Questions regarding genioplasty

[yxcvb]

Hello!

So I'm having my sliding genioplasty in January. My surgeon is on holiday and we're gonna meet before the surgery of course but now I was just researching and there are some things I'm a bit worried about. Besides being a bit scared because of the surgery ofc. 

1. If I'm not mistaken the incision they make is just under the lower teeth inside your mouth. Now I (and probably everoye) have this small tissue called inferior labial frenulum there. Do they cut through this? Or can they cut under it? How does this affect the healing process?

2. Do people who've had this surgery go and get the screws/metal parts removed? I know it can take a year or more till its possible but I'm not really comfortable having metal inside me... Maybe its silly to think about now.

3. Does this surgery affect lip positions, especially lower lip position? Because I think certain muscles which regulate this are all around the area right? I'm not sure though.

3. My surgeon said my genioplasty will improve the labio-mental crease (between mouth and chin) which is naturally very deep for me which is the result of my main problem (recessed jaw). Has anyone had this before and did the surgery really improved it?

4. How long does it take to get back to eating normally after surgery? How long till I can excercise again?

5. What about nerves? I heard there can be nerve damage in special cases. Does the chin go numb for a couple of weeks/months after genioplasty?

Thanks for any answers

Hopefully I just worry too much

[molestrip]

Didn't have genio so will make my best guess:
2. I'm with you here. Believe me. But you gotta get over this. The data is really, really good for these things and despite what surgeons say, you can always get them out if they're a problem. Most times it's local anesthesia even. There's biodegradable, which is a bad idea for jaw surgery but might be ok for genio. Lots of inflammation I hear.
3. Muscle tends to smooth out over time after surgery. I would think it would pull on the lower lip some. You should be fine if you have thick lips.
5. Numbness to chin (and lower lip I think) is very common after genio. You should expect much but not all of that feeling to return. People describe it as a feeling of tightness or slow response. I've seen exercises on Pubmed that you can do during recovery that will help your brain adjust to the new sensitivity, which might help.

You probably do worry too much. I worry way too much. Most people have no reason to worry at all but those that do, worry way too little.

[yxcvb]

Thank you molestrip

Yeah I worry a bit too much because I've never been to a hospital before (other than for being born)... Lucky me I guess. 

And by that I mean never been to a hospital even as a visitor.

I read about the lower lip rolling in a bit after surgery, which wouldnt even be bad for me considering that it rolls out a bit now due to the whole lower jaw being recessed by 8-10mm. My doctor wants to bring the jaw forward by 5-8 and lower it by 5-8mms.

I just hope they dont cut things they arent supposed to.

[PloskoPlus]

So will you have jaw surgery as well?

[yxcvb]

No, my bite is fine, probably a 1-2mm overbite. My main problem is how my chin looks.

[PloskoPlus]

No, my bite is fine, probably a 1-2mm overbite. My main problem is how my chin looks.

If you are in Europe I would consider a chin wing osteotomy.  It would improve your whole jawline, not just the chin.

[yxcvb]

I dont really want a major surgery like that, my jawline is fine, I have a good gonial angle as well, you can check my other thread I have some pictures. Even the chin alone looks good, its just that my jawline isnt long enough, I need a maximum of 8mm of correction really, same with facial length, chin wing would be an overshot I believe. I'd be really happy with 5mm in both directions, basically thats what my surgeon promised also.

[PloskoPlus]

I dont really want a major surgery like that, my jawline is fine, I have a good gonial angle as well, you can check my other thread I have some pictures. Even the chin alone looks good, its just that my jawline isnt long enough, I need a maximum of 8mm of correction really, same with facial length, chin wing would be an overshot I believe. I'd be really happy with 5mm in both directions, basically thats what my surgeon promised also.

OK then.  It's just that 8 mm sounds like a hell of of a lot for gernioplasty.  IMO the perceived need for such a large chin advancement may be indicative of recessed jaws.  BTW, you can have normal occlusion and recessed jaws i.e. both lower and upper being recessed.

[Serra]

Didn't have genio so will make my best guess:
2. I'm with you here. Believe me. But you gotta get over this. The data is really, really good for these things and despite what surgeons say, you can always get them out if they're a problem. Most times it's local anesthesia even. There's biodegradable, which is a bad idea for jaw surgery but might be ok for genio. Lots of inflammation I hear.

What do you mean there is lots of inflammation? For biodegradable screws? What are they made of anyway?

[yxcvb]

OK then.  It's just that 8 mm sounds like a hell of of a lot for gernioplasty.  IMO the perceived need for such a large chin advancement may be indicative of recessed jaws.  BTW, you can have normal occlusion and recessed jaws i.e. both lower and upper being recessed.

I do have a recessed lower jaw and normal occlusion. My dentist confirmed that. Upper jaw isnt recessed, but the angles of the teeth, both upper and lower are outside of the normal range. Meaning my lower teeth has a bigger angle leaning forward while my upper teeth are leaning backwards.

8mm is really an upper limit in my case, but I have a big bony chin so it wont be a problem.

[molestrip]

Check your airway size before committing to a surgery. No point getting this procedure done now only to discover that you have or will have sleep apnea in ten years and will want double jaw surgery to correct it. Under 10mm will definitely do it but 12mm +/- 1mm is considered adequate. Everyone's airway is different though I hear.

As to your question about inflammation, biodegradable is composed of a plastic polymer composite. One degrades quickly over a few months, the other over a few years I think. They've had a hard time getting the mixture right, they're bigger, and there's a greater chance of foreign body reactions. They're used a lot elsewhere in the body and in children but not for jaw surgery mostly because they're not strong enough. Water in flesh cleaves the polymers, slowly breaking them down into lactic acid as I recall reading. I think they're made by inion. I didn't read it myself but a surgeon mentioned the strong inflammatory response. Others just said they're too weak. Like I said, I wouldn't think shifting is too much of a problem in genioplasty alone so I would ask a few surgeons about it.

[PloskoPlus]

I do have a recessed lower jaw and normal occlusion. My dentist confirmed that. Upper jaw isnt recessed, but the angles of the teeth, both upper and lower are outside of the normal range. Meaning my lower teeth has a bigger angle leaning forward while my upper teeth are leaning backwards.

8mm is really an upper limit in my case, but I have a big bony chin so it wont be a problem.

What you're describing is a naturally compensated bite.  Decompensation is what the orthodontists do before surgery i.e make the teeth as straight as possible relative to the occlusal plane.  Then the jaws are moved into proper position.  My teeth were angled and just touched before pre-surgery orthodontics (OK, I had an underbite, which is more objectionable than an overbite, but the principle holds).  The pre-surgery orthodontics made my bite worse on purpose i.e. my teeth were made completely straight relative to the occlusal plane. 

tldr; 8mm genio sounds huge.  Don't camouflage things, get jaw surgery.  You may need no genio at all, or a much smaller one if you get a BSSO.

[yxcvb]

What you're describing is a naturally compensated bite.  Decompensation is what the orthodontists do before surgery i.e make the teeth as straight as possible relative to the occlusal plane.  Then the jaws are moved into proper position.  My teeth were angled and just touched before pre-surgery orthodontics (OK, I had an underbite, which is more objectionable than an overbite, but the principle holds).  The pre-surgery orthodontics made my bite worse on purpose i.e. my teeth were made completely straight relative to the occlusal plane. 

tldr; 8mm genio sounds huge.  Don't camouflage things, get jaw surgery.  You may need no genio at all, or a much smaller one if you get a BSSO.

The problem with this is that I'm not only talking about my fronth teeth. The angles only refer to my front teeth. Pretty much all the teeth besides those are where they should be. Like molars touching etc. So its certainly more complicated than that. Not to mention I probably couldnt afford anything but a genioplasty right now.

What I more care about is appearance, since I dont have issues with my teeth. I dont know if BSSO would provide anything more than I can achieve with a genio i.e. a slightly longer jawline.

[yxcvb]

BTW if anyone interested here is an x-ray.

As you can see what really gives it away is the very deep mentolabial fold and the general upward and backward stance of the chin.

What I really would like is actually more the extra HEIGHT of the lower third plus a small (5mm max) extra forward projection.

Basically what my surgeon told me is that this wont be a sliding genioplasty in the classic sense but more like a slide and a clockwise rotation of the end of the bone itself which could achieve the extra height.

[PloskoPlus]

I just don't see how lengthening the chin can do anything but make the mentolabial fold worse.