How to determine how many MM's for Sliding Genioplasty?

[needadvancement]

I have finally come to this point, I got my first consultation with a maxillofacial surgeon next month and my orthodontist will be there too which is good because he has given me a great result with wilckodontics, and my braces will be removed before the end of the year.

I got a slightly recessed jaw, my chin is forward but very short vertically. I want a SG with significant vertical lengthening and also some forward movement, but how do I determine exactly how many MM's to ask for? I measured top of forehead to between the eyebrows(60mm) from there to bottom of nose(55mm) and down to the chin(60mm).

Having a short face sucks so I'm hoping to get some good lengthening and finally a strong manly chin I always wanted so I don't have a babyface anymore and give some balance to my face because my nose looks big even though it isn't.
Got a new x-ray here:
http://i.imgur.com/1DFvQNF.jpg

[needadvancement]

The maxillofacial surgeon will do a ceph which will determine how many mm you are off from the ideal.  That is generally the amount of movement you aim for.  When do they the ceph and let you know what they think the movement shoud be, if that is not what you want then speak up and let them know.

Right I see. Do you know what they base this on when they look at the ceph? aesthetically speaking, I mean I realise there may be limits because of other factors. But just wondering if they go on what they think looks best..

I'm trying out photoshop and I think I want something like 5-7 mm forward and up to 10mm downward because I lack so much vertical height. But maybe I'm way over my head here.

[needadvancement]

They will take measurements of everything on your face.  They have mathematical formulas that they will use to determine where you do not meet the standard.  They call it x amount of deviation from standard.  Then they will put on overlay on a copy of your x-ray to make the measurements.  However, a good max-fac will be able to look at your face an know within a couple of mm just by looking.  See chiney's thread under the 'general' section titled 'surgery with Dr Gunson in.. weeks' for an example, he has a link to his ceph.  There is a whole science to this and it is pretty standard determining the measurements.  The difference in results usually comes down to surgical technique, aftercare, how much movement you need, and how well you heal.

EDIT:  Your case does not look difficult.

Sounds good to me. Now I'll know how competent they are if they use this method or not.
Also can you elaborate on why you think my case won't be difficult? Thanks.

[buzzhead]

I would just like to suggest that any vertical lengthening would have its limits as for how much lip tissue you have or you risk lip incompetence.

[needadvancement]

I would just like to suggest that any vertical lengthening would have its limits as for how much lip tissue you have or you risk lip incompetence.

Thanks for reminding me that's an important point. I actually do have a somewhat prominent lower lip that has room to be pulled down, I'll make sure to ask the surgeon what the limit is.
This guy had a big vertical lengthening and the change to his lips were significant. Looks like he did not get lip incompetence.

[needadvancement]

I'll be going to my first consultation this upcoming tuesday with the local maxillofacial surgeon. I'm sure he'll answer all my questions but I'm still unsure of what I want personally in terms of mm advancement. I'm trying to find info but what is the limit of SG movement untill bone grafts are need to fill the gaps? Remember I'm getting forward and also vertical advancement like this.



I'm thinking 6 to 7 mm forward and maybe more than that for vertical. I'll post some pictures soon.

[chinnychinchin]

They will take measurements of everything on your face.  They have mathematical formulas that they will use to determine where you do not meet the standard.  They call it x amount of deviation from standard.  Then they will put on overlay on a copy of your x-ray to make the measurements.  However, a good max-fac will be able to look at your face an know within a couple of mm just by looking.  See chiney's thread under the 'general' section titled 'surgery with Dr Gunson in.. weeks' for an example, he has a link to his ceph.  There is a whole science to this and it is pretty standard determining the measurements.  The difference in results usually comes down to surgical technique, aftercare, how much movement you need, and how well you heal.

EDIT:  Your case does not look difficult.

Link for the lazy http://jawsurgeryforums.com/index.php?topic=4737.0

[needadvancement]

Had the consultation today. Mixed feelings about it. My ortho was there, the main guy from the maxillofacial surgery place and the surgeon who also did my wilckodontics and wisdom tooth removal succesfully also came by and he will do the surgery, he's a man I trust and has proven to be capable for me in other treatments so am I doing the right thing going through with it with him?

I mean I can tell these people never really do surgeries for aesthetics, their job is for functional issues. The looks on their faces was sort of "Hmmm do you really want to get a chin osteotomy?".

There is another jaw surgery clinic about 2 hours away from me and on their website they have an elaborate page about sliding genioplasty and they clearly have more experience with this I believe. But I think I will go with my local surgeon who has proven himself to me before..

Next time we'll talk specifics like mm's, limitations etc. This was more of a meeting and to try and get my insurance cover this surgery, which I doubt.

So I have to wait all the way till next year ARGHH for that and longer for the surgery itself. The waits are so frustrating! I want to get this over with already. I don't fear the surgery itself at all, it's just the stress of waiting for appointments, needing questions answered etc.

[SJay]

From the lat ceph, your lower third does not seem disproportionately small relative to your mid third... if you lengthen it by 10mm, you may disrupt the balance. Can you post a profile pic of your face, so we can better asses you facial thirds? Regarding advancement, you seem to have only a very minor recession. Your mandible is far from flat as it is, won't bringing it forward accentuate your deep mentolabial fold? Perhaps you could try a temporary filler, say juvederm, to smooth out your mentolabial fold and add just a little projection. This way you get to try before you commit to a full surgery. If you want, you can PM me a profile pic and I'll morph your potential new chin for you, it would help you get a feel for how you may look with your desired movements.

[needadvancement]

From the lat ceph, your lower third does not seem disproportionately small relative to your mid third... if you lengthen it by 10mm, you may disrupt the balance. Can you post a profile pic of your face, so we can better asses you facial thirds? Regarding advancement, you seem to have only a very minor recession. Your mandible is far from flat as it is, won't bringing it forward accentuate your deep mentolabial fold? Perhaps you could try a temporary filler, say juvederm, to smooth out your mentolabial fold and add just a little projection. This way you get to try before you commit to a full surgery. If you want, you can PM me a profile pic and I'll morph your potential new chin for you, it would help you get a feel for how you may look with your desired movements.

Hey man thanks. Damn I wish I had gotten a copy of my new lat ceph. The wilckodontics surgery I had in May has decreased my mentolabial fold significantly. Before this, my lower lip almost touched my chin, but now you can actually see the whole fold whereas before it was so deep it was completely hidden.

Because of this I believe that sliding genioplasty will look much better. I will try to get the new ceph from my orthodontist this week to post it here, and I will also post pictures of my profile too. Your help will be appriciated!

[ForeverDet]

Hey man thanks. Damn I wish I had gotten a copy of my new lat ceph. The wilckodontics surgery I had in May has decreased my mentolabial fold significantly. Before this, my lower lip almost touched my chin, but now you can actually see the whole fold whereas before it was so deep it was completely hidden.

Because of this I believe that sliding genioplasty will look much better. I will try to get the new ceph from my orthodontist this week to post it here, and I will also post pictures of my profile too. Your help will be appriciated!

Is double saw surgery off the table? Because while I agree a genio with vertical lengthening done correctly should soften your mental-labial fold while also adding projection... your fold is still pretty severe. I worry it may not be sufficient or end up looking how you want. That's still a decent deep bite you have with a flat occlusal plane and jaw recession. All of which can be completely corrected via upper and lower jaw surgery (Probably clockwise rotation, down grafting of your upper jaw and then a mandibular advancement).

Ultimately any procedure other than jaw surgery will be just be masking the issue (but still potentially giving a good result) but I understand why you would opt not to have a such major surgery and all the crap and unpredictability that comes with it.

Now as far as choosing a surgeon... I would not choose (unless I had too) a doc if they don't already have experience with this kind of aesthetic oriented surgery in addition to focusing on function. And from your consult, it doesn't sound like they do even if they are a competent and skilled surgeon. Have they at least done a genio w/vertical lengthening before?

And is going to an out of state to find doc a possibility? One that specializes and has a lot of experience with chin surgery. I'm just thinking of the best route for you but I also understand the cost and logistics of going to a far away doc is not possible for some people.

And finally to answer your question, the picture you put about 6-7 mm of movement for both dimensions is a good guess. Usually 8mm is the maximum before you may see a step-off.

And although it's not universal, the 1:2(or 2.2) for ideal upper lip/chin ratio is a good guide to use. So if your upper lip is 22 mm, your chin length (from the superior tip of your upper lip to the bottom of your chin) should be around 44-48 mm. Still, your chin could be just as long now or longer so the ratio may not be helpful.

I wonder if the lengthening should exceed the advancement... So maybe 7-8mm horizontal and 5 mm vertical?

Oh and I just saw you that mentioned have a more recent ceph? So your mental-labial fold is reduced compared to the pic in your first post?

[needadvancement]

@ Foreverdet- That's useful information, thanks. Yes, for the best result I would have needed comprehensive jaw surgery. But because I never had health problems related to all of my defects in my jaws(no sleep apnea, no tmj etc.) I opted for the 'quick fix' which ideally should make a nice difference aesthetically(though not as significant as double jaw surgery of course). And after all this, the option for BSSO is always open in the future.

Yes I have a new ceph that I will try to get a hold of this week, there is a lot more bone mass right above the chin that helped diminish that crease and even my occlusal plane changed. The lower lip used to hang lower and sink into the m. fold.

Here's how the mentolabial fold looked before:
http://i.imgur.com/sShtdn3.jpg

Here's a current photo. Keep in mind I still have braces on the upper arch making my upper lip protrude more:
http://i.imgur.com/UHw9hLD.jpg

Imo the wilckodontics surgery has helped in this regard and prepared my chin to get a better result.

[Lazlo]

your mouth and lip posture look way better. Strong and handsome. Not week and loose.

[needadvancement]

I finally got a new x-ray.
here's before wilckodontics:
http://i.imgur.com/5UiaMpp.jpg

this is after half a year:
http://i.imgur.com/1DFvQNF.jpg

My mentolabial fold is less deep as I have more bone mass above the tip of the chin now. Can I get more advancement with a sliding genio now? I'm looking for 7mm forward and 7mm vertical height but not decided yet.

[terry947]

Wow this totally removed the bimaxillary protrusion. Crazy. Have you noticed any side effects from wikodontics? Looks like all you need is a genie and you're set. I'm not sure about the exact heights needed but the increase is height is going in the right direction.

Did you also get any expansion between the last molars or was it purely in the front. Also did they just basically expand and pull teeth back?