General Category > Functional Surgery Questions
Surgery Advice lefort I + sliding genioplasty? pics and x-rays included
surgeryadvice:
Hi,
Quick update...
I have decided to go with a sliding genioplasty to slightly contour and lengthen the chin. Full jaw surgery seems a bit much for me since, as kavan rightly pointed out, that would leave my eye area looking more recessed than before.
I have contacted Dr. Guyuron in Cleveland to look into him doing my sliding genioplasty. He told me during my consultation that he would also place a fat graft along my jawline under the periosteum to slightly widen my jaw. He told me I only needed a relatively minor correction. He also informed me that instead of an orbital implant he could place fat under and around my eyes to correct the negative orbital vector. I do have a question about this... Won't the fat eventually sag causing the lower eyelid to droop down and leaving me with a bigger problem than I started out with? Also, what is the consensus on how long a fat graft typically lasts? I have heard different things from patients and doctors... some say a few years, others say decades.
Does anybody have any suggestions for other good sliding genioplasty surgeons? Also, what is the consensus on Dr. Guyuron?
Thanks
PloskoPlus:
Don't get fat under your eyes. It can resorb unevenly, or worse, calcify into lumps. Guyuron is not a maxillofacial surgeon and he's quite old.
kavan:
--- Quote from: surgeryadvice on January 05, 2018, 09:19:31 PM ---Hi,
Quick update...
I have decided to go with a sliding genioplasty to slightly contour and lengthen the chin. Full jaw surgery seems a bit much for me since, as kavan rightly pointed out, that would leave my eye area looking more recessed than before.
I have contacted Dr. Guyuron in Cleveland to look into him doing my sliding genioplasty. He told me during my consultation that he would also place a fat graft along my jawline under the periosteum to slightly widen my jaw. He told me I only needed a relatively minor correction. He also informed me that instead of an orbital implant he could place fat under and around my eyes to correct the negative orbital vector. I do have a question about this... Won't the fat eventually sag causing the lower eyelid to droop down and leaving me with a bigger problem than I started out with? Also, what is the consensus on how long a fat graft typically lasts? I have heard different things from patients and doctors... some say a few years, others say decades.
Does anybody have any suggestions for other good sliding genioplasty surgeons? Also, what is the consensus on Dr. Guyuron?
Thanks
--- End quote ---
Dr. G used to do the maxfax surgeries but now he's mostly doing PS. He does a lot of bone cut genios and I think even has academic entries on the techniques. He prefers the genios to implants. F/gs when done right, pepper the fat via very small parcels into various tissue planes which increases the chances of the parcels getting a blood supply and living. f/g to lower lid/orbital rim area does not 'gravitate' to pull lid down. On contrary, it can push the lower lash line up. You are not really a dead ringer 'prominent eye' guy. So, f/g could be used to the orbital rim area for some augmentation. It can also be placed to the periosteal level to augment the jaw. Both G and Y are good at what they do. They just approach things differently. It would depend on what you want to avoid. If you want to avoid f/gs and prefer implants instead, then Y. Vice versa, then G.
girl:
--- Quote from: PloskoPlus on January 05, 2018, 09:47:09 PM ---Don't get fat under your eyes. It can resorb unevenly, or worse, calcify into lumps. Guyuron is not a maxillofacial surgeon and he's quite old.
--- End quote ---
This ^^.
You are also correct about the fat causing retraction; however, the risk of this is much lower if it is placed very deep. Not many seem to get the depth right, though.
kavan:
Note: Last night when I was responding, JSF went down. So, I forgot or was just to tired to recall all of my original response .
That said, now I remember what I forgot when re-entering my 'take'.
1: The base linear contour of your chin is good; the base where it is horizontal. On those grounds, I think a bone cut genio to advance and lengthen is good suggestion. BUT with objective to preserve base contour. So when you say Dr. G wants to 're-contour' your chin, if I were you, I'd double check to make sure he doesn't want to 'round it off'and instead wants to preserve the horizontal base contour. Basically same/similar thing I said with reference to Y; make sure he doesn't need to round it off to add the implant or that the contour of base will change from horizont to 'U' contour.
2: You could go to another guy for sliding genio on grounds that G (no longer) isolates his practice to max fax surgery or that G is too 'old'. But given his experience with genios as a function of his age/amount of time performing them, he might have more experience in the genio venue than some other guy you might find to do it. As to another guy to do the chin work, he might not be as conversant in fat grafting and rhinoplasty as is G or as conversant in facial implants as is Dr. Y.
3: Your ceph reveals normative relationships, ones looked at to make a call for bi-max surgery, especially so if you are consulting with maxfax docs who prefer doing it when the relationships DEVIATE A LOT from the norm. So, that puts you more in the venue of the plastic surgeons; Y or G who can make alterations without cutting into both jaws.
4: In GENERAL, there is a lot of UNCERTAINTY with f/gs and you are not going to resolve it via limited feedback on boards. However, the uncertainty as to 'unpredictable' results get LOWERED (and more predictable) with doctors who have been doing it for a long time and favor it. That is to say, if you took ALL the doctors now doing f/gs, many of them are 'bandwagon jumpers' who have not been at it for a long time, general uncertainty with it is higher. Hence, uncertainty levels associated with f/gs decrease the LONGER time period the doctor has been doing them.
--- Quote from: kavan on January 05, 2018, 11:36:22 PM ---Dr. G used to do the maxfax surgeries but now he's mostly doing PS. He does a lot of bone cut genios and I think even has academic entries on the techniques. He prefers the genios to implants. F/gs when done right, pepper the fat via very small parcels into various tissue planes which increases the chances of the parcels getting a blood supply and living. f/g to lower lid/orbital rim area does not 'gravitate' to pull lid down. On contrary, it can push the lower lash line up. You are not really a dead ringer 'prominent eye' guy. So, f/g could be used to the orbital rim area for some augmentation. It can also be placed to the periosteal level to augment the jaw. Both G and Y are good at what they do. They just approach things differently. It would depend on what you want to avoid. If you want to avoid f/gs and prefer implants instead, then Y. Vice versa, then G.
--- End quote ---
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