Sliding Genioplasty Swelling

[Vic]

How long does it take to be able to go out in public after a sliding genioplasty with the swelling?

[needadvancement]

Good question I'm wondering the same.

To follow up on that, can the swelling be hidden more if you grow out a full beard?

[asphyxia]

You should look decent enough by one week, expect some swelling still, but people won't pay much attention, except for talking, it will feel uncomfortable

[Vic]

Did you have much swelling to the front of the chin where the incisions were inside the mouth? also, I heard about the bottom lip rolling in and becoming thinner, does that happen and resolve itself?

[asphyxia]

front the front, yes, it seemed much to me but my relatives told me it was ok, so psychological bias, I guess, and as for the lower lip, yes, it goes a bit upward, it's been 3 months and it's still upward, but it doesn't bother me.

[Purist]

I always thought an SG brought the lip downwards.. I thought this was a primary reason not to go with an SG with mentalis strain as this would compound the problem? Is that not the case?

[kjohnt]

I always thought an SG brought the lip downwards.. I thought this was a primary reason not to go with an SG with mentalis strain as this would compound the problem? Is that not the case?

I think there are two separate issues being discussed if I understand correctly. 

Vic and asphyxia are discussing rolling of the lower lip, which should be less apparent with more boney volume in the chin when the soft tissues would be stretched.  So a SG should help that. 

Mentalis strain, as I understand, is due to a person string to keep the lips together due to too much lower facial length.  I think many things could cause this... retrusive mandible, long maxilla, open bite, etc.  I'd think a SG cold make this better or worse depending on surgical planning, but yes, more volume via SG would likely make it worse.  But the real underlying issue is improper jaw placement and the correct fix is orthagnathic surgery.  I could be wrong here as I haven't researched this much since it is not one of the issues I face personally.  In any case, mentalis strain is a different conversation than rolling of the lower lip and/or deep labiomental fold.

[ForeverDet]

I always thought an SG brought the lip downwards.. I thought this was a primary reason not to go with an SG with mentalis strain as this would compound the problem? Is that not the case?

As a rule, there is no reason for mental strain to increase with a genio as long as the mentalis muscle is properly re-attached. When it isn't, it's ptosis and the chin/lower lip hang unnaturally. Personally, my genio raised the lower lip in smiling position (covered more mandibular incisors) but little to no effect on my lower lip in repose. The only way I imagine a genio can raise the lower lip at rest is by tipping the chin bone upward which should bring the lower lip closer to the top as well as make it curl inward. And I don't mean vertical reduction genioplasty which just shortens the chin height.

In general with even jaw surgery. it's difficult to have confident soft tissue prediction since the lower lip tends to be very self supporting (or in divergent cases, not self supporting unfortunately hence the "droopy" look) instead of following the lower bone contour behind it.

I think there are two separate issues being discussed if I understand correctly. 

Vic and asphyxia are discussing rolling of the lower lip, which should be less apparent with more boney volume in the chin when the soft tissues would be stretched.  So a SG should help that. 

Mentalis strain, as I understand, is due to a person string to keep the lips together due to too much lower facial length.  I think many things could cause this... retrusive mandible, long maxilla, open bite, etc.  I'd think a SG cold make this better or worse depending on surgical planning, but yes, more volume via SG would likely make it worse.  But the real underlying issue is improper jaw placement and the correct fix is orthagnathic surgery.  I could be wrong here as I haven't researched this much since it is not one of the issues I face personally.  In any case, mentalis strain is a different conversation than rolling of the lower lip and/or deep labiomental fold.

Exactly right. Lower lip vermilion and posture changes (rolling inward in this case so the lower lip appears thinner with perhaps a flatter mental-labial fold) and lip incompetence are two different phenomenon.

Mentalis strain is the chin muscle showing hyperactivity usually due to the upper and lower lip having an excessive gap (there often is too much upper incisor exposure at rest which makes the upper lip appear short). Lips should meet at rest or only have a small gap as long as when your lips touch there is no visible chin, lip or alar base straining.

[needadvancement]

As a rule, there is no reason for mental strain to increase with a genio as long as the mentalis muscle is properly re-attached. When it isn't, it's ptosis and the chin/lower lip hang unnaturally. Personally, my genio raised the lower lip in smiling position (covered more mandibular incisors) but little to no effect on my lower lip in repose. The only way I imagine a genio can raise the lower lip at rest is by tipping the chin bone upward which should bring the lower lip closer to the top as well as make it curl inward. And I don't mean vertical reduction genioplasty which just shortens the chin height.

In general with even jaw surgery. it's difficult to have confident soft tissue prediction since the lower lip tends to be very self supporting (or in divergent cases, not self supporting unfortunately hence the "droopy" look) instead of following the lower bone contour behind it.

Exactly right. Lower lip vermilion and posture changes (rolling inward in this case so the lower lip appears thinner with perhaps a flatter mental-labial fold) and lip incompetence are two different phenomenon.

Mentalis strain is the chin muscle showing hyperactivity usually due to the upper and lower lip having an excessive gap (there often is too much upper incisor exposure at rest which makes the upper lip appear short). Lips should meet at rest or only have a small gap as long as when your lips touch there is no visible chin, lip or alar base straining.

About the lower lip, apparently the case below had a SG with jaw implants. The lower lip was advanced forward significantly, is that really possible with a good amount of projection from a SG?
https://www.realself.com/chin-surgery/before-and-after-photos#media-photo-1070844-73044-3

[ForeverDet]

About the lower lip, apparently the case below had a SG with jaw implants. The lower lip was advanced forward significantly, is that really possible with a good amount of projection from a SG?
https://www.realself.com/chin-surgery/before-and-after-photos#media-photo-1070844-73044-3

Wow that's a hell of a lot of camouflage of deep and retrusive class 2 case. I bet when he smiles or laughs his maloclussion still looks very "overbitey" despite his external soft tissue looking like his jaw is more or less class I.

But to answer your question, well assuming he just had the genio and implants then yeah, it's possible. Proof is right there. A horizontal genioplasty WITH vertical lengthening should soften the mental-labial fold which then lengthens the lower lip. I wonder if the jaw implants also affected the lower lip? I've heard of people wanting to get an implant in the mandibular sulcus area to flatten the fold.

[needadvancement]

Wow that's a hell of a lot of camouflage of deep and retrusive class 2 case. I bet when he smiles or laughs his maloclussion still looks very "overbitey" despite his external soft tissue looking like his jaw is more or less class I.

But to answer your question, well assuming he just had the genio and implants then yeah, it's possible. Proof is right there. A horizontal genioplasty WITH vertical lengthening woulds often the mental-labial fold which then lengthens the lower lip. I wonder if the jaw implants also affected the lower lip? I've heard of people wanting to get an implant in the mandibular sulcus area to flatten the fold.

Yeah and I'm getting vertical + horizontal SG (shooting for 7mm for both) as my lower lip is behind the upperlip, if it is brought forward that would be awesome camouflaging. I also heard of vertical advancement pulling the lower lip down but because I have protrusive somewhat excess looking lip tissue I think it won't be a problem there.

[kjohnt]

About the lower lip, apparently the case below had a SG with jaw implants. The lower lip was advanced forward significantly, is that really possible with a good amount of projection from a SG?
https://www.realself.com/chin-surgery/before-and-after-photos#media-photo-1070844-73044-3

I honestly can't imagine this was achieved only with sliding genio, and I don't think that the ramal implants could affect the chin area aside from a negligible amount.  I mean, you said it - the lower lip was advanced significantly.  And the labiomental fold from the lower lip curl was drastically improved.  The SG would have to be damn near an inch!  And then the lower lip would uncurl and be placed even further back when compared to the upper lip right?  This doesn't add up to me, and I'd like to see this guy's teeth.

The doctor is a max facs surgeon... perhaps he forgot to list that BSSO was also performed?  IDK.

[needadvancement]

I honestly can't imagine this was achieved only with sliding genio, and I don't think that the ramal implants could affect the chin area aside from a negligible amount.  I mean, you said it - the lower lip was advanced significantly.  And the labiomental fold from the lower lip curl was drastically improved.  The SG would have to be damn near an inch!  And then the lower lip would uncurl and be placed even further back when compared to the upper lip right?  This doesn't add up to me, and I'd like to see this guy's teeth.

The doctor is a max facs surgeon... perhaps he forgot to list that BSSO was also performed?  IDK.

I thought it was a BSSO for sure but it's not notified. Maybe they're lying, I'll try to find the surgeon's website with this case.

[ForeverDet]

And the labiomental fold from the lower lip curl was drastically improved.  The SG would have to be damn near an inch!  And then the lower lip would uncurl and be placed even further back when compared to the upper lip right?  This doesn't add up to me, and I'd like to see this guy's teeth.

haha me too! If no jaw surgery then he still has the deep bite.

I'm suspect of this only being a genio and jaw implant only however it's definitely possible. Look at the most superior part of his lower lip relative to the upper lip, it's not really that much more forward than before. Just slightly. There is flattening of his mental-labial fold which would puts the middle lip area (sulcus) in a more advanced position than before.

And with a very skilled genioplasty as well as possible a jaw implants (ramal apparently) that perhaps contribute to normalizing the soft tissue in the lip/chin area, I could see some impressive masking of the defect like in this case.

But hey, if the kid doesn't have tmj or bite stuff causing functionally issues then this treatment plan was awesome and I would have done the same. Avoiding probable nose changes from upper surgery, the awful recovery, huge costs, extra swelling, etc. Or maybe I would of  had a lower jaw advancement and genio only, avoiding the lefort and the suffering/unknowns that come with it. 


EDIT: On second thought, I think this kid got a bsso aferall! hahaha I did a quickly drew the TVL for each photo, the hair growth in his before is every so slightly obscuring where his upper lip actually starts under his nose but it's about right. So yeah, his lower lip came advanced quite a bit. Again, I guess it's possibe there was no mandibular advancement but god damn that would be crazy.

http://i.imgur.com/LbA8ipt.png

[needadvancement]

@ ForeverDet, I found a front view of that patient on the website of the surgeon, pretty sure he's the one all the way on the bottom:
http://www.drwittenberg.com/photo-gallery/chin-gallery.html

Here's the surgeon's lower jaw surgery results, the guy is not listed here:
http://www.drwittenberg.com/photo-gallery/low-jaw-gallery.html

So guess we'll have to take his word for it, it was a mere SG along with jaw implants. Never seen a better camouflage result than that.

This surgeon seems to have a particular skill to alter the lower lip with just SG's.

Genioplasty will extend the area under the chin as the muscles get natually lengthened with the advancing chin. The lower lip gains good support from a sliding genioplasty

From the second link.

And listen to this:

The chin is actually the main support for the lower lip, such that the lip will improve in its postion as well and have a better position and contour. It also allows better ability of the lips to touch naturally, which encourages natural nasal breathing rather than mouth breathing.

And he has proven it. I wish I could get my SG surgery with this surgeon. That's some serious skill to take such a simple procedure and accomplish a lot more with it.