Lower Jaw Surgery or Sliding Genio? [Pics]

[Ezra]

Hi guys. I really need some help. I'm pursuing surgery for aesthetics reasons. I don't have any pain or bite problems. I have an slight overbite, deep bite, my teeth are starting to flair but that can be fixed with braces. I just hate how small and recessed my chin looks and how short my face I'm not jutting my jaw forward.


I've seen two reputable jaw surgeons.

Dr. Gilbert wants to do:

-Sliding Genioplasty (instead of lower jaw surgery, to build a better chin area)
-Upper Jaw lowering (to give add facial length, show more teeth when smiling and resting)


Dr Choi wants to:

-Lower Jaw Surgery only ( to fix recessive lower jaw appearance. No sliding genio )
-Remove 2 molars to make room for this.
-Willing to do upper jaw as well after I asked. Doing both these surgeries is very expensive for me, tough.


All options include braces obviously. My orthodontist said both options will achieve a good result cosmetically and he didn't recommend one surgeon over the other. He said they are both great surgeons.

I'm hesitant to do upper jaw after reading about nose changes. I had a botched nose surgery that I fixed with an expensive revision from Dr. Frankel. I will not do something that changes my nose. Dr. Gilbert never mentioned nose changes but I just noticed people talking about it on this forum. If I only lowered the upper jaw, without moving it forward, would that change the nose? I'm considering just doing a Sliding Genio and no jaw surgeries.  Would a Sliding Genio be good enough, by itself?


TLDR - I'm deciding between 1.) Sliding Genio only, 2.) Sliding Genio+Upper Jaw,  or 3.) Lower Jaw only.

my real bite:

https://imgur.com/tq2lnYh

http://imgur.com/LN0tdjD

http://imgur.com/ReyqcIH

https://imgur.com/n1qXOqc

jutting forward (close to what I want to achieve, hopefully will be better):

http://imgur.com/UTdIOxa

http://imgur.com/wYLGLW4

http://imgur.com/CuDKLPU

[kavan]

slide down genio to elongate the chin.

[Jilkster]

Wouldn't your relaxed jaw look pretty decent? The biting down makes it a lot worse than in daily life.

[Ezra]

I think you'd get a nicer aesthetic result with jaw surgery + genio versus only a sliding genio, but if you do go the jaw surgery route: for heaven's sake go to the best surgeon and stop the surgery thereafter.

Since you probably don't want to hear this, but it is a shame what happened to your nose. As you have damn good features (I'm envious bro!)
You have a great projected browridge, fantastic jawline with good drop down (albeit the jawline/angle seems covered a bit by fatty tissue), nice eyes, good inferior orbital rim projection, fantastic hairline, great brows (just a tiny bit too groomed for my personal taste), nice shaped lips albeit your bite currently seems to affect the way they look in resting pose, which is one of the reasons why I feel you'd look better after jaw surgery (aside the fact the lower jaw looks retruded). Good skin and skin tone. Good temple projection, nice lateral width of your face, nice cheekbones. Good forehead shape.  Good fat distribution, albeit losing a bit of weight may make your features pop out more, and posteriorly along the jawline there seems a bit of excess fatty tissue.

Seriously dude: you're really lucky. Now don't mess that up with more surgery, so if you do go the route of jaw surgery, aim high, go to the best surgeon, and for heaven's sake: NO MORE SURGERY TO NEW FEATURES. You seriously risk ruining those good features. Surgically enhanced features are not better than the naturally handsome features you have: it's not going to get better than that. Remember that! If you're born with bad looking features you can possibly improve them with surgery, but if you have such naturally great features as you have: you're never ever going to get such completely naturally appearing goodlooking features through surgeries. So don't try!

What did your nose look like before any surgery? I hate to say it but it is still the other feature to me that stands out.

When you say a nicer aesthetic result with jaw surgery + genio, are you referring to lowering the upper jaw and a genio? That is what the first surgeon offered me.

And thank you for the compliment. It does mean something to me as I'm here obviously because I'm not feeling too secure with my appearance. It really is just the jaw thing that bothers me though. I'll have to take your advice on avoiding cosmetic surgeries in the future. Its so costly ($$ and emotionally) and in my case, apparently not necessary.

Yeah, so about my nose, I was really young and wanted to a nose that wouldn't project so far out. I went to the first surgeon I (mistakenly) liked. He really just made it crooked/upturned/thin and not closer to my face. Dr. Frankel fixed the crookedness, fixed the upturned angle, and de-projected it. He is really is a master at this.


here is my original nose:


https://imgur.com/zcZn8vC

http://imgur.com/zWZVNug

http://imgur.com/Xbzxal9

http://imgur.com/em992nV

http://imgur.com/Oj7jSh5

I didn't understand that I have recessive jaw/chin. This added to the reason I thought my nose was overprotected. However, I don't dislike the nose Dr. Frankel gave me. He did the best with what he had to work with.

What about my current nose stood out to you?

[CCW]

Both of these plans are wrong for you. You clearly have bimax recession and need double jaw surgery with counterclockwise rotation. Your chin looks adequate to me and you may not even need a genio if your jaws are rotated enough. Don't get an isolated genio because it'll probably give you a witch's chin appearance due to the amount of advancement needed to give you enough projection.

You need to get more opinions. Don't settle for the cheapest local surgeon who really is a glorified dentist, especially if you're doing this for aesthetics. In this business, you really get what you pay for.

[Ezra]

Ok so that last picture (that I quoted above as some of the other pics don't show your face as well, but I can remove it for you, just lemme know), shows your frontal face before your rhinoplasty. Some exceptional features, be careful there and don't mess with it as said.

I think Frankel did a good job on the profile of your nose, it looks much better than before since that 'sweep' was straightened. However (but this is my personal opinion): the front view doesn't look onoperated on to me. If I see your original nose I can comprehend why you wanted a bit of refinement in the tip/the 'sweep' in the side view gone, since the tip of the nose was a little bit bulbuous perhaps in some views. However, the problem is as you've seen yourself: once rhino goes wrong it is s**t difficult to fix. And everyone can see on Realself: it goes wrong more often than it goes right. So I'm sure Frankel gave you a good improvement. But my personal opinion is it does still not look completely onoperated on. The nose seems too short from the front view, the tip not completely natural shaped and should point further downwards, and ideally have a more natural shape/be better streamlined. To get a stronger, more masculine nose that complements your other features such as your masculine jawline. Very very few surgeons can do such revision worldwide. I know Lazlo always mentions Toriumi, and for females Toriumi may be over-the-top, but for such a revision case that needs a masculine result as you have: I think he may be one of the only surgeons that could pull this off. But he's very expensive. And I don't want to make you feel worse as I'm sure your nose was a good improvement. This is just my opinion.

Getting other surgery to other features is not just "not necessary" as you say: you have splendid features that would make most guys (me included) envious. You can only f*** them up if you get surgery to them; they are not going to get better. I repeat myself but surgery can only enhance features that could use enhancement, and in such a case there may be a nice improvement. But no surgery result is going to look as nice as naturally goodlooking features. You're never going to get that through surgery. This is a mistake many make (also many that get rhinoplasty). Naturally goodlooking features have good/even skintone, good/even fat coverage, complete unlimited mobility (scar tissue will affect that, even if only a little bit). Getting jaw surgery is a different story since you'd be getting osteotomies to the bone, but more soft tissue/cartilage work and you can mess up those features. It would be damn pity to see you try that out to such good features as you naturally have.

As to the jaw surgery, certainly lower jaw surgery + genio in my opinion, but we'd need to see cephs to have an idea about your bite/the upper jaw.

Well thank you and I'll keep that particular surgeon in mind. As of now, I mostly like my nose. Dr. Frankel is going to add some cartilage (from behind my ear) to the deep nasal indent on my right. This will help fill in the gash and it can be done while I'm awake. It is very minor and can only improve things. You're right though, it could definitely be much more natural looking, but the cons tend to outweigh the risks for me. All the morphs I do only make things look worse, even slight milometers to the tip tend don't really help. If I see a good morph, it could change my mind. Plus, altering the tip would change the profile view, which is pretty great right now. The only morph that looked good was when I made the bridge wider, but I can live without that for now.

As for the jaw, no surgeon has yet to offer me both a sliding-genio combined with lower jaw surgery.

One surgeon said just lower jaw by itself. The other surgeon wants to move the upper jaw downwards, combined with sliding genio.

Not sure what to do.

[Ezra]

Very true. OP should not just get a genio: he would get a deep sulcus that way too, if he'd want to get all the advancement with a genio.


As to the upper jaw: I think you're right too. Would still be good to first see a ceph though.

What is a ceph?

[Ezra]

Both of these plans are wrong for you. You clearly have bimax recession and need double jaw surgery with counterclockwise rotation. Your chin looks adequate to me and you may not even need a genio if your jaws are rotated enough. Don't get an isolated genio because it'll probably give you a witch's chin appearance due to the amount of advancement needed to give you enough projection.

You need to get more opinions. Don't settle for the cheapest local surgeon who really is a glorified dentist, especially if you're doing this for aesthetics. In this business, you really get what you pay for.

What are some good surgeons in Southern California /  Los Angeles area?

[kavan]

Both of these plans are wrong for you. You clearly have bimax recession and need double jaw surgery with counterclockwise rotation. Your chin looks adequate to me and you may not even need a genio if your jaws are rotated enough. Don't get an isolated genio because it'll probably give you a witch's chin appearance due to the amount of advancement needed to give you enough projection.

You need to get more opinions. Don't settle for the cheapest local surgeon who really is a glorified dentist, especially if you're doing this for aesthetics. In this business, you really get what you pay for.

Looks like he has somewhat of a deep bite to me (and he said that). Deep bite shows as short chin and often associated with flatter occlusal plane not needing CCW.  Also, the act of his jutting out his jaw is act of clockwise rotation which makes the chin look longer. I think a drop down genio, perhaps with a chin implant overlay would give him the biggest bang for his buck.

[CCW]

Doing just one jaw is almost always a compromise. Dentofacial deformities aren't usually limited to just one jaw and if you're going through with jaw surgery and all the risks associated with it, you shouldn't settle for a compromise. You want to get it right the first time.

Are you in California? You should consult with Dr. Gunson and Dr. Relle.

[CCW]

Looks like he has somewhat of a deep bite to me (and he said that). Deep bite shows as short chin and often associated with flatter occlusal plane not needing CCW.  Also, the act of his jutting out his jaw is act of clockwise rotation which makes the chin look longer. I think a drop down genio, perhaps with a chin implant overlay would give him the biggest bang for his buck.

I think his entire maxilla needs to be lowered, but more in the posterior part, so that it results in CCW. It's not rare for a deep bite patient to need CCW. He doesn't have the typical "too flat occlusal plane" look. His profile is too convex. His chin has a decent shape to it, so he may get away with not needing a genio at all or a small one if it's necessary. It's not a good idea to camouflage jaw recession with a genio.

[kavan]

I think his entire maxilla needs to be lowered, but more in the posterior part, so that it results in CCW. It's not rare for a deep bite patient to need CCW. He doesn't have the typical "too flat occlusal plane" look. His profile is too convex. His chin has a decent shape to it, so he may get away with not needing a genio at all or a small one if it's necessary. It's not a good idea to camouflage jaw recession with a genio.

There could be an indication for that. But, I would not say that  in absence of seeing ceph. His go-go distance is nice and wide and his jaw angles look nice and low which is why I think he could mask with drop down genio to elongate chin. This is in reference to his facial topography.

[PloskoPlus]

A deep bite can mask a steep occlusal plane.... I don't think genioplasty is a good idea - the chin bone looks fine to me.

[kavan]

What is a ceph?

An X ray that shows your dental relationships, facial bones and soft tissue contour outline.

[kavan]

A deep bite can mask a steep occlusal plane.... I don't think genioplasty is a good idea - the chin bone looks fine to me.

It's short when he closes in on his bite. When he advances out his jaw it's longer. That's why I say a chin elongation would mask things for him. He does not need much advancement there either. With bi-max (keep in mind CCW entails surgery to the maxilla), his nose relationship can change. So, my response takes into consideration his concerns about a potential change in the nose relationship. Also, i think the short chin is the main aesthetic deviance he has from looking great. That's why I think he could get away with 'masking'. Keep in mind drop down genios don't make the chin sulcus more visible. They tend towards making it less visible.