Genioplasty - yes or no?

[InvisalignOnly]

I am a middle aged female with a class 2 malocclusion and gummy smile / upper lip incompetence (see photos attached - will upload x-ray in a separate post). I am in the process of selecting a surgeon in Europe for a double jaw surgery and need some advice before my upcoming consultations. Apologies in advance for my ignorance, I am new to all this.

First of all, I understand that my mandible needs to be brought forward but is the best way to do this in my case in a 'straight line' or is it possible / a good idea to rotate or lift it somehow? Most importantly, do I need / should I ask for a genioplasty? As you can see, I have a weak chin and mentalis strain.

Secondly, I was told my maxilla needs to be rotated, is this the same as Le Fort? (Sorry if this is a dumb question.) Would they also need to do any 'impaction' in this area / remove a part of it, or is that not necessarily the case? I am asking this so I can understand and evaluate what the surgeons will tell me at the consultations.

Thank you for any advice in advance.

[InvisalignOnly]

Here is my ceph x-ray

[Daedalus]

From this point on, it’s truly hard to tell wether you’ll require a genio. I am in a similar situation, however, I had upper arch retracted with braces, in my childhood. You may want to read some replies I’ve got too, so I’ll leave a link:
http://jawsurgeryforums.com/index.php/topic,7810.0.html

Now, take anything I say with a grain of salt but in my perspective, you might get maxillary anterior impaction to deal with a gummy smile and a mandibular advancement with counterclockwise rotation.
Depending on how much your teeth will be decompensated and how much mandibular rotation will be done, you might need or not need a genio because your chin will naturally stick out due to advancement and rotation.

What’s more important, prior to a surgery you will have a full facial analysis done, where a surgeon will do his best to balance out your profile on paper before proceeding with a surgery.

[PloskoPlus]

The chin bone doesn't look too bad. It looks weaker than it is because the bottom teeth are so proclined. Uprighting them will improve the chin.

[ben from UK]

My opinion is that women should be careful with augmenting chin and/or jaw. As a woman, the ideal is kind of a weak (usually heartshaped) bonestructure. I've seen some genios and implants (mostly implants) with women that I didn't like cause it gave them too much chin/projection.

It's hard to tell based on these pics, but you might look at your teeth first instead, like previous posters said. They are not aligned and you have a bit of a gummysmile (which is not very destracting tbh). Maybe posting a better pic of full face (eyes blurred) could give you more accurate opinions. 

[InvisalignOnly]

Thank you so much for those that took the time to comment so far, I truly appreciate it! I am now inclined to think I will definitely not ask for / not need a genioplasty, I do not want my chin to be too strong / pointy. If it turns out to be still too weak after braces and surgery, I can make small corrections with fillers etc., will be easier than dealing with a chin that's too big for my face.

you might look at your teeth first instead, like previous posters said. They are not aligned and you have a bit of a gummysmile (which is not very destracting tbh). Maybe posting a better pic of full face (eyes blurred) could give you more accurate opinions.

The reason we did not touch the teeth yet is that the ortho said I need to decide on the surgeon first and then him and the surgeon will work out a plan. I understand that they will definitely need to push the lower teeth inwards to create more space and align the teeth - ortho said that it will take 6-9 months before surgery depending on whether the surgeon wants to extract teeth from the lower jaw or not. Of course he wants me to go with the surgeon he usually works together with, but seeing this is major surgery and I am paying for it privately, I would like to speak to a few doctors before making a decision.

I am quite confused about whether or not tooth extraction is necessary and if so, from where. My wisdom teeth have already been removed a long time ago. The first surgeon I went to told me he wanted to extract four premolars, two from the top and two from the bottom. I really did not like that idea and another said he would need to take two from the bottom only, while my ortho thinks it might be done without any extractions - so confusing for me.

Re: photos, I am a bit paranoid about privacy but will consider posting some more. I know that 'camouflage treatment' with braces / lip and chin fillers is an option, but decided to go for the surgery because I also have breathing issues and want a long term solution.

[kavan]

You look like your case could resolve to anterior impaction which is type of CCW in venue of most maxfax docs (as opposed to CCW posterior downgraft). Any CCW rotation to the maxilla will allow the lower jaw to swing in a more forward direction and take the chin point along with that.

Genio advancement is not really something one needs to ask for simply because it's often  planned into the surgery. Extent of genio depends on whether or not the lower jaw advancement brings the chin point out enough and also if the protrusion of the lower teeth can be made less in preparation for the surgery.

[InvisalignOnly]

You look like your case could resolve to anterior impaction which is type of CCW in venue of most maxfax docs (as opposed to CCW posterior downgraft).

Thank you - I assume this would be Le Fort 1?

[kavan]

yes.

[GJ]

Your face looks short as-is, so I'd be careful with any impaction. Your smile is only very slightly gummy. It's making you look younger.
I don't see a strong need for jaw surgery. Who said you need it and what was their reasoning / proposed movements?

I'd have to see more photos. From what I see the chin is recessed but not abnormal for a female.

[some1afterall]

I think you have a cute, feminine lower face. Nice lip curvature, dainty chin and youthful gum show. Be careful which rabbit hole you go down-jaw surgery often is not a fix all, end all and if anything can create more issues and/or negative aesthetic insecurities.

[InvisalignOnly]

Your face looks short as-is, so I'd be careful with any impaction. Your smile is only very slightly gummy. It's making you look younger.
I don't see a strong need for jaw surgery. Who said you need it and what was their reasoning / proposed movements?

I'd have to see more photos. From what I see the chin is recessed but not abnormal for a female.

I think you have a cute, feminine lower face. Nice lip curvature, dainty chin and youthful gum show. Be careful which rabbit hole you go down-jaw surgery often is not a fix all, end all and if anything can create more issues and/or negative aesthetic insecurities.

Thank you both - I am grateful for your input, this is exactly why I am so confused but I mean in a good way... Much better to be confused than making the wrong decision. It's like this: unfortunately in childhood, I was not taken to the dentist at all and did not get any opinions or help with my teeth / jaws. As a young adult, I went to ask what could be done about my teeth sticking out (which was the problem as I saw it at the time) and was told straight away I needed jaw surgery. Since then, every single dentist or orthodontist I saw told me the same thing, apparently I am a textbook case of someone that 'needs' double jaw surgery.

At the same time while I am not a model or Miss World, I have always been considered reasonably attractive and whenever I tell any of my friends / partners I want a surgeon to break my jaws and screw them back together to make me look better, people are horrified and tell me DO NOT DO IT. I am now in the position where I have both the time and the money to get it done but honestly, it's so confusing. I am posting more photos here that highlight the problem:

[InvisalignOnly]

An additional photo of me laughing - this is 'as bad as it gets' lol. By the way, psychologically, I do not feel insecure about my looks at all, I am fine as I am. (Yes, I know there are plenty of people out there that would call me ugly and a freak but that says more about them than about me, the way I see it.) I just feel like if there is a good chance my looks could be improved, why not? Especially as the doctors keep telling me I will have functional problems down the line and I already noticed I have some breathing issues.

[GJ]

I think you look pretty cute as-is.

So really it's a question of how much risk you want to take. To me jaw surgery is a great temptress in that if you have the right plan and everything goes right, sure, you will likely look better. It's all about whether you want to take that gamble. When weighing that risk, make sure not to convince yourself of problems that might arise down the road because they might not, too. You seem to want to do it, though, from what I'm reading. Do you really want to, or is it the allure and mystery of "what if?".

Regarding your case. I now see better why they want to do impaction. Still think it's risky (aging), though, given your short face. Might run into problems with your nose that you're not expecting, too, from the impaction. But technically, yes, that would be the best plan on paper, IMO.

[InvisalignOnly]

You seem to want to do it, though, from what I'm reading. Do you really want to, or is it the allure and mystery of "what if?".

Regarding your case. I now see better why they want to do impaction. Still think it's risky (aging), though, given your short face.

Exactly, I am quite worried about the aging effect. Right now I am always told I look a lot younger than my age and obviously as a woman, I do not want to lose that advantage. Do you think the less impaction they do, the smaller the risk? Or is it not that simple?

You summed it up perfectly re: 'allure / mystery'. Doctors keep telling me I will look different after the surgery and I am very intrigued by that - I would like to try it for a few days to see what it's like to live with a different face. However, this is not a video game and I will not be able to go back to this face if I do not like the new one. So yes, it is very much like gambling. Not to mention that so many people have complications like chronic pain or numbness etc. for years after the surgery. So I kind of want to do it but still have my doubts.