Revision double jaw surgery - advice

[Brachy]

Hi, I had undergone double jaw surgery and genioplasty 4 months ago.. I had maxiliary downgrafting, clockwise rotation and mandible brought forward to correct class 2 bite.. Unfortunately, plan was not correct and I would appreciate your help what needs/can be done to correct:

- lip incompetence - I can't close my lips without straining, it so much affects my speech
- protrusive profile - perhaps slight backward movement of both jaws (I have very high SNA/SNB values)

I am from Europe, what surgeon would You suggest to consult?

Please, I would appreciate your comments on my lateral view. Tnx

[kavan]

It looks like you had the type of genio to make your chin longer; a slide DOWN genio. So, now your chin muscles have to work HARDER to to close your lips. If you think you would look better with a shorter chin, then have the genio reversed so it's a slide UP genio.

[Brachy]

Thank you very much.. I will post more pictures, my mandible seems to huge for the small face I have..can chin wing be performed after orthognatic surgery to increase vertical dimension and improve lip incompetence? Tnx

[kavan]

If your mandible is too huge for you, pretty dumb to get a chin wing to make things bigger.

[Brachy]

Thanks, please find my pictures attached.. I would like to have less "angry" look, to be able to show emotions more easily.. can chin wing help achieve lip competence and maybe increase mandibular height posteriorly..what about reversing genioplasty..
I would appreciate your comments, many thanks..

[kavan]

Lip incompetence is from a STRAIN to the chin muscles. If your chin was made LONGER and too projected, you would need to seek out something that decreased the projection and made it shorter to reduce the strain on the chin muscles.

In general, chin wings are aimed at INCREASING the dimentions, you feel are too protrusive.

[Brachy]

Thanks, please help me, should I go with mandibular setback 2-3mm and reversing genioplasty (e.g. 2-3mm up).. I would highly appreciate your opinion

[kavan]

Thanks, please help me, should I go with mandibular setback 2-3mm and reversing genioplasty (e.g. 2-3mm up).. I would highly appreciate your opinion

 Will give general information, generally useful information that might help you understand things a little better. Sorry. Can't 'coach' as to specific mm displacements.

[ditterbo]

The projection of your jaws in and of themselves looks good, even attractive. But it's like both your upper and lower lips are being sucked in taught. That's what I notice as 'off' as my first impression and what my eyes draw attention to. I've kind of seen this lip issue before to different degrees with bimax, and don't understand it. I know the genio often slims lower lips a little. Were both lips noticeably fuller before braces + bimax? I could be assuming bimax made this change to your lips when they already looked kind of like this before. I guess something about the muscles controlling the lip don't take well to bimax. It's as if when the jaws go forward the lips complex try to maintain their old position and create this sucked in affect. Just speculating. 

[Brachy]

Thanks, please comment and ask.. you are helpful.. i had maxiliary downgrafting (6mm) and mandibular advancement cca 5-6mm.. so clockwise face rotation with chin slightly back (3mm) and down (4mm) my upper lip seems fuller after bimax, but lower one is very incompetent.. my surgeeon has offered slight backward movement dince I am really sad about profile..it seems like mandibula has streched my tissue significantly, I guess.. please, your opinions are very much welcome

[Brachy]

My SNA/SNB values are very high, like 89...also sella to nasion distance is 71,6mm
Please advise

[Brachy]

Please guys, I would appreciate your comments.. if needed, I can post more pictures.. my concerns are: protrusive profile, lip incompetence, speech problems due to lip incompetence.. thanks in advance

[Brachy]

Hi,
I consulted one austrian surgeon and he said that I need more clockwise face rotation to decrease mandibular projection and improve lip incompetence. Could you please share your thoughts/comments.
I do not know whether I am midface defficient or biskeletal protrusive (SNA/SNB 90, sella nasion distance 71,6mm) If needed, I can post more pictures. Many thanks

[kavan]

More clockwise rotation would tend to just increase the strain on the chin muscles to close the lips.

[Brachy]

Tnx.
This is original mail

Dear Mr. Xxx,
 
to peform a correction of your pofile, it is necessary to redo the complete surgery (more clockwise rotation).
(LFI, BSSO, chin).
Kind regards

I am really confused and sad - just want to look normal. I am scheduled for consultation with more surgeons. Does it seem that I am candidate for Lefort 3?
Reversing genio (moving up) will help improve my lip incompetence and closing lips? My original surgeon suggested slight backward movement.. please share your comments, thoughts.. thanks