Jaw/Chin implant vs Jaw Advancement?

[eastcoastian1]

Just wanted to update. Having a consultation with Dr. Jamali (Max/Fac) tomorrow. Seems to be an expert in jaw surgeries and sliding genioplasties. Would like to hear what he says.

Getting so many mixed opinions on whether an implant or sliding genio would be better.

[mike888miller]

ploskoplus

you mention:

a long narrow jaw that Yaremchuk mentioned

as a result of a chin wing.

could you provide a source for this? in a chin wing you could actually widen the ramos, and therefore i would expect that the jaw actually looks shorter

[eastcoastian1]

Just as I was starting to lean more and more toward a sliding genio, I had a Skype consultation with Dr. Jamali today and he said the only route he would recommend is jaw surgery, which is very disappointing. Even though my overbite is pretty moderate, he said because I have a bit of a deep labiomental fold, both an implant and sliding genioplasty would simply make this worse and more obvious. I've seen seen people so far and none of them have mentioned this being a problem so this really makes me feel like I'm back at square one.

[baldguy83]

I had a very deep labiomental fold as well, and was recommended against getting a genioplasty for that exact reason. Fixed it (plus a weak chin) with a BSSO + a chin wing.

[needadvancement]

Just as I was starting to lean more and more toward a sliding genio, I had a Skype consultation with Dr. Jamali today and he said the only route he would recommend is jaw surgery, which is very disappointing. Even though my overbite is pretty moderate, he said because I have a bit of a deep labiomental fold, both an implant and sliding genioplasty would simply make this worse and more obvious. I've seen seen people so far and none of them have mentioned this being a problem so this really makes me feel like I'm back at square one.

The deep fold will not only be prevented from deepening, but it will actually get rid of it if you're also getting vertical advancement on the sliding genio.

This could however be a problem if you feel that you already have a 'long face' because this method will surely lengthen the face visually as well. But if your chin itself is below average height I would still say go for it.

[eastcoastian1]

The deep fold will not only be prevented from deepening, but it will actually get rid of it if you're also getting vertical advancement on the sliding genio.

This could however be a problem if you feel that you already have a 'long face' because this method will surely lengthen the face visually as well. But if your chin itself is below average height I would still say go for it.

Thanks.

Thats just the thing. One oral surgeon said I need a little vertical lengthening, another (Jamali) said I don't need any, just horizontal which is why he said I should only do jaw surgery (despite Yaremchuk and the other oral surgeon saying this was way too extreme for my case), and then Yaremchuk said I need only some horizontal projection BUT, like you said, heavily suggested I do manidbular implants as well or else I WOULD look very narrow. Here is why he suggests an implant rather than a sliding genioplasty for my case:

"Your chin would only be augmented a small amount since it is in the range of normal projection now.Also importantly, it would be augmented at its inferior aspect thereby having minimal, if any, impact on your labiomental fold."

Getting told different things but almost everyone I have consulted with is making this a real frustrating experience.

[needadvancement]

^I see, it must be tough. My advice is if you truly have a vision and idea of what you want to achieve, you should go with the surgeon who's plan fits with your desired results. I'm having consultations for SG soon too and really need vertical lengthening, and if aesthetically the surgeon doesn't think I should do it then I'm not going to get surgery from him, I'll look for the person who agrees with me and is willing to help.

[ForeverDet]

You do not have a deep mental labial fold. The doctor is wrong. It may not be ideal but google image search it, people with moderate to severe deep bites or short face syndrome or VME with lipcompetence/very crappy lower lip posture have it (I did).

And while a modest chin implant or horizontal sliding genio would deepen it slightly as expected since your advancing the chin point, it would not be aesthetically detrimental as far as I can tell from your pictures.

And just to demonstrate two cases NOT like yours but with Class II jaw/bite issues where one had the right treatment and the other didn't. The following patient is an example of adding chin projection to someone with an already prominent chin and deep fold:



And then here's a patient with a deep fold who correctly had a mandibular advancement instead of just chin augmentation. The lower lip fold is normalized and lower 1/3rd looks pretty perfect.



At this point I'm not going to further recommend anything, just to say that adding moderate projection to your chin via any stable method (if you're really against jaw surgery) is not contra-indicated if we're going by your mental labial fold alone.

[mike888miller]

my case is very similar to yours.

when i asked my surgeon about the potential increase in labial fold, he said we could address it by filling out the area with bone graft. but seeing the photo above, it is clear that you are very much limited by how much forward projection you need, i.e. if you need more than 8mm the sliding g. starts looking weird.

[jesterofmalice]

that guy looks brilliant now. Do you know exactly what he had done?

[ForeverDet]

that guy looks brilliant now. Do you know exactly what he had done?

The caption of the pic said lower jaw surgery (BSSO) without mentioning anything else. I can believe that, he just got lucky.

His decompensated bite made room for a lot of forward mandible movement via the overjet. And he probably didn't have any upper jaw issues. So the isolated BSSO corrected the retrognathia, deep mental labial fold and overbite which gave a very aesthetically pleasing result.

[eastcoastian1]

You do not have a deep mental labial fold. The doctor is wrong. It may not be ideal but google image search it, people with moderate to severe deep bites or short face syndrome or VME with lipcompetence/very crappy lower lip posture have it (I did).

And while a modest chin implant or horizontal sliding genio would deepen it slightly as expected since your advancing the chin point, it would not be aesthetically detrimental as far as I can tell from your pictures.

And just to demonstrate two cases NOT like yours but with Class II jaw/bite issues where one had the right treatment and the other didn't. The following patient is an example of adding chin projection to someone with an already prominent chin and deep fold:



And then here's a patient with a deep fold who correctly had a mandibular advancement instead of just chin augmentation. The lower lip fold is normalized and lower 1/3rd looks pretty perfect.



At this point I'm not going to further recommend anything, just to say that adding moderate projection to your chin via any stable method (if you're really against jaw surgery) is not contra-indicated if we're going by your mental labial fold alone.

Thanks again for your detailed feedback as always.

Honestly, if I walked into a max fac or orthodontist and they told me, "yes, you should consider jaw surgery, you'd see a difference", I'd already be in braces getting ready for my surgery for the end of 2016! Haha.

The fact is, I've already gone to two orthos, two max fac, and all 4 told me I would see very little difference if I were to do jaw surgery as my jaw is only slightly recessed and said if anything I should consider chin augmentation and MAYBE invisalign to fix the class 2 on the right, but even that they said wasnt too vital. I don't want to feel like I'm "pushing" someone to perform jaw surgery on me if I really don't need it. If I was told to go for it, trust me, I would.

As it stands though, I'm mostly just getting differing opinions on implant vs genioplasty. Still not sure which route to take honestly.

Also I forgot to ask. Are there any wearable devices out there that might slightly improve the recessed lower jaw since mine is not an extreme case? Something I could wear at night like a mouth guard that might move it forward? I've seen some things out there like SomnoDent which claim to move the jaw forward, but wondering if it's a gimmick or not.

[eastcoastian1]

For anyone who has the ability to analyze an x-ray, I've uploaded a scan of my lateral ceph CT for reference.

[attachment deleted by admin]

[PloskoPlus]

For anyone who has the ability to analyze an x-ray, I've uploaded a scan of my lateral ceph CT for reference.

Steep occlusal plane. 

[eastcoastian1]

Steep occlusal plane.

Not really sure about that. I spoke with Dr. Stephen Schendel last week, another maxillofacial surgeon who primarily focuses on jaw/chin, and he told me my maloclussion was very mild and mandible advancement would only result in advancement of about 3mm, so not to even bother. He actually suggested implants.