Still feel chin recessed (weak) 3 weeks post-op, considering genioplasty

[overbiteme]

Hi everyone,

I had a small chin implant years ago.  3 weeks ago, I had Lefort 1 and BSSO (8.4mm advancement) to correct my overbit and overjet. Now I'm still abit swelling, mainly protruding upper lip.

Attached are photos of my 3 week post-op profile, which I still feel like a "before" photo of other patients. My chin is still weak, short and recessed. The chin implant looks very weird especially when I smile. I know I should wait for more days to get a more clear picture of how I look because I'm still swelling. However, I'm not satisfied with my result and feel very concerned. I just can't take this off my mind!

My surgeron did not offer sliding-genioplasty as an option to go together with my double jaw surgery, because he said my chin impant looks good and the advancement of the lower jaw would be sufficient.  The simulated post-op photo looks good. So I chose to only go with double jaw surgery without genio.

Right after the surgery, I looked at the mirror and felt the advancement was not enough. My bite is perfect after the surgery. Functiona wise, the problem is corrected. However, aesthetically I feel it's not enough. Now, I'm thinking taking out the chin implant and get sliding-genioplasty to get a stronger and longer chin with a more natural look.

Here are some of my questions:

1. Do I need to AND is that possible to take out an implant and get a sliding-genioplasty? (I saw other people've done this)
2. How long should I wait to get genio after double jaw surgery?
3. How's the recovery feel of genio comparing with the double jaw surgery?

Thank you guys for any opinions on this!

[Milli_Meters]

1) Yes. It is not uncommon.

2) 6 months- 12 months.
 
3)Should be easier than bimax , if there are no complications.

Imho your implant does not look good and a judicious chin osteotomy would bring harmony to your face. Your jaws look good.

[CCW]

Post proper profile shots where your head is level and we can see your forehead as well. Do you have before/after ceph x-rays?

[overbiteme]

All the replies are appreciated!!

Here are photos with forehead and pre/post X-ray.

[PloskoPlus]

Are you a mutant with super fast healing or is this just asian genetics at work?

After 3 weeks none will notice but you yourself.

[Milli_Meters]

She is not a "younger patient" I feel her recovery is impressive.


Also would be nice if some people answered her question about how long after bimax she can go for a genio.

Conventionally suggested period is like 6 - 12 months right?

[overbiteme]

Are you a mutant with super fast healing or is this just asian genetics at work?

If it helps anyone here, I'd like to share some recovery tips.

I'm not young. I'm 35 and I'm actually 2 days to 3 weeks post-up.  I work out to stay healthy before the surgery. Some tips I find very useful for recovery:

1. Eat a a alot! The first 2 days were awful due to the nausea caused by pain medicine. After I came back home, my mom made many broth, soup, fresh juice. Fish and chicken broth are good. Watermelon juice is helpful for reducing swelling. The 2nd week, I started to eat mashed potato blenderized wth fish or chicken.

From 10 days on, I basically blenderized everything my family have for meal. I ate even more than how much I eat before the surgery. This keeps my energy level. Also, drinking lots of water really helps. Besides normal water, I also drank alkaline water with multi-vitamin packs. Green tea is also good for swelling as suggested by my surgeon.
 

2. Walk a lot! I took 2 walks everyday from the 4th day. Because I had enough food, I have energy to walk. I walked half hour to the neareast supermarket on the 6th day and also walked all the way back.

I also kept myself active all the time. I started to work from home the 4th day (half day). I helped my family do some cooking and house cleaning as well. I drove to supermarket for some food shopping.  I don't like myself lying in bed like a patient.

3. Humidifier and sitting pillow. Humidifier helps me breathing well. I also used Simply Saline and Q tips to clean up my nostral by myself. The sitting pillow I got on Amazon is very comfy. I only woke up for the 1 week at night. From the 7th day, I always slept all the way to the morning without waking up.

4. Ice packs are the key for the 1st week. I bought more than 10 ice packs to store in the freezer. My mom helped me change the ice packs every hours for the first 2 nights. I did that by myself for the following 5 day and night.

5. I did not feel too much numbness except for the upper lip area, but my upper lip is still pretty swollen and protruding.

Feel free to ask my any questiones! Thanks!

 

[Milli_Meters]

If it helps anyone here, I'd like to share some recovery tips.

I'm not young. I'm 35 and I'm actually 2 days to 3 weeks post-up.  I work out to stay healthy before the surgery. Some tips I find very useful for recovery:

1. Eat a a alot! The first 2 days were awful due to the nausea caused by pain medicine. After I came back home, my mom made many broth, soup, fresh juice. Fish and chicken broth are good. Watermelon juice is helpful for reducing swelling. The 2nd week, I started to eat mashed potato blenderized wth fish or chicken.

From 10 days on, I basically blenderized everything my family have for meal. I ate even more than how much I eat before the surgery. This keeps my energy level. Also, drinking lots of water really helps. Besides normal water, I also drank alkaline water with multi-vitamin packs. Green tea is also good for swelling as suggested by my surgeon.
 

2. Walk a lot! I took 2 walks everyday from the 4th day. Because I had enough food, I have energy to walk. I walked half hour to the neareast supermarket on the 6th day and also walked all the way back.

I also kept myself active all the time. I started to work from home the 4th day (half day). I helped my family do some cooking and house cleaning as well. I drove to supermarket for some food shopping.  I don't like myself lying in bed like a patient.

3. Humidifier and sitting pillow. Humidifier helps me breathing well. I also used Simply Saline and Q tips to clean up my nostral by myself. The sitting pillow I got on Amazon is very comfy. I only woke up for the 1 week at night. From the 7th day, I always slept all the way to the morning without waking up.

4. Ice packs are the key for the 1st week. I bought more than 10 ice packs to store in the freezer. My mom helped me change the ice packs every hours for the first 2 nights. I did that by myself for the following 5 day and night.

5. I did not feel too much numbness except for the upper lip area, but my upper lip is still pretty swollen and protruding.

Feel free to ask my any questiones! Thanks!

 

Thank you so much for that. This is inspiring for us who are going through jaw surgery  in relatively "not young" years.

[CCW]

I think it looks good, but you have a flat chin, so getting a small genio is a good idea. Then you won't have to worry about getting the implant replaced or it getting infected in the future either.

I do actually believe it's possible to get a genio done now without having to wait 6 months. I have seen cases where a genio (or a revision) was done almost immediately after jaw surgery. Ask your surgeon.

[overbiteme]

cool thanks for the info! Can you link me this sitting pillow on amazon?

The name of the pillow is :LINENSPA Shredded Foam Reading Pillow

[ditterbo]

Going to go against the grain here.  It's too early to tell how your chin implant or anything will look 3 weeks post op.  Your smile (if that first pic is it) is definitely not back to normal.  Wait it out (as you were going to have to anyways) to see the end result. Your chin looks recessed because your maxilla is still swollen. The chin implant looks small, like maybe 3-5mm, and personally I don't see anything wrong with your chin.  A stronger labiomental fold may look weird. You're lucky not to have any lower lip/chin numbness from the bimax, but you can expect to get some from an SG. 

[Milli_Meters]

For the record I do NOT think she should immediately get a genio. Just giving the time span in which things are more settled.

doh so sorry I missed NOT in my original message.

[overbiteme]

Hi Guys, I have some updates here:

I visited my surgeron this morning. He said I can get SG for a better profile and more natural look. I asked him why we did not have the SG and bimax done together. He said he might not have a good eye, because for the bimax we had so many things need to be done. It's better to do it now because he can have a better image when the jaw bones are settled.

He said he took the impant out when doing the bimax, and the implant was actually quite big. It covers all the chin area and even bigger than that. He is not sure whether the SG would give me a better look (probably yes), because he usually only does no more than 6 mm advancement for SG. He mentioned anything more than 6mm might cause some depressions on the jaw line (anywhere between the chin and jaw). Is this common?

My surgeon(Dr. Relle) is highly rated. The bimax went very well, which made my recovery quite smooth. So I think I'd trust him on this, but still wondering should I get a second opinion? He is very experienced but as read here, he is a bit conservative. He does as less as possible to gurantee the function but does not put too much attench on the aesthetics.

As to the timeline, he said we will decide when to have SG after 2 weeks (maybe 2 months from there). We'll also decide the SG plan by then.  The main concern is how much my mouth can open to get the breathing stuff go through for the general anesthesia. He asked me to practice more mouth opening from now on.

He also mentioned the recovery of SG should be much easier and less painful than the bimax.

[ditterbo]

Hi Guys, I have some updates here:

I visited my surgeron this morning. He said I can get SG for a better profile and more natural look. I asked him why we did not have the SG and bimax done together. He said he might not have a good eye, because for the bimax we had so many things need to be done. It's better to do it now because he can have a better image when the jaw bones are settled.

He said he took the impant out when doing the bimax, and the implant was actually quite big. It covers all the chin area and even bigger than that. He is not sure whether the SG would give me a better look (probably yes), because he usually only does no more than 6 mm advancement for SG. He mentioned anything more than 6mm might cause some depressions on the jaw line (anywhere between the chin and jaw). Is this common?

My surgeon(Dr. Relle) is highly rated. The bimax went very well, which made my recovery quite smooth. So I think I'd trust him on this, but still wondering should I get a second opinion? He is very experienced but as read here, he is a bit conservative. He does as less as possible to gurantee the function but does not put too much attench on the aesthetics.

As to the timeline, he said we will decide when to have SG after 2 weeks (maybe 2 months from there). We'll also decide the SG plan by then.  The main concern is how much my mouth can open to get the breathing stuff go through for the general anesthesia. He asked me to practice more mouth opening from now on.

He also mentioned the recovery of SG should be much easier and less painful than the bimax.

The chin implant is probably less than 6mm, so maybe he was referring to how far back it went (the wings). The implant is supposed to rest over the bulk of the chin bone.  You can see my (first) chin implant was 7mm and looked like it protruded out further than yours. http://i.imgur.com/bVGVVyD.jpg

So you may end up with a slightly more forward chin with a 6mm SG, though somewhat negligible.  IMO get a second opinion and maybe a morph of how you want your chin to look. Also, he said it's easier to do an SG now than when the jaw bones are settled?? Did i read that right?

The only strange thing I see with the chin implant, albeit who knows how it looks post swelling, but is the chin pad pointing way down when you attempt to smile? That's all I see that looks off about it right now.

[overbiteme]

The chin implant is probably less than 6mm, so maybe he was referring to how far back it went (the wings). The implant is supposed to rest over the bulk of the chin bone.  You can see my (first) chin implant was 7mm and looked like it protruded out further than yours. http://i.imgur.com/bVGVVyD.jpg

So you may end up with a slightly more forward chin with a 6mm SG, though somewhat negligible.  IMO get a second opinion and maybe a morph of how you want your chin to look. Also, he said it's easier to do an SG now than when the jaw bones are settled?? Did i read that right?

The only strange thing I see with the chin implant, albeit who knows how it looks post swelling, but is the chin pad pointing way down when you attempt to smile? That's all I see that looks off about it right now.

Thanks for sharing this! Comparing to yours, I think my implant should be about 5mm. However, what my surgeon mean is he usually would not go any furyher more than 6mm, not only for my case, but generally for all his patients. He explained that he did this to avoid causing a small dent on the jaw line, where my implant wing ends.  I saw some one here had 12mm advancement SG without any depression at that area.

As to the timeline, he said maybe after 2-3months  I can get SG.  He needs enough mouth opening to proceed the procedure. Also, the bone cut area will be recovered then. I think with 2-3 months, my swelling will go away 90% and I have enough time to think through my decision.

Did you replace the implant or did you get a surgery to fix the problem? Would like to hear your story!