Jaw Surgery Questions! Chin Wing vs Sliding Genioplasty?

[Lefortitude]

Hello JSF,

I am looking to get a jaw surgery to augment my lower facial third. 

As a child i had a minor overbite which orthodontics took care of quite nicely. I have a perfect bite. 

However, I feel my lower third is very weak and makes me look too feminine.  Id like to widen my mandible, especially at the angles, add bulk and projection to my chin.

In addition, ive seen studies that show the chin wing can be a novel technique to improve signs of Obstructive Sleep Apnea

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4339332/

My signs of OSA are far to minor to try and justify a bimax for that soul purpose.  my cosmetic concern as well.

I was wondering:

1) If a Chin Wing osteotomy OR a Sliding Genioplasty Osteotomy (likely with a bone graft either way to add bulk) would be the ideal solution for my cosmetic concern. Which of the options would be superior, in what way, and could it improve my breathing during sleep?
2) What are the risks associated with these procedures, and how do they differ? aside from standard surgical risk (nerve damage, bone resorption, bad aesthetic etc)
3) If anybody has had any experience with the pyramid doctors in zurich (D. Brusco, A. Triaca) or has seen any of their chin wing results.  web results are quite scarce. PM is fine if you are not comfortable commenting on a public forum


Thanks for your help, advice, and input!

[Maxillofacial Scalpel]

You would really benefit from a sliding genioplasty procedure to correct your chin recession issues.

For your mandibular angle concerns really the best option would be a type of facial implants (whether that is Silicone or Medpor ones) . You can pick the Side Wing osteotomy route too but there are risks related to the aesthetic outcomes of it (you might have to do the procedure more than once to achieve optimal results or even have some fillers for more angularity) you should seriously consider.

[ppsk]

the genio will help but it looks like your entire lower jaw is recessed.

I think you need to consider jaw surgery.

[Lefortitude]

Thank you for your response! it seems no professional will recommend a full bimax because of the (very expensive and rather good) orthodontic work that has given me straight teeth and a perfect bite.  I would certainly consider it, however, ive been told I would have to have braces to un-do the orthodontic work and then braces again after the procedure to re do it.  since I dont have medical reasons and insurance will not cover it, Its looking to run me tens of thousands of dollars. 

Whereas the Chin wing would be roughly 20,000 including bone grafts (at pyramid) and the sliding genio at my local top surgeon around 10k all in.  Im just trying to decide if its worth it to go for the chin wing and bio-oss for nearly double the price.  I know the results will be better, but is it worth twice the cost?

[ditterbo]

I dono, to me your whole lower half is underdeveloped or just really puny.  I think a chin wing could add some heft you're sorely lacking.  I don't know what the conclusion was of side wing + SG, b/c that sounds ideal on the face of it. Your side profile shot is at an angle so it's hard to say how much you even stand to gain from an SG.

On 2nd look, your chin looks barely recessed. Again just a bad side shot imo. I don't see a simple forward SG improving your appearance much.

[PloskoPlus]

I dono, to me your whole lower half is underdeveloped or just really puny.  I think a chin wing could add some heft you're sorely lacking.  I don't know what the conclusion was of side wing + SG, b/c that sounds ideal on the face of it. Your side profile shot is at an angle so it's hard to say how much you even stand to gain from an SG.

I agree. Triaca does have amazing results widening jaws just OP's... But I'm pretty sure they are the result of multiple chin wings.
BTW in some bsso advancement  cases that I've seen the jaw widens noticeably. Others don't seem to widen at all. I'm not sure how that works (the occlusal plane?)
Also the lips are very full. This can give the illusion that the jaw is smaller than it is. Some believe that instead of banking on one large movement, one should have a series of small changes everywhere for the best aesthetic result.  So... A conservative lip reduction may help (but not on its own).
I'm not sold on  genioplasty In this case. The chin bone is projected enough, the jaw is the problem.

[ditterbo]

Interesting point on lip reduction, but personally I'd skip just about any surgery removing anything on his face.  It'll get longer over time, and I bet he's probably got a longer mid-face already.  Thinning the lips will elongate it even more.

[Lefortitude]

I agree. Triaca does have amazing results widening jaws just OP's... But I'm pretty sure they are the result of multiple chin wings.
BTW in some bsso advancement  cases that I've seen the jaw widens noticeably. Others don't seem to widen at all. I'm not sure how that works (the occlusal plane?)
Also the lips are very full. This can give the illusion that the jaw is smaller than it is. Some believe that instead of banking on one large movement, one should have a series of small changes everywhere for the best aesthetic result.  So... A conservative lip reduction may help (but not on its own).
I'm not sold on  genioplasty In this case. The chin bone is projected enough, the jaw is the problem.

Would a chin wing be able to actually address the entire jaw deficiency without changing the occlusion?

[PloskoPlus]

Would a chin wing be able to actually address the entire jaw deficiency without changing the occlusion?

Don't know. I do know that triaca will say yes it will.

[ppsk]

Thank you for your response! it seems no professional will recommend a full bimax because of the (very expensive and rather good) orthodontic work that has given me straight teeth and a perfect bite.  I would certainly consider it, however, ive been told I would have to have braces to un-do the orthodontic work and then braces again after the procedure to re do it.  since I dont have medical reasons and insurance will not cover it, Its looking to run me tens of thousands of dollars. 

Whereas the Chin wing would be roughly 20,000 including bone grafts (at pyramid) and the sliding genio at my local top surgeon around 10k all in.  Im just trying to decide if its worth it to go for the chin wing and bio-oss for nearly double the price.  I know the results will be better, but is it worth twice the cost?

Ive got straight teeth aside from minor crowding on bottom and a perfectly functional bite and I am still getting jaw surgery to address recession. A lot of very good surgeons follow a surgery first approach, which you will be a candidate for if your bite is as you say it is. Then you would only need ortho work after the op.

It would be a mistake to get a genio alone, in my opinion.

[kjohnt]

SG would be a mistake.  Both maxilla and mandible recessed, bimax.  Ask an ortho how large your overjet would be if decompensated.  It may be enough such that the additional amount your mandible comes forward will bring it in line with your maxilla so no or minimal ccw rotation.

[Peter6789]

Would a chin wing be able to actually address the entire jaw deficiency without changing the occlusion?

Yes, chin wing addresses lower jaw deficiency and does not change the occlusion.

If you are male, go for a chin wing, especially for larger movements.



Bonus: after a chin wing you can still have a jaw surgery to change the occlusion.


Start with a chin wing, and if you are not happy with the outcome, you can go for more invasive procedures.

[ditterbo]

holy crap I never thought of a chin-wing first approach.  Dump the implant in the process too and pray for a full smile recovery. Might seriously look into that.

[Lefortitude]

holy crap I never thought of a chin-wing first approach.  Dump the implant in the process too and pray for a full smile recovery. Might seriously look into that.

did you get medpor? arent they notoriously difficult to remove without doing serious damage to the soft tissue?

[ditterbo]

did you get medpor? arent they notoriously difficult to remove without doing serious damage to the soft tissue?

it's silicone and that depends on the doctor but most can't remove medpor safely, correct.