Author Topic: What do you guys think of these genio predictions?  (Read 2915 times)

nightwing

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What do you guys think of these genio predictions?
« on: November 15, 2018, 02:49:58 PM »
I had a Lefort 1 + autorotation of the mandible + 6mm genioplasty in July 2017 (covered by insurance). My MaxFac is willing to do another genioplasty (will also be covered by insurance). After my first surgery, my chin is still recessed and my lower lip could use a bit more support. I do have a normal class 1 occlusion now. My surgeon's chief resident made the genio predictions. He said he personally thinks 6mm is the best, but would like to know what I think. Do you guys think the 4mm or 6mm prediction looks better? Or should I consider a different amount (like 5mm)?

My concern is if I do another 6mm genio, it would effectively be a 12mm genio. I've read that Genio has 1:1 ratio (bone/soft tissue) up to 8mm, and things like step-off's and labiomental fold become apparent. I did email Dr Eppley about these concerns and he said

"I would not read too much into those soft tissue change opinions. While it is probably true that the greater the chin bone is brought forward the soft tissue thins a bit so the changes are not 1:1 at larger augmentations. But at the clinical level this is not really very relevant and would not factor into how the genioplasty procedure was done.

The bigger the horizontal chin advancement the bigger the step off can be. But in a 'staged' sliding genioplasty I am to sure now relevant the step off concern is."

https://imgur.com/a/eULQppe

Thanks

« Last Edit: November 15, 2018, 03:01:05 PM by nightwing »

PloskoPlus

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Re: What do you guys think of these genio predictions?
« Reply #1 on: November 15, 2018, 04:03:45 PM »
I think you need more CCW rotation.

ditterbo

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Re: What do you guys think of these genio predictions?
« Reply #2 on: November 15, 2018, 05:02:36 PM »
I think he needs a wrap around jaw implant.. maybe other things ... focusing on the chin isn't really going to help him much at this point. Just my opinion. Other areas draw me in for needing improvement over the chin.

ghiggson90

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Re: What do you guys think of these genio predictions?
« Reply #3 on: November 15, 2018, 06:25:16 PM »
I had a Lefort 1 + autorotation of the mandible + 6mm genioplasty in July 2017 (covered by insurance). My MaxFac is willing to do another genioplasty (will also be covered by insurance). After my first surgery, my chin is still recessed and my lower lip could use a bit more support. I do have a normal class 1 occlusion now. My surgeon's chief resident made the genio predictions. He said he personally thinks 6mm is the best, but would like to know what I think. Do you guys think the 4mm or 6mm prediction looks better? Or should I consider a different amount (like 5mm)?

My concern is if I do another 6mm genio, it would effectively be a 12mm genio. I've read that Genio has 1:1 ratio (bone/soft tissue) up to 8mm, and things like step-off's and labiomental fold become apparent. I did email Dr Eppley about these concerns and he said

"I would not read too much into those soft tissue change opinions. While it is probably true that the greater the chin bone is brought forward the soft tissue thins a bit so the changes are not 1:1 at larger augmentations. But at the clinical level this is not really very relevant and would not factor into how the genioplasty procedure was done.

The bigger the horizontal chin advancement the bigger the step off can be. But in a 'staged' sliding genioplasty I am to sure now relevant the step off concern is."

https://imgur.com/a/eULQppe

Thanks

1) You have great insurance.
 
2) I agree with Plosko here, I think the optimal resolution is CCW to achieve greater mandibular projection. I do think you look quite good and don't know if CCW would be worthwhile. Genioplasty is tempting, but IMO, would likely lead to an unaesthetic narrowing of the mentolabial angle.

PloskoPlus

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Re: What do you guys think of these genio predictions?
« Reply #4 on: November 16, 2018, 04:12:40 AM »
It's most important how you look from the front. A large genio may give you a really pointy chin.

Bobbit

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Re: What do you guys think of these genio predictions?
« Reply #5 on: November 16, 2018, 06:49:52 AM »
It's most important how you look from the front. A large genio may give you a really pointy chin.

He could get a segmental genioplasty with a bone graft insert to widen the chin.

kavan

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Re: What do you guys think of these genio predictions?
« Reply #6 on: November 16, 2018, 08:37:16 AM »
Drop a straight vertical line from the outermost point of lower lip. Note your chin is recessive relative to that line. Do the same on all the 'after' morphs. The 8mm advance is the least recessive relative to that line.


I would choose the 8mm genio for the following reasons:

a: Relative to the basic aesthetic guideline (straight vertical line dropped from lower lip) for where the chin should be, it should be somewhat posterior to the line but not too much posterior to it. So the chin in the 8mm genio is best fit for that guide line.

b: Not only is your chin overly recessive but it also casts 'long.  The sliding genio involves a cut made at an angle; a diagonal cut. When the chin is SLID along this diagonal cut not only is the chin advanced 'outward' or horizontally forward but it's also slid vertically upward which shortens it.

c: Because your lips are apart, you might have some lip incompetence; some strain when closing your lips. That type of strain is commonly associated with what I would call; MECHANICAL INEFFICIENCY. Something where it's just HARDER to move the lower lip 'UP' when the soft tissue (and lip moving mentalis muscles) are oriented backwards and downwards due to the bone orientation of the chin. Muscle use to close the lips becomes more mechanically efficient (easier) when the bone orientation moves outwards and upwards. The maximum of 8mm sliding genio would tend to minimize the lip strain.

d: With reference to your concern that a larger advancement would 'strain' your soft tissue in some way, that's not the case at all. On the contrary. It's the bone orientation of your chin, lack of support to the soft tissue that results in the type of muscle strain associated with the open lip posture you have. The 8mm advancement would tend towards minimizing strain, (not to mention MAXIMIZE aesthetics). So, I would disregard any 'concerns' about soft tissue ratios to bone movement and consider it a NON-ISSUE.

e: Possible STEP-OFFS also become a 'So what' (non) ISSUE in consideration of the reasons mentioned above where the 8mm advancement both maximizes aesthetics and minimizes lip strain. Easily addressed via filler to camouflage later down the line or filled in with some 'bone paste' during the genio.

f: With reference to suggestions of more CCW, the sliding genio (movement along an an upward diagonal cut) gives more of the LOOK of CCW. Sometimes the extent of CCW achieved via Lefort 1 and auto rotation of mandible is limited by the occlusion of teeth.

g: Increased labial mental fold is also a non issue or a MINOR trade-off given the benefits mentioned above. Like, SO WHAT???, you get a deeper fold there in exchange for much better soft tissue support, maximization of aesthetics and minimization of lip strain.
« Last Edit: November 16, 2018, 12:52:08 PM by kavan »
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PloskoPlus

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Re: What do you guys think of these genio predictions?
« Reply #7 on: November 16, 2018, 08:44:32 AM »
He could get a segmental genioplasty with a bone graft insert to widen the chin.
I keep hearing about such genios, but have never seen one.

nightwing

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Re: What do you guys think of these genio predictions?
« Reply #8 on: November 16, 2018, 03:37:22 PM »
Thanks for the responses.

Kavan, you make some great points.

a. Personally I prefer 6mm over 8mm — the 8mm is too much imo. Also feel like 8mm draws attention to my high gonial angle. I would never get implants however.

b. Should I ask them to slide it vertically upwards or is that something that will already happen regardless?

c. You are correct, I do still have some lip incompetence which is why the second genio will be covered by insurance. I think 6mm strikes a good balance between aesthetics and functional improvement.

d. That makes sense.

e. That also makes sense. I could always do a fat transfer to my jawline if anything.

f. Yeah I’m sure my occlusion limits more CCW and I wouldn’t want to go through another jaw surgery anyways.

g. Another valid point.

Do you think my chin will end up being pointy from the front, as Plosko said?


 

kavan

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Re: What do you guys think of these genio predictions?
« Reply #9 on: November 16, 2018, 05:34:01 PM »
I'm assuming the forward sliding genio (suggested to you by your doc) is what it usually is which is part of the chin slid along itself as in advancement over an angled plane (via the diagonal cut made to slide it 'forward'. So a 'forward' advancement has 2 components; horizontal for profile projection and vertically upward. So, what you have to establish from your doctor is whether or not the 8 (or 6) mm refers to ONLY the horizontal advancement or if it refers to the total advancement over the angled cut. For example if the 8 (or 6) mm advancement refers to the total advancement along an angled cut, then 8 (or 6) would not be 'pure' horizontal. It would be less. Just like the horizontal 'leg' of a right angle is less than the hypotenuse. Basically, if the sliding forward advancement genio is what it usually is, you would not have to make a separate request to move it vertically upward along with horizontally forward because that type of genio has 2 components; horizontally outward and vertically upwards.

That type of genio visually shortens the chin from the front. So, it won't be making your high gonial angles look higher. It will give illusion the gonial angles are no SO high and make your lower face look LESS 'long'. So, I don't think it would make the chin look 'pointy' from the front given the 'point' of the chin; the pogonian goes both horizontally forward and vertically upward which tends to give illusion of more width to the chin or less narrowness to it. However, it's not my assessment that your chin will be 'pointy' so you need to ask Plosko to clarify why he thinks that would come about.

If you have a preference for one 'after' over the other, then just go according to your preferences which is why the doc gave you 3 to choose from.
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haven

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Re: What do you guys think of these genio predictions?
« Reply #10 on: November 21, 2018, 05:39:10 PM »
I'm inclined to agree with Kavan's suggestion of seeking only a genio. You already had surgery and while you still have a "recessed chin", you still look good. You also look pretty young. Don't overthink too much. Some people get got obsessing over this stuff, especially the younger people. Look into a genio if you want. From the morphs, the difference between 6 and 8 don't seem apparent and there's an obvious difference between 4 & 8. Why not settle for the middle, and like Kavan said it could help with your lip incompetence if it's a concern of yours.