Looking for feedback on my lower-third. What's wrong with it? How can I fix it?

[surgerymax94]

Hello all.

First time posting here - sorry if this is in the wrong place (please point me in the right direction if so).

For background - I am 24, never had braces, been a mouthbreather since I was a kid. I've always been self-conscious about my appearance, but in the last year or so I've been putting in the research as to which specific features are making me ugly.

In my opinion, the jaw and chin area are destroying my face. I am not an expert on this stuff, but it looks to me like my jaw is recessed and my chin is very weak.

If anyone could give feedback on my photos and suggest potential solutions, I'd really appreciate it.

[surgerymax94]

This photo shows my jowls/cheek fat more clearly.

[Dogmatix]

What matters most is your opinion and how you feel. If you feel strongly that your chin is destroying your face and that this consumes you, there is room to have it advanced.

It's not as easy to just walk in and say you want it advanced, there are several aspects to consider. Like your bite and airways.

Simplest solution is jaw implant or genioplasty. These are procedures that doesn't alter the bite and can be done straight away. But, if you have a class II bite, or narrow airways, I would never advice for such solution. Always start from the bottom and fix the underlying problems if there are any.

These are decissions that fast can escalate to several years of braces and a big surgery, you need to decide how important this is for you and what you're willing to go through.

[surgerymax94]

What matters most is your opinion and how you feel. If you feel strongly that your chin is destroying your face and that this consumes you, there is room to have it advanced.

It's not as easy to just walk in and say you want it advanced, there are several aspects to consider. Like your bite and airways.

Simplest solution is jaw implant or genioplasty. These are procedures that doesn't alter the bite and can be done straight away. But, if you have a class II bite, or narrow airways, I would never advice for such solution. Always start from the bottom and fix the underlying problems if there are any.

These are decissions that fast can escalate to several years of braces and a big surgery, you need to decide how important this is for you and what you're willing to go through.

This is extremely important to me. I am willing to do what it takes to markedly improve my appearance. Are you suggesting that the chin should be my focus rather than the jaw?

I believe I do have narrow airways - I suffer from moderate sleep apnea. What is the typical solution for this? A google search suggests bimaxillary osteotomy 

[Dogmatix]

This is extremely important to me. I am willing to do what it takes to markedly improve my appearance. Are you suggesting that the chin should be my focus rather than the jaw?

I believe I do have narrow airways - I suffer from moderate sleep apnea. What is the typical solution for this? A google search suggests bimaxillary osteotomy

No, I'm not making any statement regarding to focus on the chin or full jaw surgery. The chin is a part of the jaw, and there are different options depending on what the full diagnosis would be.

Next step would be to see a surgeon and get an evaluation. Don't go to a plastic surgeon, go to a max-fac surgeon or othodontist who is trained to evaluate your bite and airways.

To effectively treat sleep apnea, the lower jaw needs to be advanced. If there is room to advance only the lower jaw (overjet), then a lower jaw surgery can be enough. But I doubt you have such situation and it would be bimax. But these are questions we don't have enough information to comment on, your surgeon needs to tell you.

[surgerymax94]

Thanks for your advice. I will be seeing a couple of MaxFax surgeons in London soon as my first paycheck comes in from new job. F*cking expensive @ £200-250, but gotta be done.

[kavan]

Thank you for posting your photos along with your question.

Never having braces before is a good thing because you would not need 'decompensation' if you elected to have the maxfax surgery. So, no situation where they would have to say reverse the direction of where the braces moved your teeth and to do that to prepare you for the direction they need them in to do a surgery.

There is some indication in favor of maxfax surgery. Such as your lower lip being somewhat behind your upper and your chin being too far behind a vertical line dropped from your lower lip. So, indication for lower jaw and chin advancement.

However, diagnostics would have to be done as to whether or not the upper jaw would also need to be moved in order achieve goal of lower advancement. That's because both jaws are interdependent  such that the teeth of both jaws need to mesh together correctly after the surgery.

[april]

Never having braces before is a good thing because you would not need 'decompensation' if you elected to have the maxfax surgery. So, no situation where they would have to say reverse the direction of where the braces moved your teeth and to do that to prepare you for the direction they need them in to do a surgery.

They also have to decompensate natural compensations that have occured.

[kavan]

They also have to decompensate natural compensations that have occured.

Technically so. But I hope it was clear my explanation was meant for someone new to all this where the salient message was he was lucky he didn't have to be in braces AGAIN, as in a second time, after prior ortho.

[april]

Yes he is very lucky to not have gone through previous ortho work. I know what you were saying. But as a newbie he might think that means he won't need to have decompensation for surgery, and I'm adding that he will likely still need it. Assuming he has a malocclusion.

One reason is that nature itself also works hard to compensate for a bad bite.Teeth will do what they can in order to best function: over-erupt, tilt inwards/outwards, etc. So all compensations needs to be undone first to allow the jaws to be repositioned ideally, and for the most dentally stable result.

[kavan]

Yes he is very lucky to not have gone through previous ortho work. I know what you were saying. But as a newbie he might think that means he won't need to have decompensation for surgery, and I'm adding that he will likely still need it. Assuming he has a malocclusion.

One reason is that nature itself also works hard to compensate for a bad bite.Teeth will do what they can in order to best function: over-erupt, tilt inwards/outwards, etc. So all compensations needs to be undone first to allow the jaws to be repositioned ideally, and for the most dentally stable result.

He'll (most likely) need to be in braces to prepare for surgery.

[Post bimax]

IMO your lower jaw and chin are in fact recessed.  If you decide to pursue surgery, make sure you take your ‘CEPH’ xrays with neutral head posture and post them to this forum. That will help us assess any proposed plan and whether you need rotation of the jaws in addition to any advancement.

[surgerymax94]

He'll (most likely) need to be in braces to prepare for surgery.

Again, I am very new to all this. But I think my bite is fairly normal. If this is the case, Will I still need braces? And if there is no major over or under bite, does that suggest I'd need bimax rather than just something for lower jaw?

[Post bimax]

Again, I am very new to all this. But I think my bite is fairly normal. If this is the case, Will I still need braces? And if there is no major over or under bite, does that suggest I'd need bimax rather than just something for lower jaw?

The answer is maybe, but probably. The surgeon may still want to ‘decompensate’ your teeth further, and many surgeons require braces so your bite can be fine-tuned post op.

[kavan]

Again, I am very new to all this. But I think my bite is fairly normal. If this is the case, Will I still need braces? And if there is no major over or under bite, does that suggest I'd need bimax rather than just something for lower jaw?

I don't have any specific information as to how your present bite is going to factor into a surgery proposal. That's what getting diagnostics is for. What I can tell you is that bites DO factor into surgery proposals and having a good one or one you're already satisfied with doesn't PRECLUDE the need to change it via braces in preparation for a surgery.

I'll repeat (but in a different way), that people who DO have their 'bite right' as in those who have had prior ortho often need to be in braces to UNDO their bite in order to prepare for the surgery. So, if your bite is 'OK', it might need to be made 'not OK' during the time period in braces to prepare for the displacements planned into the surgery.

So, IF your bite is 'normal' or ok NOW, that doesn't rule out needing braces to prepare for the displacements made in surgery. Just like it doesn't rule out people who had ortho prior to get their 'bite right' from needing to be in braces (again) to prepare for surgery. It's just a matter of needing to UNDO what ever bite you have now ONCE.

As to bimax or single jaw surgery, that's a matter of what the DIAGNOSTICS kick up. Sometimes for the lower jaw to be advanced, the upper jaw has to be displaced to accommodate that goal. Also, time in braces is more often than not, a contingency for preparing for surgery.

If you're asking if you are the EXCEPTION to the GENERAL info I gave here and instead, want to know IF you're 'THE ONE' who definitely can get ONLY single jaw surgery AND won't need braces, that's what DIAGNOSTICS are for.