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

[Serra]

Oh man. First of all, I'm going to write a summary of my story. There are parts throughout it where you'll think I'm stupid and want to throw rocks at the past version of myself. Believe me, I do too.

Last August, I had lower jaw surgery and genioplasty for a class 2 anterior open bite. The surgeon wanted to change to double jaw surgery at the last minute, but having no gummy smile, I refused. He said we could still do lower jaw surgery with 85% chance of stability. He said the jaw would be setback a little, and the chin advanced 3-4mm. Even with the hypothetical double jaw surgery and its planned upper jaw advancement, the lower jaw would be "setback into ideal occlusion." I just blindly trusted this dr with an excellent reputation. He had told me he would "fix my face," after all. I'm going to call this surgeon Dr. Asshole.

During surgery, Dr. Asshole did whatever the hell he wanted for my chin instead of following his plan. It was advanced 8mm, lopsided, and elongated by leaving a vertical gap between the mandible and chin. I'll attach the x-ray to show you what I mean.

As the swelling came down, I freaked out. I looked like a mix between the lochness monster, a transsexual and Jay Leno. Dr. Asshole had told me the length was due to the vertical gap left there due to the exaggerated movement. I had said it looks like my chin is a centimeter longer. His response was that SG actually shortens the face. Feeling completely powerless and in an emotional frenzy, I conceded to his explanation and did a revision a month after the original surgery. He set it back a few millimeters, closed the gap and fixed the asymmetry.

After this, my face was shorter but still looked longer than it did originally, as did my chin. Iatrogenic soft tissue deformities appeared: my mentalis muscle was drooping and dimpling upon closure of my lips. I had never had mentalis strain before. My face looked very gaunt and masculine to me. My lower lip shrunk considerably. I could not look in the mirror without emotionally breaking down.

I went to other surgeons in my area and they were either clueless about the drooping tissue, or refused to see the issues, or not eager to take on my case. I saw Dr. Asshole again and told him I wanted to reverse the genioplasty and have the muscle fixed. He said he'd successfully fixed the muscle issue once before. He told me he was tempted to just shave down the chin instead of reversing it, and of course resuspend the mentalis muscle.

I'd posted here sometime during this time. Someone told me not to let him touch me again. I knew I should have listened, but at the time it looked like I had no other options. I was on the verge of succumbing to my loss of will to live. I had no job and no money as well.

Dr. Asshole said he was very capable of reversing it. I brought up ragirl's SG reversal story that I'd read online, where a surgeon said he hadn't been capable of reversing the chin bone to its original place. Dr. Asshole said that inability to reverse it was not possible.

After several appointments, I was still adamant on reversing the chin. I didn't care about my profile if it made me look horrible from all other angles. Dr. Asshole finally said that we'll do a reversal. He said this at my last pre-op appointment a month before the Feb. 26 surgery, 5 minutes before the surgery and at one week post-op.

BTW, during the surgery, the screws in my lower jaw were removed as well. I swelled up more than I ever did in the initial jaw surgery, to the point I was waking up with an eye swollen half shut.

I wore a jaw wrap religiously for 3 weeks+ after the 3rd surgery to help the mentalis muscle reattach properly. When the majority of the swelling was down, and I took the wrap off, something looked off. My chin looked strong and my face long. Apparently, the rotation of my lower jaw had only accounted for 1mm of chin projection. Something was amiss.

I asked Dr. Asshole for the routine post-op x-rays, pretending not to suspect anything. He said he didn't think it was necessary as he didn't suspect an infection. Naturally, this set off alarms in my head. Within the following week, I emailed his surgical coordinator if I could come in for a few minutes to do an x-ray. She said we'll do it at my next appointment.

I was going crazy at this point. Finally, I obtained an x-ray from my ortho. I went to see another maxillofacial surgeon and they confirmed to me that my SG had not been reversed. I don't know however, what he did exactly, but to me it obviously looks like he aggressively shaved down the shelf of the sliding genioplasty. The anterior-posterior projection of my chin is hardly different compared to before.

What I was planning to do, was get temporary anchorage devices (TADs)/miniscrews to intrude my teeth and reduce anterior facial height a tiny bit and allow for a small auto-rotation of my mandible and maybe help the iatrogenic chin dimpling. Basically, what I wish I had done originally, when 2-3 years ago I barely found any literature on the subject and orthos were telling me that TADs may not work and are experimental. Now I find they fix open bites much worse than mine and give double jaw surgery-like results without the effects on the nose.

So now, I am still looking to reverse the genioplasty. My face is a mess. I still have dimpling/mentalis bunching and droopiness. I'm terrified. I've seen one ortho in person about TADs and she said go see a surgeon first. She called my current chin "rough looking." Also, one of my cheeks now looks gaunt and flat on 3/4 view. I don't know why. She noticed this on her own without me saying anything.

I'm wondering what my course of action should be. Obviously, I am pursuing justice in regards to my asshole sociopath of a surgeon. I'm actually seeing him this week. That should be interesting.

Anyway, this is where your help comes in. If you can chime in with any insight in regards to the following, it would be so, so helpful:

- What does it look like he did on the x-rays to you?

- Does it even look like it can be reversed?

- What are your opinions on someone with a now normal bite getting TADs for vertical reduction, auto-rotation of mandible, and possibly mentalis strain? (Referenced to as "slow impaction" in this paper; astounding results: https://www.aaoinfo.org/system/files/media/documents/Paik%2C%20Cheol-Ho%20--%20Revised%3B%20Molar%20Intrusion%20Using%20TADs%3B%20The%20Key%20Element%20to%20Correcting%20Anterior%20Open%20Bite.pdf )

- Surgeons who might be able to help?

- Any advice regarding my situation, etc.

[Serra]

Someone messaged me asking for pictures in the flesh. Here is my profile pre-op, after the second surgery and soon after the third surgery. The second pic collage is the same thing, just with the current chin pic having less swelling.

Keep in mind, while the chin looks good in profile view, it is in complete disharmony with my face when you see it from the front or 3/4. It shouldn't have been done on someone who theoretically needed an impaction.

In the xray, if you draw a straight line from my lower incisors to my chin point, you can see the curvature/projection of my chin is completely different compared to originally.

[Serra]

Dr Asshole is in Montreal, Canada. I don't want him to find this post by writing his name publicly. Message me if you want his name

[Serra]

can you post a picture from the front?  because, like you said, i don't see what's wrong from the side...

I would have to post my entire face and I don't want to. Believe me, just google sliding genioplasty and long/longer face and you'll see this is a common complaint. As someone who had a skeletal open bite, which is synonymous with long face syndrome, this shouldn't have been done on me. He wanted to do a 4-6mm upper jaw impaction on me for christ's sake. I look like a witch now, with a mandible that still sits low/back but with a manly, long chin that juts out of my face. It also changed the way my lower lip sits for the worse and it is smaller. (The lip is even crooked now because of how the bony change pushes a deep epidermal cyst up onto the left side of my lower lip.)

Chialatia had the same complaints as me before she had her SG reversed. Her chin was lengthened and it masculinized her face.

[needadvancement]

I wish I could take your chin enhancement for myself.

[Serra]

I wish I could take your chin enhancement for myself.

It's not worth the balling, dimpling and drooping of the mentalis muscle.
These pictures are too low-res to adequately show the dimpling and balling but you get a small idea of it. It's much worse in person.

[needadvancement]

I just read a bit more about your case. Something definitely went wrong there but I'm not sure what.

[Serra]

I saw another maxillofacial surgeon today. He said it can't be reversed to how it was.
So now I have
a long, gaunt, masculine face
crooked bottom lip
shrunken bottom lip
chin ptosis
severe mentalis strain dimpling
mentalis balling
a side of my face that lost the cheek curve, probably due to chin bone being advanced more
and no hope.

I can't take it. I can't.

[needadvancement]

That much damage from a sliding genio how could this be?

[Lazlo]

honestly from the side i thought your first result looked awesome (i mean the second pic in your series of photographs). You definitely had a retrognathic chin and then you had it fixed --sure it was a strong chin but not masculine, that type of look is considered highly attractive, look at any female model or Angelina Jolie or whatever, all have strong, long well defined chins and jawlines. So i think your results looked great. Did you have the ptosis, balling etc. AFTER the first surgery or after the revision? Cause I think it's the revision which was a bad idea.

But don't worry, everything can be fixed. It might take time, you might have to fly and save money and find the right surgeon, but it's not a life ending situation. So steel up your courage and start devising a plan of action.

[PloskoPlus]

I was at the doctors the other day.  I was flipping through a fashion mag (Vogue?). I suddenly realised that those women have MASSIVE jaws and chins. 

[Serra]

honestly from the side i thought your first result looked awesome (i mean the second pic in your series of photographs). You definitely had a retrognathic chin and then you had it fixed --sure it was a strong chin but not masculine, that type of look is considered highly attractive, look at any female model or Angelina Jolie or whatever, all have strong, long well defined chins and jawlines. So i think your results looked great. Did you have the ptosis, balling etc. AFTER the first surgery or after the revision? Cause I think it's the revision which was a bad idea.

But don't worry, everything can be fixed. It might take time, you might have to fly and save money and find the right surgeon, but it's not a life ending situation. So steel up your courage and start devising a plan of action.

Muscle issues appeared after the revision. Believe me, I NEEDED it. I looked like a monster. Even the surgeon admitted as much without using those words.
Different surgeons tell me different reasons for the muscle issues. Dr Asshole speaks of an elasticity in the muscle that developed from it being elongated in the first surgery and then not being suspended enough in the second. Another surgeon says the cut was not symmetric. One says it's scar tissue. It could also be from the cut being too wide or something.

I'm going to post a pic of an actress to explain my situation; an actress who is speculated to have gotten a chin implant which had a drastic effect on her face shape making it look longer and gaunt; Katie Cassidy:





to


I think she had a SG, not a chin implant. Her facial changes are eerily similar to mine. Except, mine are worse because I have vertical maxillary excess that was never addressed.

For more pics of this girl's facial changes and discussion on another forum: http://s1.zetaboards.com/anthroscape/topic/5792083/1/

[Serra]

I was at the doctors the other day.  I was flipping through a fashion mag (Vogue?). I suddenly realised that those women have MASSIVE jaws and chins.

Forward grown jaws, no doubt. SG on my jaw just accentuated the steep angle of my lower jaw. It lengthened a jaw pointing to the floor instead of a jaw pointing to the wall.

[Serra]

That much damage from a sliding genio how could this be?

I waltzed into this surgery knowing only of the risks of numbness and infection. Don't be me.

[girl]

Forward grown jaws, no doubt. SG on my jaw just accentuated the steep angle of my lower jaw. It lengthened a jaw pointing to the floor instead of a jaw pointing to the wall.

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.