Genioplasty date confirmed but unsure about expected outcome.

[Purist]

I'm about to undergo a genioplasty in the first week of October but due to the angle of the mandible and narrow profile of the chin the expected outcome is difficult to gauge with my surgeon stating I should expect some recession after the surgery. My chin is very retruded, i.e no chin.

The first hospital I went to, turned me down stating that I would end up with a pointy chin which would not be to my liking. So, I've resorted to Photoshopping to decide if "pointy" is acceptable. Right now, I'm considering not continuing with the surgery.

Do you think the attached x-rays are a realistic stab at the outcome?  It's a tiered genioplasty and I'm not great at editing.

Please note I cannot have jaw surgery before anyone asks

[kavan]

This is an approximation. It is done ONLY to relay the cut is usually a diagonal one for the chin slide. If tiered, then 2 cuts. It's also done to confirm you won't be getting a lot of augmentation or not to expect it.

For chin augment, one usually does not want to go past the blue drop vertical. Norms for chins are slightly behind the drop. It is to demonstrate not to expect getting even too close to it.

[GJ]

Unfortunately, that mandible angle is too steep for genio to be much use. It might improve your situation, but it might also result in a deep, unnatural labiomental fold. What you truly need is a pretty significant CCW rotation. At least that's what I see. Did you see an orthognatic surgeon for opinion?

[Purist]

So based on what Kavan is saying, it would look like this, which unfortunately wouldn't be acceptable to me. That's a shame.

[kavan]

Unfortunately, that mandible angle is too steep for genio to be much use. It might improve your situation, but it might also result in a deep, unnatural labiomental fold. What you truly need is a pretty significant CCW rotation. At least that's what I see. Did you see an orthognatic surgeon for opinion?

If any genio, it would most likely be the kind where a bone buttress material is between the cut sections for more augment. It's not the sliding genio though.

[kavan]

So based on what Kavan is saying, it would look like this, which unfortunately wouldn't be acceptable to me. That's a shame.

Can't make a prediction of exactly how it would look. More of a matter of saying not a whole lot can be expected from the SLIDING procedure. You would need to look for docs who could advance more but fill the SPACE left from doing that with a material to support the cut bone segments.

[girl]

Agree, absolutely don't get a genioplasty on its own.

Edit - Reading back through your posts, it seems that you're from the UK. Given what you've been told, this doesn't surprise me. You won't get the surgery you need here I don't think. Have you expanded your search to Europe? You deserve the best outcome.

Also, 40s is not too old for jaw surgery!  There are 70 year olds who get it done. Don't take those remarks as the absolute truth. These surgeons aren't comfortable in handling your case and are making excuses
 ("long roots?")

I had a SG with a long, retruded face and it worsened my situation substantially. It just doesn't work when the occlusal plane is so steep.

(PS - I don't know what it is about UK society but I think we're rather ageist compared to others).

Unfortunately, that mandible angle is too steep for genio to be much use. It might improve your situation, but it might also result in a deep, unnatural labiomental fold. What you truly need is a pretty significant CCW rotation. At least that's what I see. Did you see an orthognatic surgeon for opinion?

[kavan]

Agree, absolutely don't get a genioplasty on its own.

Edit - Reading back through your posts, it seems that you're from the UK. Given what you've been told, this doesn't surprise me. You won't get the surgery you need here I don't think. Have you expanded your search to Europe? You deserve the best outcome.

Also, 40s is not too old for jaw surgery!  There are 70 year olds who get it done. Don't take those remarks as the absolute truth. These surgeons aren't comfortable in handling your case and are making excuses
 ("long roots?")

I had a SG with a long, retruded face and it worsened my situation substantially. It just doesn't work when the occlusal plane is so steep.

(PS - I don't know what it is about UK society but I think we're rather ageist compared to others).

You would need more basic knowledge in reading ceph x rays to say that. They are not making excuses. his roots are quite close to the edge of his jaw. It's obvious from the X ray.

[GJ]

Also, 40s is not too old for jaw surgery! 

More than age it's health. If you're 60s and like an avid swimmer or cyclist you can probably get it no problem. That's why they do pre-op physicals, though.

Eat well, exercise, sleep, and you'll have more options for much longer.

[kavan]

More than age it's health. If you're 60s and like an avid swimmer or cyclist you can probably get it no problem. That's why they do pre-op physicals, though.

Eat well, exercise, sleep, and you'll have more options for much longer.

Health they use for GENERAL surgical risks. But for max fax , they also look at the jaw bones to see if there is enough 'room' to make the cuts, bone density, distance away from mandibular nerve, condition of the teeth, etc.  Some people just have very diminutive jaws, too small to make the cuts or too fragile. Others have jaws like pit bulls even when older.

[ditterbo]

Couldn't he/she be considered for the inverted L osteotomy then, instead of the standard BSSO?

[girl]

If they're in the UK, they won't be equipped to deal with complex cases though, so their opinions on the matter aren't to be trusted. That's why I encouraged him to get opinions from abroad from well-known leaders in the field.

Not sure if he had a health check, I just think there's an assumption that a 40+ person is "old" here. I once saw a healthy guy who was 40 or so on a forum. He said that a UK doctor gave him the impression that jaw surgery was a "young person's thing" and that he was over the hill for it.
 

[kavan]

If they're in the UK, they won't be equipped to deal with complex cases though, so their opinions on the matter aren't to be trusted. That's why I encouraged him to get opinions from abroad from well-known leaders in the field.

Not sure if he had a health check, I just think there's an assumption that a 40+ person is "old" here. I once saw a healthy guy who was 40 or so on a forum. He said that a UK doctor gave him the impression that jaw surgery was a "young person's thing" and that he was over the hill for it.

There's no 'assumption'. He has NO room in his jaw and his tooth roots are too close (deep). They told him right. Risk with little reward is evident in the X ray. Doesn't matter what his age is. His ceph x ray gives the info=HIGH risk.

[girl]

The "assumption" was me referring to the age aspect - not the tooth roots.

[Purist]

girl, I made that age comment last year after visiting a third NHS hospital.  They remarked that recovery from jaw surgery is much harder in your forties and for that reason (as well as others Kavan has stated), they would be reluctant to perform surgery.

I'm fortunate that I can postpone the surgery for 12 months which I'm now going to do.

I am also getting braces in the next 6-8 weeks from one of the best UK orthodontists. I have a lot of protrusion, just to add to the messed up jaw. Even this will be tricky with multiple extractions to push the teeth back before retroclining them. So the roots don't come out of my jaw.

The orthodontist did ask me to consider postponing the surgery for at least nine months, as I may be so happy with the result I may not want surgery.  That's the second orthodontist that has said that. I'm sure it will be a huge boost to my self esteem but we all know the chin will still be severely retruded.