Sliding Genioplasty lost projection after swelling was gone, using filler?

[tim06]

I think he's already in Europe as he (or maybe someone else) mentioned they knew him from a German board. Anyway, something like a Lefort2 set back would be more in venue of doctor who also has CRANIO-facial expertise underbelt. It's very common for many of the max fax guys to to just want to stick to the lefort 1s since that's the most kind of common Lefort done. Not to mention the other Leforts are much more challenging. So, would basically take an 'uncommon' MOTIVATION to hunt down the guy for the job. What he has does not look like an easy fix (protrusion to the L2 area). But I guess it's  a good thing that just some more chin bulk would bring him more happiness. Maybe a silicone pre-jowl implant or some deeply placed MACRO-lane. Both can be taken out or down if they don't do the trick.

Yes correct I am from Germany. I agree that a Lefort 2 with BSSO would be the perfect procedure but it is just unrealistic. It would require years of completely unnecessary orthodontic work to prepare for the surgery. And like mentioned I don't believe that there are any doctors who would do a Lefort 1 or 2 just for aesthetic reasons.

At the moment I really consider getting a custom made silicon implant. The big advantage would be a very short recovery time and much less pain since no bones need to be cut. And it would also give me a much greater opportunity to be able to influence the aesthetic result.

[kavan]

Yes correct I am from Germany. I agree that a Lefort 2 with BSSO would be the perfect procedure but it is just unrealistic. It would require years of completely unnecessary orthodontic work to prepare for the surgery. And like mentioned I don't believe that there are any doctors who would do a Lefort 1 or 2 just for aesthetic reasons.

At the moment I really consider getting a custom made silicon implant. The big advantage would be a very short recovery time and much less pain since no bones need to be cut. And it would also give me a much greater opportunity to be able to influence the aesthetic result.

Well, as long as you don't expect your lower lip to line up with the top. Keep in mind a vertical dropped from your lower lip has your chin lining up with it and if you go too much beyond that it can give look of crescent moon chin.

[tim06]

Well, as long as you don't expect your lower lip to line up with the top. Keep in mind a vertical dropped from your lower lip has your chin lining up with it and if you go too much beyond that it can give look of crescent moon chin.

Yes sure, but what would you recommend in my situation?

[kavan]

Yes sure, but what would you recommend in my situation?

When the solution (L2 set back) to the asthetic problem (protrusive leftort area) can't be done because the doctors you've asked to do it say 'no', other suggestions are just MAYBEs and not substitutes for the solution.

Maybe a silicone  implant or some deeply placed MACRO-lane. Both can be taken out or down if they don't do the trick. You would have to be cautious about going too far with the implant as I mentioned above and be aware that it is hard to reproduce the type of even over all favorable swelling you are wanting to reproduce. Those are just maybes for the CHIN as in maybe they will volumize the chin more in the way you liked it soon after the SWELLING.

The 'maybes' for the CHIN are limited to maybe they will given you the look of post op swelling to the chin area. But there is no 'maybe' about that compensating for the protrusive L2 area.

[Jilkster]

When the solution (L2 set back) to the asthetic problem (protrusive leftort area) can't be done because the doctors you've asked to do it say 'no', other suggestions are just MAYBEs and not substitutes for the solution.

Maybe a silicone  implant or some deeply placed MACRO-lane. Both can be taken out or down if they don't do the trick. You would have to be cautious about going too far with the implant as I mentioned above and be aware that it is hard to reproduce the type of even over all favorable swelling you are wanting to reproduce. Those are just maybes for the CHIN as in maybe they will volumize the chin more in the way you liked it soon after the SWELLING.

The 'maybes' for the CHIN are limited to maybe they will given you the look of post op swelling to the chin area. But there is no 'maybe' about that compensating for the protrusive L2 area.

I see you suggesting macrolane a lot, do you have any context for its use in the face? My dermatologist considered it unsafe.

[kavan]

I see you suggesting macrolane a lot, do you have any context for its use in the face? My dermatologist considered it unsafe.

I could give the generic term which would be; high viscosity filler ('thick' filler), a type of filler meant to be injected very DEEP to areas where there is already some thick tissue coverage for them which can be used 'off label' for areas like to the lower jaw and chin. But if someone then asked for an example of one (you know a trade name for one), I could say; 'macrolane is an example of one.'

Maybe from now on I'll just say: 'High viscosity filler. Ask your derm.'

[Jilkster]

I could give the generic term which would be; high viscosity filler ('thick' filler), a type of filler meant to be injected very DEEP to areas where there is already some thick tissue coverage for them which can be used 'off label' for areas like to the lower jaw and chin. But if someone then asked for an example of one (you know a trade name for one), I could say; 'macrolane is an example of one.'

Maybe from now on I'll just say: 'High viscosity filler. Ask your derm.'

Is macrolane even regularly used in the face though?

[kavan]

Is macrolane even regularly used in the face though?

It's OFF LABEL use.  On label is body filler. Very 'thick' filler that can be used off label to jaw area. But not used regularly for that.

[tim06]

It's OFF LABEL use.  On label is body filler. Very 'thick' filler that can be used off label to jaw area. But not used regularly for that.

In Europe the producer stopped selling it completely.

[kavan]

In Europe the producer stopped selling it completely.

Well, that definitely makes it 'off label' use. lol

Thanks folks for the feedback on this product. In retrospect, I should have just said; 'High viscosity' or 'thick filler' and not mentioned the trade name of the thickest one I could think of.

[BrazilianJaw]

Really looks like a maxilary protusion. Perhaps a BSSO with lower extractions could bring some improvement.

In cases like these, would be possible in the same surgery to perform a lefort 2 set back and in the same procedure a lefort1 + bsso with a big maxilomandibular advancement to creates a very strong lower third?

[kavan]

Really looks like a maxilary protusion. Perhaps a BSSO with lower extractions could bring some improvement.

In cases like these, would be possible in the same surgery to perform a lefort 2 set back and in the same procedure a lefort1 + bsso with a big maxilomandibular advancement to creates a very strong lower third?

The Lefort2 area includes the Lefort 1 area.

[tim06]

The Lefort2 area includes the Lefort 1 area.

I am thinking about visiting Dr. Brusco in Zurich or at least making a 3d scan of my skull and sending him an email with pictures and asking for advice. Do you know any talented surgeons in Germany for such a case?
I know about dr. Z but I guess he would just offer me a chin-wing and this is not a good solution without chin-visor osteotomy or other procedures.

[kavan]

I am thinking about visiting Dr. Brusco in Zurich or at least making a 3d scan of my skull and sending him an email with pictures and asking for advice. Do you know any talented surgeons in Germany for such a case?
I know about dr. Z but I guess he would just offer me a chin-wing and this is not a good solution without chin-visor osteotomy or other procedures.

Here's the deal. I just stick to helping with conceptual stuff like showing/explaining where the problem is. On you, it looks like you have excess protrusion to the Lefort 2 area and that you could use some advancement to the BSSO area. The other concept is that chin alterations won't compensate for that.

The only thing I can suggest as far as doctors are concerned is to take note of the doctors who wrote the paper about L2 set back (included here. Brazil jaw tracked it down) and research from there.

[ditterbo]

Curious if a lefort 2 that actually brings his center face backwards instead of forwards is really a smart move long term? Isn't he going to age better with this extra midface surface area? It doesn't look disfiguring at all as it is now either.  Not included in this decision making so far I think is the state of his airway, and how that can be impacted from any of these set backs we're talking about - lefort 1 or 2.