but can't really find it, I'm curious to see if there are photos of people who have a very deep fold and possibly worsened ones after sugery, would be very helpful if someone could find and post any.

[PloskoPlus]

Chin visor is described here:

http://www.pyramide.ch/KlinikPyramide.CorporateWebsite/media/PyramideCorporate/PDFs/Centers/ZKG/Journal_fuer_Aesthetische_Chirurgie_Januar_2013_Brusco.pdf

AFAIR, you had camouflage orthodontics (upper jaw extractions) to fix an overbite when you were younger?  IMO, then get jaw surgery and get it over and done with.  I've seen cases like yours online and in real life - squarish face with an overbite and a very horizontally long but vertically short chin.  As if nature is trying to compensate for a short mandible.  The whole process won't take 2 years, probably 18 months at the very most.  And that time will fly whatever you do.  Look for orthos using Suresmile.  Supposedly it cuts down treatment time dramatically.  But of course prefer a competent ortho first and foremost.

[notrain]

@plosko:

I am counting two premolars in his upper arch. what makes you say he had extractions ?

@OP

You need CW Rotation Advancement (Bimax). Read this:


Low occlusal plane - brachycephalic patients

http://www.scielo.br/scielo.php?script=sci_arttext&pid=S2176-94512012000400028

[PloskoPlus]

@plosko:

I am counting two premolars in his upper arch. what makes you say he had extractions ?

You're right, I confused him with someone else.

@OP

You need CW Rotation Advancement (Bimax). Read this:


Low occlusal plane - brachycephalic patients

http://www.scielo.br/scielo.php?script=sci_arttext&pid=S2176-94512012000400028

Right again.

[needadvancement]

Yes I did not have any extractions except for the two lower wisdom teeth last year which was necessary.

@plosko:
I am counting two premolars in his upper arch. what makes you say he had extractions ?

@OP


You need CW Rotation Advancement (Bimax). Read this:


Low occlusal plane - brachycephalic patients

http://www.scielo.br/scielo.php?script=sci_arttext&pid=S2176-94512012000400028

Thanks, I've read it but I don't have al the knowledge you guys have yet so I don't quite understand, it seems the patient in the photos had a chin too prominent and got it fixed, doesn't seem to be like my case..Could you elaborate more on what you posted please?

[notrain]

it seems the patient in the photos had a chin too prominent and got it fixed, doesn't seem to be like my case..Could you elaborate more on what you posted please?

you also have a chin that is too prominent, it is just masked because of the backwards (class 2) lower jaw.

the important thing are the occlusal and mandibular plane angles, which are flat (both you and the girl). that's why you need clockwise rotation of the entire complex, simply advancing your lower jaw would make you look like that girl preop.

[needadvancement]

you also have a chin that is too prominent, it is just masked because of the backwards (class 2) lower jaw.

the important thing are the occlusal and mandibular plane angles, which are flat (both you and the girl). that's why you need clockwise rotation of the entire complex, simply advancing your lower jaw would make you look like that girl preop.

I think I see what you're saying now. However, would this adress the severe lack of chin height though? The girl already had adequate chin height before(imo) so seems like they had enough to work with already.

[needadvancement]

I found some pictures of people with similar issues and they had a SG and it looks quite good imo.

This guy was very similar to me, the short prominent chin with the deep fold and a broad jaw. The results he got look amazing(the page doesn't mention other surgeries so I'm assuming this is all from a SG), his fold seems to have decreased and the transition from chin to the rest of the mandible looks natural. So can it be true what I said before, that a genioplasty could work on me if the majority of the movement is done vertically?

Theres some more on this page(warning-graphic pictures)
http://www.lovethatface.com/cosmetic-facial-surgery-richmond-va/lower-facial-procedures/chin-surgery-lower-facial-implants/

[Modigliani]

^ That guy's nose and lips look different. Are you quite sure he didn't have upper jaw work? Looks like it's been advanced.