Chin follows lower jaw advancement?

[needbiggerboat]

Probably considered a dumb question, but after a few weeks looking into all of this I still don't have a complete understanding in regards to the relationship between all the bones in the face and how moving one can effect the others..

Does lower jaw advancement always cause the chin to follow in parallel? Say hypothetically you advance the lower jaw 5mm, is that going to push your chin out 5mm as well? Or is that only moving forward the arch of bone your bottom teeth sit in and nothing else? I'm confused by this because as far as I can tell many people require sliding-genio's as well as their lower jaw advancements. Giving me the (probably mistaken) assumption that moving the lower jaw only will not effect the chin as much (or at least not proportional to the mm of lower jaw advancement) hence people requiring the accompanying genio procedure to achieve chin movement...?

Reason I ask is because my situation seems to be opposite of many other's. My chin is already out well beyond my lips. My mouth kind of caved in after wisdom teeth extraction and bad camouflage ortho a few years back. New ortho provider is recommending surgery for function, but visually I know I would like to have the bottom and top lips both pushed out further to meet the chin line. Hoping it's possible to bring the bottom lip out further with lower jaw advancement without it causing the chin to move forward as well. Is that possible? Have multiple consultations with surgeons scheduled, just the wait is a drag and I'm feeling curious and anxious/impatient about whats possible.

Thanks homies

[InvisalignOnly]

If you already have a prominent chin, you'll probably need a genio to reduce it or change the shape if you get lower jaw advancement. Genio is not just about linear advancement of the chin; it's often about the shape, plus some people need their chin reduced, not advanced. But to answer your question: if they move the lower jaw forward, the chin will move forward too, it will not stay in place while the mandible moves. Just look at an x-ray of the jaws from profile and you can probably visualise how it works.

[needbiggerboat]

Just look at an x-ray of the jaws from profile and you can probably visualise how it works.

Thanks for the reply. Understood everything you said. I can see what you mean about the connection of the mandible and the chin in an x-ray, I just wasn't certain where the cuts where made during surgery and if those cuts allowed that arch of bone to be freely moved without affecting the chin.

Also thats my bad for not really putting 2 and 2 together with genio just being a blanket term for chin augmentation.. It's difficult to find any useful information on genios that reduce the chin tho since it seems like 99.9% of chin work out there is an attempt to advance chins. I see a couple cases of people who've had their chins shaved (Dr. Guy Watts in Australia being one who has images up) but definitely not that many chin shaves easily found online, and none local to me I can find here in California. Also it seems all jaw surgeons are just doing chin advancements, so a shave unfortunately may be a second procedure with a cosmetic surgeon. I wonder how many jaw surgeons are comfortable doing an aesthetic chin shave (or pull back if thats possible, but i guess that means you're pulling the lower jaw back with it, so thats probably just the inverse of my original question and ultimately a no go, leaving only the shaving option) It would suck to have jaw surgery and then need to go in for something cosmetic like a chin shave 6 months later if the jaw surgeon couldn't offer it themselves. I'm already in a position of needing a septoplasty and wondering if theres any local surgeons who do jaw and septo at once, but so far it doesn't look like either Gunson or Relle in Socal do septoplasty (that I can see) or any records of them doing chin shaves for that matter (that I can see). Only surgeon I've found who does septo and is well known for jaw is Derek Steinbacher (he seems to be a master of faces and multiple surgeries so could probably do chin shave too) but he's on the exact opposite end of the country from me. Anyways sorry for the rant, thanks again for the info.

[InvisalignOnly]

I guess it's a cultural thing that in Western countries 'chin shaving' is not done as often as advancement; my understanding is that it is very common in some Asian countries, and it is also a standard part of facial feminisation surgery which is a procedure that more and more maxillofacial surgeons specialize in. I do not think a 'cosmetic surgeon' (whatever you mean by that) should be messing around with chin osteotomies, that is definitely an area for a qualified maxillofacial surgeon.

[needbiggerboat]

I guess it's a cultural thing that in Western countries 'chin shaving' is not done as often as advancement; my understanding is that it is very common in some Asian countries, and it is also a standard part of facial feminisation surgery which is a procedure that more and more maxillofacial surgeons specialize in. I do not think a 'cosmetic surgeon' (whatever you mean by that) should be messing around with chin osteotomies, that is definitely an area for a qualified maxillofacial surgeon.

I'm aware of asian countries like Korea being very into shaving procedures but those are much different than what I require or am interested in.. Those countries are approaching it as a method to shave down the entire jaw line and the sides of the chin to get a very "V" like shape with a point right at the tip of the chin, not so much a reduction of the projection of the chin..

I personally just need my chin to sit back in proportion to the projection of my lips, and if its being shaved it would have to be done in a way that maintained a good (or even the same) over all shape, only less long. It's nothing to do with masculine/feminine, only distance it sticks out in front of the lips. Which I imagine would require a very aesthetic/subtle (cosmetic) approach.

And I'm not sure if there is a language barrier here or if I'm mistaken, but what I meant by "cosmetic" or you could say "plastic" surgeon is someone who specializes in shaping things in an aesthetic way that compliments the rest of the face.. a "cosmetic" surgeon would be the same as someone who specializes in anything like rhinoplasty or breast augmentation. As far as I'm aware many maxillofacial surgeons who perform mostly jaw surgeries do not always take aesthetics into consideration. I've seen it mentioned that for them if the jaws align well and the bite is correct after surgery then that is all that matters, regardless of whether or not the patient is unhappy with the overall altered appearance of their face afterward. I was under the impression that is the reason someone like Dr. Gunson gets so much attention, because he is one of the few maxillofacial surgeons who does put so much attention toward aesthetic outcomes as well as function/bite.

[InvisalignOnly]

Yeah I know you mean a 'plastic' surgeon but personally I'd not let a plastic surgeon touch my facial bones. Good maxillofacial surgeons take aesthetics into consideration, if they didn't, there would be some rather terrifying results from jaw surgery.

[kavan]

The chin can be displaced in it's own right (independently in a GENIOPLASTY) in the absence of a (lower jaw advancement) BSSO. However, the chin  can NOT independently stay where it is in the presence of a lower jaw advancement BSSO. It will move along the directional displacement path of the BSSO.

If your problem is isolated to just the mouth area being caved in, you would need to look into types of isolated osteotomies that independently move only the alveolar process (tooth bearing part of the jaw/s). That type of surgery is called: 'Subapical Alveolar Osteotomy"

[needbiggerboat]

If your problem is isolated to just the mouth area being caved in, you would need to look into types of isolated osteotomies that independently move only the alveolar process (tooth bearing part of the jaw/s). That type of surgery is called: 'Subapical Alveolar Osteotomy"

Thanks for the easy to follow details on chin/mandible and relations between genio only and bsso movements. Makes sense.

Am I right in my perception that Sub Alveolar Osteotomy on the lower arch looks a lot more intense in terms of the kind of cutting done, in comparison to just regular mandible advancement? Looks like they littleraly cut that entire lower arch off its foundation to the point of being able to walk away from the body with it in their hands. As intense as that looks, would that be a procedure that requires very deleicate and precise surgeon hands? More so than a BSSO would? Any idea if SAO is less commonly performed and might require a search for a particular doctor who can do it and do it well? Thanks for any further insights yo!

[kavan]

Thanks for the easy to follow details on chin/mandible and relations between genio only and bsso movements. Makes sense.

Am I right in my perception that Sub Alveolar Osteotomy on the lower arch looks a lot more intense in terms of the kind of cutting done, in comparison to just regular mandible advancement? Looks like they littleraly cut that entire lower arch off its foundation to the point of being able to walk away from the body with it in their hands. As intense as that looks, would that be a procedure that requires very deleicate and precise surgeon hands? More so than a BSSO would? Any idea if SAO is less commonly performed and might require a search for a particular doctor who can do it and do it well? Thanks for any further insights yo!

Well, I can't see your perception. But can tell you that the SAO doesn't move the the mandible as does the BSSO. Nor does it move the chin. I don't DO surgery. So, no hands on experience to convey how difficult one is over the other. Just to say that BASED on your targeting the problem to mouth area being caved in relative to the chin and wanting the the chin to stay where it is, you would need to be looking into/researching (Googling) SAO's and doctors who do them. Professional journal articles about the various combinations of SAO's, list the doctors who wrote them in addition to bibliography that cites other doctors journal articles on the subject matter. Academic research can be used in the act of looking for leads as to which possible doctors. The cuts are below the ROOTS of the teeth (teeth are always embedded in the alveolar process of the jaw/s). Cuts can be limited to just a frontal segment of teeth or to the entire alveolar process of the jaw/s.

[april]

Reason I ask is because my situation seems to be opposite of many other's. My chin is already out well beyond my lips. My mouth kind of caved in after wisdom teeth extraction and bad camouflage ortho a few years back. New ortho provider is recommending surgery for function, but visually I know I would like to have the bottom and top lips both pushed out further to meet the chin line. Hoping it's possible to bring the bottom lip out further with lower jaw advancement without it causing the chin to move forward as well. Is that possible? Have multiple consultations with surgeons scheduled, just the wait is a drag and I'm feeling curious and anxious/impatient about whats possible.

If you have a caved in mouth they might do clockwise rotation with the advancement?

Not sure where I saved this from, but this shows clockwise rotation

[needbiggerboat]

If you have a caved in mouth they might do clockwise rotation with the advancement?

Not sure where I saved this from, but this shows clockwise rotation

Cool, thank you for sharing, it's nice to visualize that. I had my first consultation with a surgeon (one I've never seen mentioned here before, he was recommended by my ortho), and he proposed clockwise rotation for me as well. He said it would bring the lips out while bringing the chin back a bit. But it seemed to me it would make my face longer, like moving things this way would tilt everything downward and adding length? (I didn't really get clarification on that since I didn't think of it until after I left the office).

I have consultations with Relle, and Gunson coming up. I'm eager to hear their recommendations in comparison. I don't know how to feel about clockwise rotation as its clear to me I've not spent nearly as much time researching the various procedures as all the other members in the forum.. all I know so far is I see CCW mentioned like it's the holy grail. I don't know if that can be applied to everyone's case or if it's only frequently mentioned because it works for the more typically seen receded chin cases. Either way I definitely get "CCW is the only thing worth doing, and the only one that's going to give an ideal aesthetic outcome along side function" vibes when I search around this forum.