bsso plus sliding genio vs chin wing

[mike888miller]

although i did not follow your points 100pc , i agree fully about what you are saying on ramus, and in fact the chin wing docs (i have met most of them) actually agree fully, the most aggressive of them told me she could do about 1cm widening, which would result in .7cm or so being visible, if you get the biggest of the shelf implants you can get more.

i have not once seen an example of a chin wing that has resulted in the patient having a wider, more masculine jaw. and i have check most of the focums and have specifically asked for this from the doctor.


there is no free lunch in life, if you want a wider, steeper jaw you will have to run the risks that come with having an implant, i think infection rate is around 10pc and that of permanent nerve damage is 5pc. personally it is a risk i am willing to take.  i wonder if the doctors give you a discount in case he has to redo the surgery? could he reuse the implants? of the shelf they cost around 700 for the pair so it is not the end of world.


i think the more interesting discussions for us are of the shelf vs custom implants

i see the pro for custom mainly if you want to integrate the chin implant, if you have major asymmetry or extreme requirements.

the negative must clearly the cost, i think it is about 4k difference but do not have many data points, maybe people here have more.

[mike888miller]

morph jaw widening attached . any feedback appreciated

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[Optimistic]

morph jaw widening attached . any feedback appreciated

Please don't take this as an insult as it's 110% not my intention...

To me your face looks like someone who is recoiling their head back against the neck. It looks like you'd need double jaw surgery to advance both jaws forward. If this is the case I'd try to get as much advancement as possible (ante face). After this you could look at chin wings and implants to improve jaw angles. I just don't see this working any other way.

[Optimistic]

I have consulted for sliding genio, chinwing, implants.

About chinwing I said it can not elongate ramus vertically. I have difficulty explaining in English. Chinwing can elongate the ramus, but not without changing the steepness of the ramus since the lower border of the mandible slides forward. So if the border of the mandible is rotated the ramus is elongated but the steepness is changed too since the mandible border is slid forward. So you never get the sharp vertical shaped jaw angle, and the vertically orientated elongated ramus. The nice long vertical orientated ramus you see in men with strong jaw angle: you won't get it with the chinwing. Unless the mandible border is segmented with the surgery, but as I wrote it, Z. said he hardly does it. Segmenting the border will give stepoffs too and can give more asymmetry if not meticulously done.

Triaca did exactly this to me. Segmenting and grafting. Result was significant improvement in ramal length and jaw angles. "Step off" existed, however quite natural and similar to any gonial angle in my opinion. Looking on a CT scan it was quit nice, certainly well formed and remodelled. However!!!! This could be my genetics. Maybe I heal well? People complained of step-offs from BSSO with grafting and yet I had a segmented chin wing with perfect healing. Perhaps the results don't replicate so easily?

In any case I just want to say it can be done. The limitations you mention to exist of course. If you want to go forward 1cm then the ramal angle is going to suffer as it's brought forward so much. That would be like 1cm forward, plus segment and 1cm backwards. 2cm total gap. Its too much tension for one surgery. In these instances you can segment a bit, do some bone grafting, see what happens. In such extreme cases then yes I can see a case for implants, but I would still personally advocate getting chin wing first and ramal implants later. To me that would be a good compromise should grafting not work out for you. Especially if CT Bone is used. I like those implants a lot.

Implants have their own negative points. But I do not agree it is the devil as some say. Many people have had implants in one or other place of their body and lived with them for decades. Also face implants. And if there is complication it can be removed and reinserted. Without long recovery, mostly days or week of recovery, often can be done under local anesthesia. The bone cutting surgery is big surgery which asks lot of recovery from the body.

Chin wing recovery certainly sucks like any jaw surgery, but two weeks is not a massive deal. At just a few days post-op I was feeling pretty good. Just made sure I had enough liquid meals to keep me sustained and some nice snacks like pasta, scrambled eggs etc. The point I make here is that I don't feel recovery should be a consideration, only the result. The recovery is not bad enough.

However I would not choose a chin implant (I would not consider it). I would chose sliding genioplasty.

Agree. There is also chin visor osteotomy for labiomental fold. Triaca invented this I think, and it's impressive

But mandible implants I find most of the time give far better and more predictable result then the chinwing. Infection rate is low. I do not understand why people are so against it here. It can give an artistically far better result. It is more predictable. You can change the outward rotation of the jaw angle, you can change the slope of the jawline. The chinwing by far has not that versatility. Also not when done two times. Unless you would also have the jawline shaved. But still have to find first patient wanting to do that too

Sure, if it's custom why wouldn't it? The result will be way more predictable. But there are too many disadvantages such as infection, displacement, bone erosion that you simply don't get with a chin wing osteotomy. Furthermore, what predictability do you want with a chin wing? For my operation we discussed changing jaw shape, width, angle, mandibular plane, everything. Because once you are talking about segmenting a wing osteotomy almost anything is possible (within limits no doubt). If I find a before photo I might PM you just to show you the difference. For me it was DRAMATIC. I also believe in Dr Mike Mew. So after 6-12 months post-op if one started chewing hard gum the masseters would enlarge and provide maybe even more width to the face.

But Optimistic has good result from chinwing so it is possible. I have seen a few good results, but also lot of not so remarkable results. The few good results: some had 2 surgeries. The difference was then good, but never as sleek as with jaw angle implants. And that is logical. Someone would have to have perfect foundation, good jawline slope, already good ramus, not too little sideward projection of jawline, outward rotated jaw angles at least a bit from the start, nicely shaped chin (although chin portion can be segmented too but not often done and still surgeon is limited to what you have), and then get a segmented chinwing to really get that masculine jawline with vertical oritentated ramus as very goodlooking of men often have. I still have to see first patient with such basis.

My results are n=1. Not reliable. All I can say is my result was good. My opinion is simply that chin wing depends on starting point. It's an osteotomy that can replace an implant, but if there is a tiny jaw to begin with there is nothing that can be done to make him have a model jawline without implanting. I also believe it's better than a sliding genio because it's more natural to be moving the lower jaw as a mass forward, instead of a tiny bit of bone near the chin. It's why I'd always opt for chin wing and implants over sliding genio and implants.

But yeah, if you have a good starting point chin wing can do something nice.

 I also saw results that I found not good. I would love to see Optimistic's result and know who did his surgery. As said we all want good result so if I'm wrong, I would not mind, I would want to know. But technically chin wing can not give such artistically molded result as implants. You are not molding the bone, you are changing the shape only in segments and when the chinwing is not segmented only in a big segment that still has same fundamental shape. Whereas with implant you can change entire shape and your basis hardly matters.

I'll consider the pictures if you are actually considering this as a surgery, otherwise I'm not too interest in voyeurs

Remember though with a chin wing the following is possible:
- Advancement
- Rotation (flatter mandibular plane)
- Segmentation (widening posterior position of mandible for flared jaw angles)
- Bone grafting (to smoothen cuts and add bone to areas around ramus and gonial)
- As jaw is rotated and advanced it'll look bigger already
- chin visor can be done at the same time to improve labiomental fold
- and maybe more I'm forgetting right now

And don't forget all this can be done with your bone healing to "like new" with no infection, a natural result to look and touch.

If you seek perfection you need God or machine Like 3D printed implants (CT Bone). So if you demand "I MUST HAVE THE PERFECT JAWLINE" and your starting point sucks, and you don't care about complications of an implant, maybe chin wing isn't for you. But to my view it's the better option for anyone who needs to alter chin and jaw position without affected occlusion.

I don't want to sound like I work for someone as I learned surgeons pay people to post crap on forums, but just to say if you haven't read his studies they explain a lot. If you don't find let me know I think I have some saved still.

I've now had a second chin wing - waiting on result. The ramal angle is always a concern and if it's still a problem maybe I'll do implants too. After my first one it was ok, but not "perfect" for reasons I explained above and tension. Looking at my face however, not a scan, nobody would say I had a steep angle. But again, I think I had a good starting point. Chin was recessed but jaw and ramus were never that bad. Quite decent really.

[mike888miller]

opti -

how much advancement, angle reduction and widening did dr t achieve for you.

which pic are you referring to?  i appreciate the feedback, we re all here for an honest exchange of knowledge, fake flattery would do harm, so thx again.

i did try to keep my head parallel so that the foto would not be flattered by kyphotic i.e. forward head posture.

[Optimistic]

opti -

how much advancement, angle reduction and widening did dr t achieve for you.

which pic are you referring to?  i appreciate the feedback, we re all here for an honest exchange of knowledge, fake flattery would do harm, so thx again.

i did try to keep my head parallel so that the foto would not be flattered by kyphotic i.e. forward head posture.

I refer to the pictures of you in profile. Face seems flat.

The surgeon is total s**t and a con man who photoshops his results, but look up Prof Sailer to see what I mean. I think you would need to advance both jaws as far forward as possible to get the look you want.

If you didn't move the upper jaw forward I'm not sure you'd get much advancement of the mandible, and consequently still have loose skin etc. Futhermore, bimax surgery could open up airways more.


As for my surgery I can't tell you specifics as I've had a repeat operation. I'm currently recovering so couldn't provide meaningful photos. My first op I can say dropdown was pretty significant and jaw angles improved a lot. Chin advanced about 1cm. I'll privately send photos if you are interested when I'm feeling better.

[mike888miller]

better yet google sailer and scam - the guy has set up a foundation for african cleft victims, out then he pays himself massive consulting fees etc out of that fund. he also charges 50k for a bsso. having said all that, i fully agree with his ante face aesthetic approach, like his after pics, respect the fact that he is one of the small number of docs in europe that are comfortable with implants and bs, has a lot of experience and is referenced by peers, but i just don't have that kind of cash.

what did you mean with drop down?

[mike888miller]

this is my x ray of the airway passage, seems like there is enough space?

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[Schrödingers Jaw]

@schrodinger

Now you make me real curious about the chin wing. I am especially interested in these augments as you put it:

- Segmentation (widening posterior position of mandible for flared jaw angles)
- Bone grafting (to smoothen cuts and add bone to areas around ramus and gonial)

But for this kind of augmentation, can the results really rival implants?

[Schrödingers Jaw]

Bump

As chin wing makes the ramus angle more obtuse, would it be possible to get a chin wing and then ramus implants for a complete jawline?

[Schrödingers Jaw]

That is what I find most dissatisfactory about the chin wing (I called it banana shaped jaw angles, which they seem to me: they are not sharp). Also the jawline seems almost shortened horizontally in most results I've seen, but that must just appear that way visually. Since in most cases the jawline/wing is not horizontally shortened (some cases left out, Brusco wrote a paper about that): it just moves forward making the jaw angle obtuse as you said.
But I want to see more chin wings with more surgeons since I still like the idea of it and I hope different surgeons have very different results. It's just a pity that most results I've seen thus far are disappointing  .

The goal seems to defeat the purpose if you still take jaw implants later. Then you might as well get a genioplasty with jaw implants that give drop down. I'm considering going the genio route too.

I've seen results that indicate that widening is possible, the implants would only be to make the ramus angle more sharp and not to replace the chin wing procedure.

Here are some Chin Wing results, what do you think?

http://www.pyramide.ch/KlinikPyramide.CorporateWebsite/media/PyramideCorporate/PDFs/Centers/ZKG/Journal_fuer_Aesthetische_Chirurgie_Januar_2011_Triaca.pdf

[Schrödingers Jaw]

I'm interested in Chin Wing because my mandible could be moved further forward, widened and my ramus is a bit short as well. I thought I could do it in one go, with my own bone since I still have a decent foundation so to speak.

I'll take pictures and ask for advice I think, just gotta buy a camera