Damage control after botched surgery. One hell of a drama. Forensic analysis

[needadvancement]

EXACTLY.

This is precisely what a sliding genioplasty does when performed on people with retrognathia. I have seen at least 6 results (including my own) that looked bad due to pre-existing jaw problems that were either undiagnosed, inaccurately diagnosed or treated incorrectly.

I can't help noticing how doctors have hopped on the genioplasty bandwagon to make easy money, selling it as a "natural solution". As a result, they frequently misdiagnose retrognathia as a "weak chin" so that they can get a healthy stream of income buttressing the "big cases" that pay out later down the line (or they do genios to avoid sacrificing potential income, given the fact that chin implants have to be bought in first). Doing a genio on a retrognathic lower jaw is, 8 out of 10 times, a terrible idea. Even more so when the patient has a long face, a recessed mid face and a disharmonious relationship between the facial thirds - a situation that requires either jaw surgery OR, a well thought out camouflage tactic to "improve" rather than correct one defect without throwing the rest of the face out of balance.

If the rest of the face (including the mid face) is narrow or horizontally underprojected, adding a comically large chin to "make up for it" will make it look as if half of the lower face is making a bid for escape. That gives a very different look to the model-like jawline of Angelina Jolie. It will also tent the cheek skin forward if it's aggressive; this happened to me.

 A "weak chin" in isolation presents as a curved back piece of bone on a horizontally aligned jaw and a harmonious relationship between the facial thirds. Retrognathia and weak chins exist in tandem, but there seems to be absolutely no effort on the part of doctors to determine a) to what extent is the jaw recessed vs. the chin bone and b) the RELATIVE proportions of the lower jaw, the mid face, etc. to the projection of the chin. All they do is look at that stupid horizontal line, which is akin to trying to build a house without first ensuring that the underlying foundations will even support the new structure. 

In fact, the genio seems to be used as a "cover up" by doctors who fail to rotate the lower jaw or advance it enough.

As open_bite says, the natural angle of the jaw is a crucial determinant of what your genio results will look like. If your jaw is steeply inclined and your surgeon happens to be one of the 90% of uninspired, unskilled doctors out there who do the same thing on everyone without giving it a second thought, the cut piece of chin bone will be advanced downwards and vertically, rather than horizontally. This causes balling and dimpling IN ITSELF - no-one's chin is designed to house a malpositioned, incorrectly aligned piece of rock, no matter whether it's "your own bone" or not.

I have seen results of chin implants that have been placed incorrectly (i.e. pointing down vertically); in those cases, that caused balling and dimpling. It's not simply due to repeated reoperation nor failure to resuspend the mentalis muscle. If something like this is wrong then it can never be right.

If there is vertical maxilliary excess and a retrognathic lower jaw, then you will look like a witch. Yet all they will do is refer to that ridiculous horizontal line.

Anyway, let this be a warning to everyone who's thinking of getting a genioplasty to "cover up" a recessed jaw. You will regret it.

What about a recessed lower jaw that has a chin with good forward growth but very stunted vertical length? Would a SG be a good candidate there? One with mostly vertical lengthening and a but of forwarding too..

[girl]

What about a recessed lower jaw that has a chin with good forward growth but very stunted vertical length? Would a SG be a good candidate there? One with mostly vertical lengthening and a but of forwarding too..

I should clarify - I was referring to advancement genioplasty in my previous post. Not vertical wedge resection or narrowing/chin reshaping - these could be useful, depending on the starting point.

In my view, doing an advancement genioplasty on a recessed jaw = a big no no unless all other facial proportions are in sync and the forward growth of the lower jaw was "stunted" but not steeply inclined.

In that situation, it could work - as long as there was no mid face retrusion or vertical maxilliary excess. Those 2 things should rule out a genio automatically. Even oval shaped faces should avoid genios.

[girl]

I overlayed your before and after pics on Photoshop - this clearly shows the remaining chin: 


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[Serra]

I overlayed your before and after pics on Photoshop - this clearly shows the remaining chin:

Thank you ragirl; that's very, very helpful

I saw Dr. Asshole yesterday. He is insisting that it's been reversed and the chin is flat like before. They did an xray on me and sent it to me. It looks different than the one I got at the ortho a bit. He was also taking his time to analyze it before he came to talk about it in the room with me.

The orange x-ray is Dr Asshole's. I'll attach a pan x-ray from my ortho to show one side has a huge step-off while the other has a much smaller one.

[molestrip]

@ragirl I think you give those surgeons too much credit. They'd make a lot more money with jaw surgery, except many patients would decline because of how much more invasive it is. I'm going to blame incompetence. This is why you need to use someone who only does jaw surgeries, several times a week!

@open_bite That actress looked better before. Failure to accomplish desired results is probably the biggest risk factor in any aesthetic surgery. So you had a lower jaw surgery and your surgeon revised your chin a month afterwards? He could have easily screwed up your jaw surgery! I wonder how healed the muscle was from the initial surgery too and if that's why you're having issues. At least the chin is a relatively easy area to access. I suspect it can still be fixed. The good news is that, given enough time, your peers will eventually catch up with you We all ugly starting in our 40s.

[terry947]

so if you have a retrognathic mandible then youd obviously need to advance it so that a SG would look good?

Is that a way to avoid a longer looking face with a SG?

[Serra]

so if you have a retrognathic mandible then youd obviously need to advance it so that a SG would look good?

Is that a way to avoid a longer looking face with a SG?

No. It's not that simple.
My lower jaw was rotated forward. If anything closing my open bite should have made my face shorter. My face still looks longer.

[Serra]

Pics of dimpling and crooked lip. Do you guys think the crookedness is due to a cyst right under my lip on my left or that it's the muscle drooping on the right causing it? The muscle drooping doesn't look bad in these pics but in other pics you see it is. I'm manipulating either the cyst or the chin muscle with my fingers in the photos to try to figure it out.
My lip was crooked right after the first surgery when there was no drooping, so I thought it was the cyst, but drs say it's likely the muscle. Sorry the pics are sideways - they won't rotate. Just download them to see them the right way up.


Oh and just for kicks, I'll include a pic of the monstrously huge crooked chin he gave me in the first surgery. *EDIT: removing this pic*

I just found out my surgeon stopped being the maxillofacial surgeon in chief at the hospital the same month as my jaw surgery after many years. Hmm.


I asked a surgeon on allexperts about the drooping and he said this:

It is a little difficult without examining you, but the drooping could be from a poor alignment of the tissue, too much stretching of tissue on one side or it could be some minor trauma to the nerve that affects the muscle tone of the lip.

To repair, the cause needs to be determined and then correct the situation.  I'm not sure if the area can be made equal to the other side after the trauma, but you need to see an evaluation directly with a different plastic surgeon or oral and maxillofacial surgeon,

If you have additional questions, feel free to contact me again.
Joel S. Teig, DMD, Retired Diplomate ABOMS - As a retired diplomate I will attempt to answer your questions to the best of my knowledge.

[Serra]

@ragirl I think you give those surgeons too much credit. They'd make a lot more money with jaw surgery, except many patients would decline because of how much more invasive it is. I'm going to blame incompetence. This is why you need to use someone who only does jaw surgeries, several times a week!

@open_bite That actress looked better before. Failure to accomplish desired results is probably the biggest risk factor in any aesthetic surgery. So you had a lower jaw surgery and your surgeon revised your chin a month afterwards? He could have easily screwed up your jaw surgery! I wonder how healed the muscle was from the initial surgery too and if that's why you're having issues. At least the chin is a relatively easy area to access. I suspect it can still be fixed. The good news is that, given enough time, your peers will eventually catch up with you We all ugly starting in our 40s.

Yes he did.
The 40s thing is not encouraging. I spent my early 20s anticipating and sacrificing for this surgery, waiting to be able to not worry about it. Now I can't look in a mirror without crying. Before this surgery, I at least liked going out into the world and took some pride in my appearance. Now I do everything to hide even from myself.

[aristidine]

@open_bite I can understand why you're sad and upset but from these photos, and only seeing the lower third of your face mostly, even with the dimpling there, you look really pretty to me. you seem to have wonderful skin, and have beautiful lips.

i have seen super conventionally attractive people - both men and women - with slight imperfections like scarring or other markings on their face and it made them even more attractive to me somehow. i realize i'm just one person, and i'm definitely not trying to tell you how to feel or take away from your experience, but i bet you are still super beautiful. it's this combination of post-surgery regret, feeling betrayed by your surgeon and the fact that this wasn't a part of your appearance before that's causing overfocus on this one comparatively small area of your face, because overfocusing and ruminating like that is our mind's attempt to fix the problem. don't forget that the dimensions of attraction lie in how all your features come together.

it just bums me out to read this "Before this surgery, I at least liked going out into the world and took some pride in my appearance. Now I do everything to hide even from myself." although i can fully relate to the feeling.

[Serra]

@open_bite I can understand why you're sad and upset but from these photos, and only seeing the lower third of your face mostly, even with the dimpling there, you look really pretty to me. you seem to have wonderful skin, and have beautiful lips.

i have seen super conventionally attractive people - both men and women - with slight imperfections like scarring or other markings on their face and it made them even more attractive to me somehow. i realize i'm just one person, and i'm definitely not trying to tell you how to feel or take away from your experience, but i bet you are still super beautiful. it's this combination of post-surgery regret, feeling betrayed by your surgeon and the fact that this wasn't a part of your appearance before that's causing overfocus on this one comparatively small area of your face, because overfocusing and ruminating like that is our mind's attempt to fix the problem. don't forget that the dimensions of attraction lie in how all your features come together.

it just bums me out to read this "Before this surgery, I at least liked going out into the world and took some pride in my appearance. Now I do everything to hide even from myself." although i can fully relate to the feeling.

thanks for the kind words. why can you relate to the feeling?
the thing is, it does affect how all my features come together. the whole shape of my face has changed in addition to iatrogenic tissue deformities and asymmetries the surgery created.
it's extremely traumatizing. I have looked 4 different ways in the last 9 months, and the last surgery was one I didn't consent to.

[Serra]

Guys, does it look like my lower jaw was lengthened? I'm trying to figure out if that is a reason why my face looks so long now.
Take a look at my xray after my first surgery. To me, it looks like it was lengthened.
My surgeon told me before the surgery it was being set back, which didn't really make sense to me at the time because I was class 2.
One male surgeon said if anything, the jaw movement should make my face look shorter.
One female surgeon said it's a smidge longer but barely.
I spoke to Deschamps-Braly on the phone the other night. He said the jaw movement could be contributing to what I see that I don't like now.

I'm so confused. I would reverse the jaw surgery if that's also what's doing it, then use tads to fix the bite like the f**king ortho should have done. I can't live like this.


They finally sent me more cephs, weeks after I asked for them. I wish I had the same angle from pre-op, but I just sent a request asking for my medical record. How can they say it's reversed? Doesn't it clearly look like it's not?

[dantheman]

Looked at your pre-op and post op ceph. Interestingly your jaw angle doesn't look that steep in those. Sorry I didn't read the fine stuff, but it looks like you had an open bit with mentalis strain, that accentuated the class 2 appearance. I have a similar profile and some of the best surgeons recommended chin wing or genio, so I'm not sure this was necessarily the wrong decision in your case...

[Serra]

Looked at your pre-op and post op ceph. Interestingly your jaw angle doesn't look that steep in those. Sorry I didn't read the fine stuff, but it looks like you had an open bit with mentalis strain, that accentuated the class 2 appearance. I have a similar profile and some of the best surgeons recommended chin wing or genio, so I'm not sure this was necessarily the wrong decision in your case...

I never had mentalis strain until postop. I never had lip incompetence.
Usually open bite is solved with upper jaw surgery as it's caused by vertical maxillary excess. My maxilla wasn't touched. I think TADS would have worked better.