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

[tim06]

I had a sliding genioplasty and two weeks after the procedure it looked perfect! Due to the swelling my lower third had the perfect proportions and projection for my face. But since the hefty swelling went away it looks now really not good.

Is there any way to get back to the 2 weeks post surgery swelling with filler? I was so happy with the result, it had the correct volume from all angles and now it just went away

2 weeks post op:


18 months post op:

[kavan]

The chin is actually in line with the lower lip and pretty much where the chin should be 'in it's own right'. Aside from the fact that there is more BULK in the swelling photo and filler RARELY mimics the look of DIFFUSE even swelling, it's still about the same projection. However, in both photos your upper lip is too far forward to the lower lip which is an indicator that genio ALONE was not the entire solution to your profile imbalance.

Via my displacement changes, the visual info I'm getting suggests a Lefort 2 type set back for a protrusive area above the Lefort 1 area in addition to a BSSO. It looks like you have a protrusive Lefort 2 area in addition to a slightly retrusive lower jaw.

You probably could get away with a bi-max with lefort 1 set back and BSSO advance and spare yourself from pursuing any Lefort 2, a rhinoplasty would be needed in addition for better overall balance.

Although I try to AVOID suggestions towards the more complex and involved leforts, (usually because the next person reading it THINKS he/she also needs same when they don't), in this case, I'm seeing protrusion in the Lefort 2 area.

[needadvancement]

I went through the same disappointing thing bud. Good thing you posted pictures, anybody considering SG and going through post-surgery needs to see them.

The look of the initial swelling is not achievable with jaw augmentation alone because it adds size in areas all around the critical points which of course are only there temporarily.

[tim06]

The chin is actually in line with the lower lip and pretty much where the chin should be 'in it's own right'. Aside from the fact that there is more BULK in the swelling photo and filler RARELY mimics the look of DIFFUSE even swelling, it's still about the same projection. However, in both photos your upper lip is too far forward to the lower lip which is an indicator that genio ALONE was not the entire solution to your profile imbalance.

Via my displacement changes, the visual info I'm getting suggests a Lefort 2 type set back for a protrusive area above the Lefort 1 area in addition to a BSSO. It looks like you have a protrusive Lefort 2 area in addition to a slightly retrusive lower jaw.

You probably could get away with a bi-max with lefort 1 set back and BSSO advance and spare yourself from pursuing any Lefort 2, a rhinoplasty would be needed in addition for better overall balance.

Although I try to AVOID suggestions towards the more complex and involved leforts, (usually because the next person reading it THINKS he/she also needs same when they don't), in this case, I'm seeing protrusion in the Lefort 2 area.

I asked for a BSSO and the doctor told me it is not possible since my bite is fine. No doctor will do a lefort 1 or 2 for aesthetic reasons. The only options left are Chin Wing, Implant, or Fillers.
A chin wing is too dangerous and would most likely just result in an even pointer chin, and a visible plate that stands forward.

During my SG the chin was moved by 11 mm.

[tdawg]

I asked for a BSSO and the doctor told me it is not possible since my bite is fine. No doctor will do a lefort 1 or 2 for aesthetic reasons. The only options left are Chin Wing, Implant, or Fillers.
A chin wing is too dangerous and would most likely just result in an even pointer chin, and a visible plate that stands forward.

During my SG the chin was moved by 11 mm.

Can you post a picture of your teeth biting down, from the side? From the way your upper lip sticks out I would be pretty surprised if you didnt have a significant overjet.

[kavan]

I asked for a BSSO and the doctor told me it is not possible since my bite is fine. No doctor will do a lefort 1 or 2 for aesthetic reasons. The only options left are Chin Wing, Implant, or Fillers.
A chin wing is too dangerous and would most likely just result in an even pointer chin, and a visible plate that stands forward.

During my SG the chin was moved by 11 mm.

None of the options you mentioned, (alone) would address what looks like excess protrusion to the area I showed. I guess you could get an implant to bulk up your chin more if you feel more bulk there would please you.  I'm just telling you where I see excess protrusion to the face which is in the lefort 2 area.

[tim06]

None of the options you mentioned, (alone) would address what looks like excess protrusion to the area I showed. I guess you could get an implant to bulk up your chin more if you feel more bulk there would please you.  I'm just telling you where I see excess protrusion to the face which is in the lefort 2 area.

Yes, but it is simply not possible to address this. I asked this multiple maxillofacial surgeons and they refused to do it.

[tim06]

Can you post a picture of your teeth biting down, from the side? From the way your upper lip sticks out I would be pretty surprised if you didnt have a significant overjet.

No, none of my doctors ever mentioned that. It was checked before I got the SG and ruled out.

[kavan]

Yes, but it is simply not possible to address this. I asked this multiple maxillofacial surgeons and they refused to do it.

Ya, I can see that it would be difficult for many max fax docs and also to find the few who could do. Member= 'Brazilian Jaw' shared an article of this nature. https://zeze.sci-hub.cc/135c43ccde4fa76fe829841dcca29c62/konopnicki2016.pdf
if you're interested.

[tim06]

Ya, I can see that it would be difficult for many max fax docs and also to find the few who could do. Member= 'Brazilian Jaw' shared an article of this nature. https://zeze.sci-hub.cc/135c43ccde4fa76fe829841dcca29c62/konopnicki2016.pdf
if you're interested.

No you understood me wrong, they can do it, but will not do it for me. It is like amputing a healthy arm. If something goes wrong during the procedure they could loose their licence.
Also my upper jaw is already very wide forward, moving it even more forward with a BSSO would not result in a good aesthetic face.

[kavan]

No you understood me wrong, they can do it, but will not do it for me. It is like amputing a healthy arm. If something goes wrong during the procedure they could loose their licence.
Also my upper jaw is already very wide forward, moving it even more forward with a BSSO would not result in a good aesthetic face.

You may have misunderstood me too. I was not suggesting to move your upper jaw forward. The suggestion was for a set back to it.

[tdawg]

No, none of my doctors ever mentioned that. It was checked before I got the SG and ruled out.

Could you post a photo anyway? Just for the sake of curiosity.

[ditterbo]

There's no guarantee your lower lip will meet your upper after lower jaw surgery advancement.  I think some others here can attest to that from their own experience.  But that would be the way to try to correct that discrepancy.  Yeah as kavan said, if you want more heft in your chin area then consider a custom type of chin implant with no advancement but bulk to the jowls and area left and right of the chin b point/apex.  I don't mind the supposed protrusive upper face at all. Looks good even.

[girl]

I asked for a BSSO and the doctor told me it is not possible since my bite is fine. No doctor will do a lefort 1 or 2 for aesthetic reasons. The only options left are Chin Wing, Implant, or Fillers.
A chin wing is too dangerous and would most likely just result in an even pointer chin, and a visible plate that stands forward.

During my SG the chin was moved by 11 mm.

Jaw surgery isn't just a "bite only" thing, or at least it shouldn't be - it's about correcting skeletal imbalances. For e.g., traditional orthodontics (like I and many others have had) "corrects" a class II bite but does not deal with the resulting skeletal problems, which is where jaw surgery comes in. 

If you're from the UK (I'm guessing) then you'll need to contact surgeons in Europe for the correct diagnosis.

To counter the 'healthy limb' argument, you had an involved surgery that was not really right for you, which IMO is worse than having a slightly more involved surgery that is aimed at correcting the actual problem.

 

[kavan]

Jaw surgery isn't just a "bite only" thing, or at least it shouldn't be - it's about correcting skeletal imbalances. For e.g., traditional orthodontics (like I and many others have had) "corrects" a class II bite but does not deal with the resulting skeletal problems, which is where jaw surgery comes in. 

If you're from the UK (I'm guessing) then you'll need to contact surgeons in Europe for the correct diagnosis.

To counter the 'healthy limb' argument, you had an involved surgery that was not really right for you, which IMO is worse than having a slightly more involved surgery that is aimed at correcting the actual problem.

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.