Can you do genioplasty twice?

[hallonsylt123]

Ok, So I want to have a more manly stronger chin. I have posted here before and been at a consultation.

Problem is, I live in Sweden. The surgery is not common here for aestetic purposes. Only one surgeon does it.

He says that his limit is 5.5 mm horizontal and 3.5 mm vertical movement.
I asked Dr. Eppley and he says I would probably need twice that for my goals to be reached.

My question is, can I do the surgery again after it has healed to add a few mms? That would honestly be cheaper than travelling across europe for it.

Or, can you add an implant afterwards and make up for the difference that way?

https://www.realself.com/question/norway-surgeon-conservative-sliding-genioplasty#10256358 <- Link to pictures.

[Post bimax]

you can do either or both

[kavan]

I've taken a look at an appropriate head posture profile photo from your RS series, used some anthropometric measures of average 'real life' distances as to approximate a SCALE. I found the HORIZONTAL displacement measure your doctor stated for CHIN about 90% correct and not about 50% correct as Eppley is basically saying when he says approx 2X as much augmentation of chin is needed. What Eppley is NOT telling you is that the NET lower facial profile imbalance is from BOTH chin AND jaw recession. Eppley is telling you what he can do which is an implant chin augmentation that EXCEEDS how far the chin itself should 'stick out' to COMPENSATE for mandibular recession.

The other doctor is also is just resolving his answer to promote what HE can do with chin augmentation. But since he IS a maxfax, he hasn't bothered to tell you about 1/2 of the NET recession is attributable to the mandible. Not just the chin.

In the event you DON'T REALIZE that what you are asking for is a LARGE chin augmentation to COMPENSATE for TOTAL recession you have where about 1/2 is from the mandible and the other 1/2 from the chin. That's something that won't look AS BALANCED as would a BSSO in addition to genio. Only people with little to no chin recession but with some mandibular recession can mask the mandibular recession with a genio, usually the type that goes outward and downward. But, when chin augmentation ONLY is used for BOTH combined mandibular recession PLUS chin recession, it can look unnatural or just weird.

As to whether you can first have genio and then get an implant over that, the answer indeed is YES. However, using a chin augmentation to compensate for recession to mandible in addition to chin often looks 'off'. (Crescent moon chin).

Your doctor is just going to address chin recession. The reason the horizontal displacement does not seem like 'enough' is what you are seeing is not only chin recession but also jaw recession.

By the way a SLIDING genio to bring chin 'forward' has 2 displacements: horizontally outward and vertically UPWARD. So, there is a chin shortening with it. You did NOT mention WHICH vertical direction of your proposed genio; up OR down. If a genio is to go BOTH horizontally outward and vertically downward a 'Down and Out' genio. Both the amount down and out can be LIMITED if the doctor does NOT sandwich a bone BUTTRESS (material to fill in the GAP it leaves)  when the segment is totally separated from where it was cut.

[hallonsylt123]

[...]

By the way a SLIDING genio to bring chin 'forward' has 2 displacements: horizontally outward and vertically UPWARD. So, there is a chin shortening with it. You did NOT mention WHICH vertical direction of your proposed genio; up OR down. If a genio is to go BOTH horizontally outward and vertically downward a 'Down and Out' genio. Both the amount down and out can be LIMITED if the doctor does NOT sandwich a bone BUTTRESS (material to fill in the GAP it leaves)  when the segment is totally separated from where it was cut.

Thank you for your answer.
Sorry for leaving that part out. The genioplasty planned is 5.5 mm outwards and 3.5 mm downwards. The doctor is indeed limiting it because he does not like to use a buttress. I have my concerns with that but he is one of most experienced Maxfax in Sweden, but he has not done much purely aestetic work before apparently.

I think he won't perform a BSSO since my occlusion is perfect.

I'm sorry I don't fully understand when you say half is from the mandible and half is from the chin. The chin sits on the mandible does it not? So lengthwise, they should be the same in the end? Do you mean there is a widthproblem aswell and thats what you mean by mandible? If you could take even more time out of your day to explain I would be very grateful.
Also thank you for stating you think it is 90% correct instead of 50%. I did think Eppley estimate was a tad high maybe.

[kavan]

Thank you for your answer.
Sorry for leaving that part out. The genioplasty planned is 5.5 mm outwards and 3.5 mm downwards. The doctor is indeed limiting it because he does not like to use a buttress. I have my concerns with that but he is one of most experienced Maxfax in Sweden, but he has not done much purely aestetic work before apparently.

I think he won't perform a BSSO since my occlusion is perfect.

I'm sorry I don't fully understand when you say half is from the mandible and half is from the chin. The chin sits on the mandible does it not? So lengthwise, they should be the same in the end? Do you mean there is a widthproblem aswell and thats what you mean by mandible? If you could take even more time out of your day to explain I would be very grateful.
Also thank you for stating you think it is 90% correct instead of 50%. I did think Eppley estimate was a tad high maybe.

The half coming from chin and half coming from mandible (approximation) is basically a concept I introduced to TIE IN with Eppley saying he noticed (approx) 2X the horizontal advancement needed than that which your doctor proposed. Basically that the pogonian (chin point) could be advanced approx 2X (horizontally) than your doctor proposed. Although there is some truth to that in so far as noticing about how far the pogonian should go forward, the chin ITSELF (sans rest of mandible) can be evaluated individually by dropping a straight vertical from the lower lip where the chin should go a little in back of that line or at most touching that line. That gives basic 'visual' approximation of how far horizontally to advance the chin. The visual approximation for how far the the WHOLE mandible should go forward is to drop a line kind of tangent to the upper lip area and noting how far behind the lower lip is away from that. In that way, one gets basic idea of mandible recession RELATIVE to the line dropped from UPPER lip. Both types of recession are SEPARATE even though BOTH TOGETHER will give TOTAL advancement to the pogonian (chin point). Hence they need to be entertained separately so one does not get 2X the advancement to the chin actually needed in an attempt to COMPENSATE for the mandibular recession.