Author Topic: surgery in 2 days: sliding genio, chin wing or orthognatic? pics + xray  (Read 5023 times)

landscape

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jawguy: i asked him a similar question, but he wanted to make things simple and didn't get into too much detail. since i still had many things to ask, he just said it would be easy to alter the genio advancement in case i decide to go for orthognathic surgery in the future. he's a professor at one of the most renowned universities in the country with a lot of international experience, so he must know a thing or two.

earlier today we met and i brought the subject of chin wing osteotomy up. he said it's a very tricky procedure and not worth the risk of permanently damage the inferior alvelar and mental nerves; that's the main reason it isn't widely accepted and practiced by the scientific community.

haven: it's not that the lower lip will be noticeably advanced, but it seems like moving the chin bone forward subtly affects its position. a mandible advancement is definitely more appropriate for significant changes there.

from what he told me, he'll advance 8mm forward and 2mm downward (since the cut chin bone has to be kept in contact with its matrix, that's the limit. otherwise, bone grafting will be required, and he wants to avoid that); he also said the style of the cut he will perform adds to the height even more, so let's assume the end result will be 3-4mm of vertical growth. no filler, for sure.

a s**tty thing to say, but he told me not to expect huge changes and to keep my expectations low, then the result might be surprising. i don't expect to come out looking like a model, for sure, and i am realistic about the fact that we are dealing with my (and not some generic) face and that its specificities impose limits that should be respected. in any case, he emphasized that orthognathic surgery would be my best choice, but, as i explained before, i'm reluctant to do it at this point and would like to bet on a less invasive procedure first to make sure that's not enough to improve my appearance and, hopefully, my apnea too.

i have partially jewish blood, haven. i uploaded a few more pictures so you can have a better idea of my overall appearance. criticism is welcome; feel free to comment on it. that's why i'm posting photos. i want know how others see it too. as i implied in a different post, i simply want to hear informed, more objective opinions to be a bit more certain that i'm in a path where i can at least expect positive changes and won't look worse than before.

anyway, i rebooked the surgery to saturday to gain decision time.

bex

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What is your AHI/RDI? And are you fairly young (let's say, younger than 30)? If so, I would count on your apnea getting significantly worse in the next few years. There's never a good time to get major surgery and orthodontics, but I can tell you from experience that I feel like I had a few years of my life taken from me when my apnea got worse in my early 20s.

If I would have had the opportunity to get orthognathic surgery years before my apnea got that bad, I would have done it in a heartbeat.

Personal experience aside, I think orthognathic surgery would be the best option from both an aesthetic and medical standpoint.

fulcanelli

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It’s a tough call. I can see where your dr is coming from, I think a genio will be an improvement but as you know it won’t be perfect. But you might be satisfied with the result and decide you don’t want to go down the uncertain road of full on jaw surgery.

I had just a genio when I was told I was borderline for full jaw surgery. It’s not perfect but it was a definite improvement and I am glad I did it.

Good luck with whatever you decide.

landscape

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thanks for the great answers, everyone.

kava, your post was very elucidating. people (myself included) usually confuse receding chin with receding jaw; now i see they are different things, both of which are traits i carry.

i'm in my late 20s. my ahi is 27.8, which is considered moderate. i've been told it'll get worse. a month ago i began practicing correct tongue posture and i'm pretty sure it helps and will help even more down the road to keep my apnea under control.
anyway, after reading so many comments here suggesting it, i started getting used to the idea of going through orthognathic surgery already.
it would make the decision easier for me though if i could just do it straight away instead of spending a year or more in preparatory orthodontics. i would rather take care of my teeth afterwards. do you guys know if and how much that could interfere with the result of the surgery? is that even an option? i will first try the genio nonetheless and see how that improves things.

fulcanelli, was your case similar to mine? would you mind sharing before and after pictures with me? i would be grateful!

kavan

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My post to which you are responding came in at same time another post came in.  I have some more to add:

No way to tell what type of genio this guy is doing for you and I would establish how 'easy' this this is predicted to be for ANOTHER (unknown) doctor later down the line.

from what he told me, he'll advance 8mm forward and 2mm downward (since the cut chin bone has to be kept in contact with its matrix, that's the limit. otherwise, bone grafting will be required, and he wants to avoid that); he also said the style of the cut he will perform adds to the height even more, so let's assume the end result will be 3-4mm of vertical growth. no filler, for sure.

He has not told you WHAT type of genio this is and made it so 'SIMPLE' as to PRECLUDE you from even doing research on the type for which you would need a NAME of said type or a diagram of said type.

jawguy: i asked him a similar question, but he wanted to make things simple and didn't get into too much detail. since i still had many things to ask, he just said it would be easy to alter the genio advancement in case i decide to go for orthognathic surgery in the future. he's a professor at one of the most renowned universities in the country with a lot of international experience, so he must know a thing or two.

For WHOM will that be 'easier' for; HIM, someone whom we can assume is more ADVANCED than other doctors  OR is he extrapolating on the capacities of a 'who knows who' other doctor later down the line. So ESTABLISH for WHOM he is speaking for, HIMSELF who will be DOING your surgery later down the line, the surgery INSURANCE will PAY for or is he extrapolating on the abilities of some UNKNOWN insurance doctor.

STOP! Ask YOURSELF if you are EXTRAPOLATING his abilities where it might be easy for HIM to adjust to another doctor (unknown to you and him at this point in time). Like why would you extrapolate his abilities (which relate to him, himself doing and undoing things with ease) to PREDICT how easy his work would be for another unknown doctor to undo?

He didn't explain to you what type of genio it was. So, you have NO INFORMATION as to the type NAME of the type of genio even to do your own research as to how 'easy' it is to undo. There are ways to simplify  a general concept as I've done. So I would ask WHY a TEACHING professor would not do so. The art of teaching is being able to break down and simplify a complex concept. From what you convey, he hasn't done that and it does NOT simplify things for you to keep you in the lurch as to what type of genio it's called and to rely on the old: 'Because I'm  the doctor and I said so.'

Disregard this question ONLY IF he is speaking for HIMSELF and HE will be the one DOING either your full maxfax surgery later down the line OR if he is offering to UNDO HIS surgery later down the line so the other doctor doesn't have to deal with revision genio OR he
 demonstrates he has ample familiarity with which ever doctors who COULD be doing your surgery later down the line and enough so to PREDICT their capacities.

As to what is 'easy' for a maxfax doctor, later down the line perhaps one that the INSURANCE pays for in the even you later opt in favor of the full maxfax...you know what that is?

A VIRGIN FACE, virgin bone structure that does not need to be UNDONE to do something else.

ETA: ETA:

As far as what he told you about the chin wing procedure, he told you RIGHT. For example, for people with very STEEP mandibular plane angles (like banana type jaw) who also have little 'room' between the teeth roots and the border of the mandible, between which the NERVE traverses AND the cut is made, it gets more tricky to make a high angled cut through a small passage. Even if no nerve damage, it can just resolve to a glorified genio where one does not see much improvement at all to the back of the jaw area because they have a type of contour to begin with that does not lend itself to what they were hoping to get out of it.


thanks for the great answers, everyone.

kava, your post was very elucidating. people (myself included) usually confuse receding chin with receding jaw; now i see they are different things, both of which are traits i carry.

i'm in my late 20s. my ahi is 27.8, which is considered moderate. i've been told it'll get worse. a month ago i began practicing correct tongue posture and i'm pretty sure it helps and will help even more down the road to keep my apnea under control.
anyway, after reading so many comments here suggesting it, i started getting used to the idea of going through orthognathic surgery already.
it would make the decision easier for me though if i could just do it straight away instead of spending a year or more in preparatory orthodontics. i would rather take care of my teeth afterwards. do you guys know if and how much that could interfere with the result of the surgery? is that even an option? i will first try the genio nonetheless and see how that improves things.

fulcanelli, was your case similar to mine? would you mind sharing before and after pictures with me? i would be grateful!
« Last Edit: June 20, 2018, 10:12:16 AM by kavan »
Please. No PMs for private advice. Board issues only.

jawguy123

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people (myself included) usually confuse receding chin with receding jaw; now i see they are different things, both of which are traits i carry.

I haven't looked at / done the ceph analysis, but I'm not sure how much of a receding chin (microgenia) you have. At least part of the reason your chin sits behind your lower lip is that your lower lip is "artificially" forward due to the proclination of your lower incisors (compensating for your skeletal discrepancy).

It would be interesting to see how much genio movement your doctor would plan if you were also doing the orthognathic surgery.



anyway, after reading so many comments here suggesting it, i started getting used to the idea of going through orthognathic surgery already.
it would make the decision easier for me though if i could just do it straight away instead of spending a year or more in preparatory orthodontics. i would rather take care of my teeth afterwards. do you guys know if and how much that could interfere with the result of the surgery? is that even an option? i will first try the genio nonetheless and see how that improves things.


More recently (due to advances in the hardware fixation -- the plates that hold your jaws together after the surgery), the surgery-first approach has started to gain traction. This would involve getting braces on, then surgery shortly after, then more time in post-surgery ortho. That said, I don't know if you'd be a candidate, since according to this 2015 overview (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4314839/) criteria include "Normal to mild proclination/retroclination of incisors." I'd ask your surgeon.

Also if you do think you're going to pursue orthognathic surgery I would avoid the genio on Saturday. You'd likely need a revision genio (reduction), and reduction movements are typically less predictable/reliable than expansion. Plus, you'd have scar tissue, old hardware, etc. Not to mention you're putting yourself through an extra surgery.

PloskoPlus

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Your surgeon just wants to collect some easy cash.

haven

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If you're concerned about your sleep apnea you should look into jaw surgery. It might not completely alleviate it as your doctor claims but it will be a good preventive measure to keep it from potentially becoming severe if you do nothing.

You should probabaly take longer to decide and see which options you have regarding jaw surgery procedures.

Are you Américan? There are plenty of CA based surgeons that get mentioned here.

landscape

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i should clarify some things in defense of my doctor:
i was the one who approached him asking for the quickest solution. i'm temporarily in my home country (where i have a excellent health insurance), but i live somewhere else. i've been postponing my trip back with the intention of solving health issues that have plagued me for a while and were clearly affecting my well-being. staying here for such an extended period of time (the few years required by orthognathic surgery)  is out of question. if i'm eligible for sfa (thanks for the article, jawguy, i just wrote my surgeon regarding this), it'll be easier to review my current decision. i could maybe come back at the end of the year with everything planned beforehand and go through the operation.

haven, i'm (south) american!

landscape

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update:

seems like i'm not a candidate for sfa. kinda disappointed. i decided to go for the genio first and see how that goes.

kavan

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i should clarify some things in defense of my doctor:
i was the one who approached him asking for the quickest solution. i'm temporarily in my home country (where i have a excellent health insurance), but i live somewhere else. i've been postponing my trip back with the intention of solving health issues that have plagued me for a while and were clearly affecting my well-being. staying here for such an extended period of time (the few years required by orthognathic surgery)  is out of question. if i'm eligible for sfa (thanks for the article, jawguy, i just wrote my surgeon regarding this), it'll be easier to review my current decision. i could maybe come back at the end of the year with everything planned beforehand and go through the operation.

haven, i'm (south) american!

I think you could clarify whether or not HE (who you are sure of can easily UNDO your genio) is going to be YOUR doctor who does the full surgery later down the line OR will another (unknown doctor at this point in time) be doing it. IF SO, please clarify why the genio doctor can easily PREDICT that undoing his work will be 'easy' for the next doctor.
Please. No PMs for private advice. Board issues only.

haven

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Well good luck. Be sure to let us know how it goes.