In a week - sliding genioplasty w/ double jaw surgery: yes/no?

[notsureyet2015]

Hey all -

I'm  having double jaw surgery in roughly a week, with my upper jaw moved forward 8mm and rotated clockwise (up by 3 mm in the back), and my lower jaw moved forward 4mm and also rotated clockwise to match the upper.

My surgeon says I could benefit from a sliding genioplasty with 2-3mm of advancement--which is a below average movement. This wouldn't be covered by insurance.

I'm torn on whether this is worth it: on one hand, 2-3mm doesn't sound like a lot. But on the other hand, I'd love to maximize the aesthetic result (I'm male), and with clockwise rotation I imagine my chin will move 'backwards' slightly despite the advancement.

Did anyone else have a 2-3mm advancement? Worth it?

Thanks!

[notsureyet2015]

Some photos attached

Thanks all!

EDIT: Photos fixed

[Vic]

You didn't upload the X-ray mate, you uploaded the pic twice

[notsureyet2015]

Links fixed! Thanks for flagging

[kjohnt]

I think the occlusal plane of your mandible right now looks good.  Hopefully it stays about right there once the maxilla is rotated clockwise. 

But yes, given the clockwise rotation, your chin will likely look the same or slightly more recessed and I'd personally definitely go with the genio.  3mm seems about right. 

One thing that could affect it and make it less necessary is that after the mandible is moved forward I think your lower lip may come back just a bit since the skin will be slightly tighter.  I've seen this before from other patients' before/afters.  Also the risk of nerve issues increases. 

All in all, I still say go with the genio.  It's a mild movement and, while it adds to the cost, I think you'll be happy later if you decide to do it.  This is just my personal opinion of what I'd do if I was you.

[notsureyet2015]

Thanks for the advice!

On my end, what I'm weighing is potentially doing the genioplasty in a year if I don't like the results after surgery. Presumably, in a year they could perform a superior and more exact movement than they can now where it's unclear what exactly I'll look like after. However, I don't really like the idea of doing surgery again.

On clockwise rotation, I'm pretty sure most of the rotation is happening on the maxilla with less on the mandible (he had mentioned with finishing orthodontics that they'd still need to pull down my back molars).

[kjohnt]

Yeah if you are willing to pay for the anesthesia twice, that's definitely a good plan.

[notsureyet2015]

I think I'd prefer not to do surgery again. So really the trade off is: 2-3mm advancement now with some aesthetic improvement, or Xmm(?) advancement later with potentially more aesthetic improvement? Finding it to be a tough call.

Is there any reason to ask my surgeon to consider 4mm instead of 2-3mm?

[kjohnt]

It is a tough call... one I'll need to make as well I assume.  If you can stand waiting to heal to make a judgement, then likely going through surgery again along with the extra costs, you'll be more likely to get the preferred outcome.

Regarding genioplasty movement, I would think 1mm won't make much difference but 2 or more will.  Generally speaking and from my research, the gonian or tip of chin bone should align vertically with your lower incisors.  But I've seen exceptions either way so you must take into account soft tissue of the chin.  Personally I think 3 or 4 for you now would be good but again, IDK how the bsso will affect everything. 

From what I've read, even surgeons don't like to make promises based on morphs and such because the soft tissue piece is difficult to predict.  Too bad you don't have more time, because a decision would best be made after input from a few different surgeons.

Edit: and after seeing your pics again, I think 3mm is plenty assuming the mandibular occlusal plane angle remains unchanged.