Author Topic: Is it possible to get a chin wing after genioplasty?  (Read 4829 times)

IconVillage

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Is it possible to get a chin wing after genioplasty?
« on: August 08, 2019, 06:05:36 AM »
Are these compatible procedures depending on what type of graft was used?
« Last Edit: August 08, 2019, 10:55:47 PM by IconVillage »

tim06

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Re: Is it possible to get a chin wing after genioplasty?
« Reply #1 on: August 09, 2019, 04:03:16 PM »
Why would you want that? A chin wing is a modified form of a genioplasty so it makes little sense to plan to get both.
I saw the results of a patient of Dr. Dr. Brusco who performed a ching wing on him. It didn't look better than the normal sliding genioplasty I got which the patient thought as well. Its nothing but a more invasive genioplasty that rarely results in a better aesthetic outcome. I also saw 2 results of Dr. Zarrinbal in a german forum.
I didn't upload this pic and I am surprised its on Pinterest but thats the patient I am talking about:


Post bimax

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Re: Is it possible to get a chin wing after genioplasty?
« Reply #2 on: August 09, 2019, 04:52:06 PM »
I mean, that’s pretty good no?

kavan

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Re: Is it possible to get a chin wing after genioplasty?
« Reply #3 on: August 09, 2019, 05:04:50 PM »
I mean, that’s pretty good no?

It elongates his whole mandibular border. Fortunately the patient didn't need a lot of advancement which is when the mandibular border segments are moved a lot forward.
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kavan

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Re: Is it possible to get a chin wing after genioplasty?
« Reply #4 on: August 09, 2019, 05:16:11 PM »
Are these compatible procedures depending on what type of graft was used?

If you are considering one over the other as to which to do first, it's best to consult with a doc that does the chin wings in addition to the consultations about what ever kind of genio you are planning to have. The dependency relates to the prior cuts more then the type of grafts. Some prior cuts are not compatible with those they do in chin wings.
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IconVillage

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Re: Is it possible to get a chin wing after genioplasty?
« Reply #5 on: August 13, 2019, 11:41:01 PM »
Why would you want that? A chin wing is a modified form of a genioplasty so it makes little sense to plan to get both.
I saw the results of a patient of Dr. Dr. Brusco who performed a ching wing on him. It didn't look better than the normal sliding genioplasty I got which the patient thought as well. Its nothing but a more invasive genioplasty that rarely results in a better aesthetic outcome. I also saw 2 results of Dr. Zarrinbal in a german forum.
I didn't upload this pic and I am surprised its on Pinterest but thats the patient I am talking about:


I'm considering PEEK or titanium jaw angle implants to drop down the gonial angle a bit, widen the jaw angles a little, and allow for a more pronounced jawline, and figured I'd check into the osteotomy route first before going down the implant road. If a sidewing and chin wing could produce these results I think I'd go with the osteotomy route over implants, just to avoid bone erosion and infection possibility with implants. I think that Brusco result is pretty good, as well as the ZSO he got, his gonial angle has improved, his ramus is now longer and his ogee curve looks better. Out of curiosity, what is the name of that German forum?




If you are considering one over the other as to which to do first, it's best to consult with a doc that does the chin wings in addition to the consultations about what ever kind of genio you are planning to have. The dependency relates to the prior cuts more then the type of grafts. Some prior cuts are not compatible with those they do in chin wings.

I've already had a sliding genioplasty, with vertical lengthening and horizontal widening and HA grafting. I think the chin wing surgeons would have to see the exact cuts to make a judgement of whether or not it is compatible.

kavan

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Re: Is it possible to get a chin wing after genioplasty?
« Reply #6 on: August 14, 2019, 08:50:01 AM »
If you are considering one over the other as to which to do first, it's best to consult with a doc that does the chin wings in addition to the consultations about what ever kind of genio you are planning to have. The dependency relates to the prior cuts more then the type of grafts. Some prior cuts are not compatible with those they do in chin wings.



I've already had a sliding genioplasty, with vertical lengthening and horizontal widening and HA grafting. I think the chin wing surgeons would have to see the exact cuts to make a judgement of whether or not it is compatible.

Well, yes, they would have to see the cuts which was suggested in my prior response to your asking if possible to get chin wing after genio.
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Tomasjohn

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Re: Is it possible to get a chin wing after genioplasty?
« Reply #7 on: January 04, 2022, 05:25:33 AM »
Why would you want that? A chin wing is a modified form of a genioplasty so it makes little sense to plan to get both.
I saw the results of a patient of Dr. Dr. Brusco who performed a ching wing on him. It didn't look better than the normal sliding genioplasty I got which the patient thought as well. Its nothing but a more invasive genioplasty that rarely results in a better aesthetic outcome. I also saw 2 results of Dr. Zarrinbal in a german forum.
I didn't upload this pic and I am surprised its on Pinterest but thats the patient I am talking about:


I just want to add the front and sied view of the referenced before and after because it is much more useful (you can find the original on IG).

https://imgur.com/a/84uVctq

Good example. Same result (from front) not possible with only genioplasty in my opinion. It is a good example because it shows a case where someone does not have a very steep angle (I hope I see this correct) and who did not rotate the segment (or not much, not 100% sure by the scan) by lowering the back more. It looks like he lowered the whole segment almost equally and moved it forward.



kavan

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Re: Is it possible to get a chin wing after genioplasty?
« Reply #8 on: January 04, 2022, 06:16:53 PM »
I just want to add the front and sied view of the referenced before and after because it is much more useful (you can find the original on IG).

https://imgur.com/a/84uVctq

Good example. Same result (from front) not possible with only genioplasty in my opinion. It is a good example because it shows a case where someone does not have a very steep angle (I hope I see this correct) and who did not rotate the segment (or not much, not 100% sure by the scan) by lowering the back more. It looks like he lowered the whole segment almost equally and moved it forward.

Correct observation.

On this example, we have the before and after  ( cuts on ceph) to observe and cross reference the BASIS of an opinion. Your opinion is based on observing the correct geometric relationships that apply to the example shown whereas the poster expressing the opinion that chin wings are just like someone elses normal sliding genio and/or are just 'invasive genios'  belies he's not observing the cephs right in front of him, which clearly show the chin wing cut, in that particular person, is NOT at all like a genio. So, if he saw some photos of a person with a chin wing that looked no different to him than just a genio, he  may have seen a photo of someone who had too high of an MPA to begin with which would have precluded getting a full chin wing cut that goes through the posterior jaw angles.

So, yes, indeed, there is a relationship between angle of inclination of the MPA and ability to make a chin wing cut all the way through the mandibular border. Lower MPAs allow for the cut to go all the way through the mandibular border to the posterior jaw angle where as higher MPAs only allow for what may be termed an 'extended genio'; something that doesn't cut all the way back through the posterior jaw angles. A vertically 'short' body of the mandible is also a factor.

What the chin wing doctors are looking at (or for) basically is whether or not the inclination of the MPA exceeds what ever inclination limit they have as to ability to cut through the mandibular border all the way through it and/or whether or not the mandible body is vertically long enough such that there is enough 'space' BELOW the NERVE to cut through safely without risk of nerve damage. Those with vertically short mandibular bodies and high MPA inclinations would be at high risk for nerve damage if they got a cut all the way back through the posterior jaw angles. Hence, there indeed is a relationship to be observed which IF actually observed (as you've done here) is sufficient to understand why some people START OUT with a type of 'bone geometry' that is very compatible with a full chin wing cut and some don't. The ones who do can get the most from the chin wing. Those that don't get the least from it.

In this example, the person is actually an IDEAL candidate for a chin wing. His MPA is inclined low enough for them to easily cut right through the mandible and there is enough vertical space to the body of the mandible for the nerve to be out of the way of the cut. The advancement of the whole segment is modest to minimal in this person because he doesn't need much chin advancement. What he needs is mostly what he got which is the 'drop down' to lower the border of the segment which you see on the ceph as something sandwiched in between the cut and the lower border of the mandible.
 

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Tomasjohn

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Re: Is it possible to get a chin wing after genioplasty?
« Reply #9 on: January 05, 2022, 09:26:14 AM »
Correct observation.

On this example, we have the before and after  ( cuts on ceph) to observe and cross reference the BASIS of an opinion. Your opinion is based on observing the correct geometric relationships that apply to the example shown whereas the poster expressing the opinion that chin wings are just like someone elses normal sliding genio and/or are just 'invasive genios'  belies he's not observing the cephs right in front of him, which clearly show the chin wing cut, in that particular person, is NOT at all like a genio. So, if he saw some photos of a person with a chin wing that looked no different to him than just a genio, he  may have seen a photo of someone who had too high of an MPA to begin with which would have precluded getting a full chin wing cut that goes through the posterior jaw angles.

So, yes, indeed, there is a relationship between angle of inclination of the MPA and ability to make a chin wing cut all the way through the mandibular border. Lower MPAs allow for the cut to go all the way through the mandibular border to the posterior jaw angle where as higher MPAs only allow for what may be termed an 'extended genio'; something that doesn't cut all the way back through the posterior jaw angles. A vertically 'short' body of the mandible is also a factor.

What the chin wing doctors are looking at (or for) basically is whether or not the inclination of the MPA exceeds what ever inclination limit they have as to ability to cut through the mandibular border all the way through it and/or whether or not the mandible body is vertically long enough such that there is enough 'space' BELOW the NERVE to cut through safely without risk of nerve damage. Those with vertically short mandibular bodies and high MPA inclinations would be at high risk for nerve damage if they got a cut all the way back through the posterior jaw angles. Hence, there indeed is a relationship to be observed which IF actually observed (as you've done here) is sufficient to understand why some people START OUT with a type of 'bone geometry' that is very compatible with a full chin wing cut and some don't. The ones who do can get the most from the chin wing. Those that don't get the least from it.

In this example, the person is actually an IDEAL candidate for a chin wing. His MPA is inclined low enough for them to easily cut right through the mandible and there is enough vertical space to the body of the mandible for the nerve to be out of the way of the cut. The advancement of the whole segment is modest to minimal in this person because he doesn't need much chin advancement. What he needs is mostly what he got which is the 'drop down' to lower the border of the segment which you see on the ceph as something sandwiched in between the cut and the lower border of the mandible.

Yes I agree.
Just one more thing I want to add: I think what really refined the result was the malar osteotomy. It gave him some angularity. I added a foto where i highlighted it. Not entirely sure tough.

https://imgur.com/a/84uVctq

kavan

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Re: Is it possible to get a chin wing after genioplasty?
« Reply #10 on: January 05, 2022, 05:30:28 PM »
Yes I agree.
Just one more thing I want to add: I think what really refined the result was the malar osteotomy. It gave him some angularity. I added a foto where i highlighted it. Not entirely sure tough.

https://imgur.com/a/84uVctq

A diagonal cut was made through the lower lateral orbital rim (of the zygoma) and down through the lateral inferior orbital rim (of the zygoma). Then after that, it looked like they continued with somewhat of a vertically downward cut to where you see the hardware which, i think, could be the suture line between the zygoma bone and the maxilla. Anyway, it was a cut that allowed them to 'pry' the cheek bone outward for more of a convexity to the upper 'ogee curve' which you see in oblique view. It's a combined frontal and lateral displacement to the 'cheek bone'. It kind of looks like they used some bone material (bone buttress) to fill in the gap they created to pry the thing outward. Then they secured the loose end to an area i think is called the 'maxillary buttress'.

Since it's a combined frontal and lateral displacement, in the frontal view, you will see some tapering inward from the top of the curve as it travels down to the lower cheek which is what you illustrated. So, yes. Correct.

I think I shall make you my protege.
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Gadwins

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Re: Is it possible to get a chin wing after genioplasty?
« Reply #11 on: January 05, 2022, 11:50:06 PM »
Yes I agree.
Just one more thing I want to add: I think what really refined the result was the malar osteotomy. It gave him some angularity. I added a foto where i highlighted it. Not entirely sure tough.

https://imgur.com/a/84uVctq

Since you also seems to be interested in this kind of malar osteotomy, I just want to point out, that in the frontal photo he is looking a bit more down in the right picture (you can see it by his nose or ears). The reason is, why the surgeon let him look like that, because this kind of malar osteotomy makes your face a bit flatter towards the nose. You could see it really good if there were some photos from above or below (your face gets a bit floppy from this view). Also it disorts your cheek muscles, when you are smiling. Since this guy has more or less a compact head, this negative side effects are not so obviouse compared to somebody with a long and narrow head.

Tomasjohn

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Re: Is it possible to get a chin wing after genioplasty?
« Reply #12 on: January 06, 2022, 11:40:52 AM »
I think I shall make you my protege.

I take that as a compliment, so thank you.

Since you also seems to be interested in this kind of malar osteotomy, I just want to point out, that in the frontal photo he is looking a bit more down in the right picture (you can see it by his nose or ears). The reason is, why the surgeon let him look like that, because this kind of malar osteotomy makes your face a bit flatter towards the nose. You could see it really good if there were some photos from above or below (your face gets a bit floppy from this view). Also it disorts your cheek muscles, when you are smiling. Since this guy has more or less a compact head, this negative side effects are not so obviouse compared to somebody with a long and narrow head.

Ok interesting information, thank you.

Breakingbad

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Re: Is it possible to get a chin wing after genioplasty?
« Reply #13 on: January 07, 2022, 01:59:11 AM »
Since you also seems to be interested in this kind of malar osteotomy, I just want to point out, that in the frontal photo he is looking a bit more down in the right picture (you can see it by his nose or ears). The reason is, why the surgeon let him look like that, because this kind of malar osteotomy makes your face a bit flatter towards the nose. You could see it really good if there were some photos from above or below (your face gets a bit floppy from this view). Also it disorts your cheek muscles, when you are smiling. Since this guy has more or less a compact head, this negative side effects are not so obviouse compared to somebody with a long and narrow head.

Yes, I see the "floppiness" you're referring to. However, I'm curious about how it "distorts your cheek muscles," as you say. Do you mean that it makes the face appear tighter? I presume that the anterior and lateral movements involved here would elongate or 'pull tighter' the zygomaticus muscles due to the geometry here. Is this what you're referring to?

needadvancement

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Re: Is it possible to get a chin wing after genioplasty?
« Reply #14 on: January 07, 2022, 03:42:28 PM »
I would think that's a good idea if you don't have a developed chin bone to begin with. Although I may be unaware of CW techniques where they might be able to add SG type cuts along with the whole segment anyhow.