Do I Need Jaw Surgery or Genioplasty? (With Pic)

[sanddunes]

Hey everyone this is my first time posting.

I have always been unhappy and self-conscious about my profile, and I finally have decided to do something to improve it.   Do I need jaw surgery or a genioplasty, or both? 

I went to a plastic surgeon who recommended a genioplasty, 4mm horizontal advancement and 5mm vertical increase.  He said I could maybe benefit from orthognathic surgery... he thought both upper and lower jaw would need to be moved forward.  But he said it would be very expensive and take a year or two and that I might be better off with a genioplasty for roughly the same asesthetic result.

Here are some pics.  At this point I am confused at what the best option is.  I do have some TMJ and breathing problems, tongue thrust which has caused a little bit of an open bite.  I did have orthodontics about 10 years ago which I think might have contributed to my recessive chin/jaw.

The middle pic of the sketch is what the plastic surgeon said he could do as a before/after with the sliding genioplasty.  I kind of wonder though if 4mm advancement would actually get me the "after" result though.  It seems like I would need more?  Also, I am having a hard time figuring out what a 5mm vertical advancement would do to the front of my face.

Any advice?





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[treevernal]

I don't think a genio alone is right for you and I really do believe you'll be unhappy with the results.  All the functional reasons alone are enough to warrant bimax over just genio but also, your before profile looks better than the predicted one.  Here's why:

Your chin alone is only mildly retruded.  Advancing only the chin would over compensate for your other facial issues that jaw surgery can correct: lip strain, nasal base retrusion, submental skin laxity, etc.  I'm not trying to be a dick but I had all of those issues (more severe than you tho) and I am very happy I went the bimax route. Your lip strain is already elongating your face and a genio that vertically lengthens your chin would not look good.  

This is just my opinion tho!  No doubt a genio is much easier to go through than bimax and the decision is a personal one.

[sanddunes]

He thought my photoshop picture was a starting point but not completely accurate I guess.   Would you say I have a retruded mandible based on these pics?  And how can you tell if your upper jaw needs to come forward also.  The plastic surgeon seemed to think both my lower and upper jaw should be moved forward, but it would be too expensive/time consuming and the genioplasty would be more practical at this point.

[sanddunes]

Thanks treevernal.  What is a lip strain and nasal base retrusion?  I guess I am kind of a newbie to all this lol

[treevernal]

If the frontal photo is of you as you are now (no photoshopping) you can see how good-looking you are currently.  Your lower jaw/ chin ate large enough as is, the only issues I see are nasal base and upper lip strain/retrusion and lack of submental definition.  CCW rotation of your upper and lower jaws should correct this in a natural-looking way and not look overcompensated as a genio alone would.

By lip/nasal base strain I mean it looks like your upper lip is stretching down to close (could be due to the open bite and/or a long/gummy maxilla.  I would never have noticed these things years before tho and most people won't.

Again, you have great features/proportions to begin with. I believe a genio alone would mask them and bimax would enhance them.  But I'm no doctor and your best bet is to consult with more maxfax docs.

[CK]

i would say your lip posture is okay. if aesthetics is your only concern i would consider the genio before jaw surgery. while jaw surgery might produce a stronger aesthetic, i cant see how it would deliver a major improvement overall compared to the genio. the risks, and the costs, may outweigh any possible aesthetic benefit.

definitely take your time, you dont want to undermine what you already have.

[Kristen]

You look absolutely great as is now.    If you truly have functional issues that's another story.
Get oral myology to fix your tongue thrust no matter what you do.   Check with an ENT to see if there are any nasal , adnoid or tonsil issues affecting breathing. 

[sanddunes]

So I went to an oral surgeon (Dr. Kurt Friedman)  today for a consultation.  He said that the orthodontist I went to when I was 12 pushed my upper jaw back with braces to meet the recessed lower jaw, instead of moving my lower jaw forward and then lining the teeth up that way.  He said that is why I have always had an open bite and braces alone could not fix my bite.  He did not think I really have a tongue thrust, and said maybe that is what the orthodontist told me just to explain why he couldn't close my open bite.  

He said I could benefit from jaw surgery, and wants me to go to an orthodontist and then do a full work-up.  The problem for me with all this is cost.  I do have health insurance, but apparently my plan (Aetna POS) considers orthognathic surgery to go under "TMJ" benefits, and that has a lifetime maximum benefit of $2500.  He said the cost could be well over $25,000+ with braces, so I need to be prepared for that.  How does anyone afford jaw surgery??!?!?  So crazy.
  
He thought the sliding genioplasty alone would work to cosmetically cover the jaw problem (since my case is not severe), but of course would not be a "real" fix -- just a cosmetic one.  The one thing I forgot to ask him about was my airway.  I feel pretty sure that it is smaller than it should be due to my recessed lower jaw.

At this point, I'm not sure what to do.  I definitely don't have the money for jaw surgery right now, and I'm not sure if I ever will in the next few years.  I wonder if there is a chance I can get the insurance to cover more of it?  Has anyone heard of orthognathic surgery going under TMJ benefits -- the open bite/misalignment is actually more of a problem than the TMJ.

In the meantime, I am going to see Dr. Rodger Pielet who is supposed to be an expert in genioplasty to get his opinion.  His before and after photos look pretty amazing if any of you want to look.

http://drpielet.com/genioplasty-chin-augmentationreduction-photos/

[Marisama]

Insurance covered my surgery and it was not a TMJ benefit.

[Daftones]

lol, nice photoshop. you will not look like that at all, the extra chin will completely change your facial structure.


the sketch your surgeon made looks accurate.

go for it dude, I hear it isnt so bad on its own. I got double jaw plus the genio, and it was a pain (worht it tho). in your situation, your a handsome lad, but a bit weak chinned. I would just get the chin done and see where that takes you... double jaw is a huge commitment!

[overbiter]

Is it possible to borrow money from a bank or your family to fund the operation? I wouldn't let money problems stop you if you really want it.

It's hard to say whether a genio or jaw surgery would be better, it all comes down to what you really want, perfect results or just a quick fix improvement. One thing I would say is that the genio your surgeon gives you is bound to be different if he is just masking the situation rather than doing a double jaw op. Would he really be suggesting the 5mm vertical movement if he was doing a jaw surgery? I seriously doubt it, that is just to make up for the loss in height perceived from having a short mandible. If you're looking for perfection upper, lower and genio is the way to go.

[sanddunes]

lol, nice photoshop. you will not look like that at all, the extra chin will completely change your facial structure.

the sketch your surgeon made looks accurate.

Thanks for the input.  When you say the extra chin will completely change your facial structure, what do you mean.  Because it will make the proportions on the face different?  i.e. how big the nose looks etc?

What made you decide to go for the double jaw + genio vs just the genio? 

[sanddunes]

Is it possible to borrow money from a bank or your family to fund the operation? I wouldn't let money problems stop you if you really want it.

It's hard to say whether a genio or jaw surgery would be better, it all comes down to what you really want, perfect results or just a quick fix improvement. One thing I would say is that the genio your surgeon gives you is bound to be different if he is just masking the situation rather than doing a double jaw op. Would he really be suggesting the 5mm vertical movement if he was doing a jaw surgery? I seriously doubt it, that is just to make up for the loss in height perceived from having a short mandible. If you're looking for perfection upper, lower and genio is the way to go.

My parents think the whole idea of jaw surgery or chin surgery is unnecessary and are against it.  So I doubt they would help me out with it.  I do have about 8k in savings that I could use torwards it, but the surgeon was saying it could cost well over 20k, so I don't know where I could get that from if insurance won't pay.

You are right -- I am sure the plastic surgeon was basing his dimensions on just doing a genioplasty alone.  If the mandible was moved forward also then all the measurements would change as well.  What is your thought about adding vertical height to a face with just a genioplasty -- does it tend to look natural or make the face look too long?

[Daftones]

Thanks for the input.  When you say the extra chin will completely change your facial structure, what do you mean.  Because it will make the proportions on the face different?  i.e. how big the nose looks etc?

What made you decide to go for the double jaw + genio vs just the genio?

you'll get more length of your face, tighter skin, etc. you will just look different from your photoshop. you will most likely look like what the surgeon thinks you will look like?

as for genio vs double jaw + genio for myself... I had apnea + overbite+ + sloppy profile, so a genioplasty wouldnt have been the 'right fit'.

http://overbite-jawsurgery.blogspot.ca/

^^^ my site, you can see the changes there (had surgery a couple weeks ago).

You have a strong jaw, just a weak chin. It's an expensive decision to make, but it's worth it if you feel it is.

[sanddunes]

Hey everyone, thought I would give an update on what I decided to do.

I am going forward with the double jaw surgery and my surgery date is August 15th.  My insurance (Aetna) is covering the surgery.  They approved my surgery a few weeks after my Dr. sent in all the clinical records.  I was kind of surprised to be honest it was that easy to get it covered.  I was expecting to have to go to battle with them.  Also, I found a surgeon that did not charge any out of pocket fees, so I did not have to pay 850 for the workup like the other Dr. wanted.  My total out of pocket for the surgery will be about $500 + $5400 for the braces.

The plan is to advance the upper jaw forward 5mm and the lower jaw 7.1mm, along with a 1mm impaction.  The Dr. said the jaws will be rotated out.  I am having braces put on a week before the surgery.  Because I have had braces before they are able to do a "surgery first" approach, which means I will only be in braces for 8-12 months after surgery.

SO bottom line is I am excited, but also slightly worried about the recovery process after.  I think I am doing the right thing by doing double jaw surgery vs genioplasty.  Functionally, I am so tired of the pain and tightness in my lower jaw, my bite not meeting at all, the open bite that causes me to "whistle" sometimes when I talk and makes chewing dificult, and I will also get a much bigger airway.  Aesthetically, my Dr. thinks a genioplasty would not have looked good and that this will be a much better result. 

Any thoughts about the proposed advances?  Does 7mm seem like a good amount for the lower jaw to be advanced?