"Best" surgeons for genioplasty?

[berback]

Any ideas which surgeons arguably have the "best" sliding genioplasty results (anywhere in the world) and pictures we can post/discuss?

[yxcvb]

How much forward/downward movement you can get is dependent on the thickness and shape of the bone, plus how much the nerves can stretch, not really by any kind of theoretical "maximum". My surgeon calculated in my case that 8mm is the maximum, while others might have less/more.

[needadvancement]

How much forward/downward movement you can get is dependent on the thickness and shape of the bone, plus how much the nerves can stretch, not really by any kind of theoretical "maximum". My surgeon calculated in my case that 8mm is the maximum, while others might have less/more.

But still most people report nerve damage post surgery. I don't know if that's because a lot of surgeons aren't competent enough to do the calculations you mentioned or the surgery itself is that unpredictable and risky?

[ForeverDet]

Well the statement that A&G elongate the chin with a maximum of 4mm with sg surgery appears not to be true. I like this result a lot. (Arnett & Gunson, found this picture in the following thread, didn't find the exact source though: http://www.jawsurgeryblog.com/forums/viewtopic.php?f=8&t=3628&start=30).

This is an amazing change. I'd love to see more sg results of A&G. The guy underwent orthognathic surgery too though of course.

Actually it is true even though I disagree with their philosophy on it. The chin point itself which was seems to be what you're referring can end up 40mm if needed (I don't think I've seen much more than that but it would be fore people with basically no chin) from where it started mostly through a large mandibular advancement which is what A/G can do. The cutting of the chin bone itself to be advanced aka sliding genioplasty is where the 4mm max figure comes from.

For what's worth, I had a 8mm genio before having double surgery with Gunson where they advanced my mandible around 13mm and it wasn't an issue. I don't know if it would have made much difference if I never had the genio and they lengthened my mandible a bit more then done a smaller genio.

I think the main reason they sway from larger genios is that in the past doctors would compensate for the inadequate mandible advancement with large genioplasty. Also that step-off deformity may result from genio's although I believe that can be dealt with during surgery with some sort of augmentation like HA or implants. But anyway once counter-clock rotation was utilized, the occlusal plane abnormalities could be corrected and this allowed huge jaw advancements with stable results. In any case, I don't think it would be necessarily "poor planning" as they put it if someone had slightly smaller BSSO and larger genioplasty as long it didn't compromise the final result.

And OP not sure if you meant doc's who do just genioplasties or in conjunction with jaw surgery but A/G don't do isolated genioplasties.

[yxcvb]

But still most people report nerve damage post surgery. I don't know if that's because a lot of surgeons aren't competent enough to do the calculations you mentioned or the surgery itself is that unpredictable and risky?

I doubt most people would report nerve damage, but nerves get streched which can take some time to heal completely. Very few people have any kind of permanent damage with this surgery. Most people have some kind of numbness after surgery which might take weeks/months to stop.

[needadvancement]

I doubt most people would report nerve damage, but nerves get streched which can take some time to heal completely. Very few people have any kind of permanent damage with this surgery. Most people have some kind of numbness after surgery which might take weeks/months to stop.

Well imo numbness falls under nerve damage and I have yet to see somebody post-surgery say that everything has gone back to normal, but that could be because most people stop updating post-surgery.

I also wonder that besides the stretching of the nerves do they sometimes get damaged or even severed during surgery?

[Gregor Samsa]

I had a very minimal genioplasty along with a Le Fort I and I have no numbness whatsoever.

[SGseeker]

Bumping this post! Who are the "best" sliding genioplasty surgeons in the world??

So far I have read above Arnett and Gunson. Do they even perform SG alone ? I read on another forum that they only do it combined with jaw surgery. If they do it alone- how much is it ? Anyone have experience going to them for only a SG ?

Any other surgeons in the world that anyone would say are "THE BEST" ?

THANKS

[chinnychinchin]

Actually it is true even though I disagree with their philosophy on it. The chin point itself which was seems to be what you're referring can end up 40mm if needed (I don't think I've seen much more than that but it would be fore people with basically no chin) from where it started mostly through a large mandibular advancement which is what A/G can do. The cutting of the chin bone itself to be advanced aka sliding genioplasty is where the 4mm max figure comes from.

For what's worth, I had a 8mm genio before having double surgery with Gunson where they advanced my mandible around 13mm and it wasn't an issue. I don't know if it would have made much difference if I never had the genio and they lengthened my mandible a bit more then done a smaller genio.

I think the main reason they sway from larger genios is that in the past doctors would compensate for the inadequate mandible advancement with large genioplasty. Also that step-off deformity may result from genio's although I believe that can be dealt with during surgery with some sort of augmentation like HA or implants. But anyway once counter-clock rotation was utilized, the occlusal plane abnormalities could be corrected and this allowed huge jaw advancements with stable results. In any case, I don't think it would be necessarily "poor planning" as they put it if someone had slightly smaller BSSO and larger genioplasty as long it didn't compromise the final result.

And OP not sure if you meant doc's who do just genioplasties or in conjunction with jaw surgery but A/G don't do isolated genioplasties.

Hmm just wondering, did you specifically request a larger genio?

[needadvancement]

I think I'm gonna end up with an unknown maxillofacial surgeon at the local hospital for this surgery.

Do people travel a lot to known surgeons for a sliding genioplasty? For orthognathic jaw surgery I can understand but what about SG.

[SGseeker]

I just re-read this thread and saw my earlier comment/questions when I started researching. A&G can do a SG alone without jaw surgery (since they are doing mine).
I am going to Dr. Gunson for SG (travelling from Toronto) because of all of the horror stories I have read of people going to plastic surgeons for a SG and getting botched (too common).

I feel that although it is a straightforward procedure you need to go to someone who does a lot of jaw surgeries AND  SG's in order to have a better result. (fingers crossed). I know that A&G have been doing this for a while and have been on more complex cases and also take into account end result aesthetics which made me feel more comfortable. I have consulted with other maxillofacial surgeons (NY and Toronto). They were good options but the consult I had with Dr. Gunson was a lot more comprehensive and in depth which added to my comfort.

Going back to your question of what do other people do: they go to the best, they go to regular maxillofacial surgeons in state, and they go to plastic surgeons. There is not enough information about SG in isolation to know what's best for you to do. Follow your gut.

[ForeverDet]

Hmm just wondering, did you specifically request a larger genio?

I had the genio in 2007 with a local doc. I requested the maximum possible because I mistakenly thought it would correct most of my jaw issues. Plus my chin was way back there.

SGseeker - your case is the first I've head of them doing isolated genio's, which is awesome! It must be rare because their staff used to say they didn't do that.

[SGseeker]

I had the genio in 2007 with a local doc. I requested the maximum possible because I mistakenly thought it would correct most of my jaw issues. Plus my chin was way back there.

SGseeker - your case is the first I've head of them doing isolated genio's, which is awesome! It must be rare because their staff used to say they didn't do that.

Yes - I am the first i have heard of as well. They did say they don't normally do this. They wanted me to come in for a consult. Dr. Gunson was going to recommend double jaw surgery but after doing all of his analysis the difference was only 2mm. He is doing a rotational genioplasty which is something that not many surgeons perform overall (he said only a handful in the US). I think that is why he is taking it on and the fact that I came all the way from Canada to see him? maybe that had something to do with it. Overall I have read from many people they don't do it alone. I'm hoping it is a good thing he is taking it on.