Planing my Bimax+Genio (X-Ray included)

[jshelp]

Hey Guys,

as the title say i am planning my bimax+genio and wanted your opinion if the movements recommended to me are fine.
I mostly do it for Aesthetics, since i have a roundish face appearance despite being not overweight. Friends noticed that i have a "moon face" or pancake" face.
Beside that i often get told that i breath heavily and i often being tired despite sleeping enough so maybe this help with it as well.

X-Ray: https://imgur.com/a/U1OKIlb

@gj and @kavan i would love to hear your opinion I can also pn you soft tissue pics which i feel uncomfortable post them public.

Movments that got recommend to me

• Bimax Advancment with Counterclockwise rotation: about 7mm maxilla and 9mm mandible
• About a 6mm genioplasty, with bone graft, so i dont get a witch like chin

Thanks in advance!

[SMSOMS]

You have a fabulous bony chin.  I would not touch it.  The lower incisors are already behind pogonion by several millimeters and advancing it makes that even worse.  A normal chin position is the facial aspect of the lower incisors equal to pogonion providing the Incisor mandibular plane angle does not exceed 96 degreesYour occlusal plane is steep and your maxilla a bit recursive but you also have a very strong brow which makes nasion look retruded and many of your landmarks will be altered.  I would decide where the final chin position need to be and do a CCW rotation and no genio.  A witches chin comes from too much muscle stripping.  A deep and unesthetic labiomental fold comes from advancing a chin that does not need advanced as in your case.  My 2 cents

[GJ]

You're welcome to email me photos.

Based on that x-ray, the mild CCW seems right. It's hard to believe you'd need a 6mm genio in addition to that. Seems the chin would be pretty ideal once you rotate CCW. Your left condyle looks a bit smaller than the right. The roots of your incisors look splayed. I've never seen that, and I'm not sure why that would happen, but might be worth knowing the cause before starting treatment.

Overall, you look like a borderline case to me. I'd have to see the in the flesh photos because based on this scan I'm not sure I'd consider surgery. There is mild recession and a high angle, but it looks within norms, and your bite looks good.

[jshelp]

You have a fabulous bony chin.  I would not touch it.  The lower incisors are already behind pogonion by several millimeters and advancing it makes that even worse.  A normal chin position is the facial aspect of the lower incisors equal to pogonion providing the Incisor mandibular plane angle does not exceed 96 degreesYour occlusal plane is steep and your maxilla a bit recursive but you also have a very strong brow which makes nasion look retruded and many of your landmarks will be altered.  I would decide where the final chin position need to be and do a CCW rotation and no genio.  A witches chin comes from too much muscle stripping.  A deep and unesthetic labiomental fold comes from advancing a chin that does not need advanced as in your case.  My 2 cents

I agree that on the x-ray it seems like my chin is fine, but somehow on the soft tissue pics it doesnt show. And i think the the advancement of the chin addition to the bimax would further lengthen my mandible.
And to escape a deep and unaesthetic labiomental fold i thought some bone graft would prevent it. I sended you some Soft Tissue pics so you get an idea what i mean. Thanks for your help! 

You're welcome to email me photos.

Based on that x-ray, the mild CCW seems right. It's hard to believe you'd need a 6mm genio in addition to that. Seems the chin would be ideal once you rotate CCW. Your left condyle looks a bit smaller than the right. The roots of your incisors look splayed. I've never seen that, and I'm not sure why that would happen, but might be worth knowing the cause before starting treatment.

Overall, you look like a borderline case to me. I'd have to see the in the flesh photos because based on this scan I'm not sure I'd consider surgery. There is mild recession and a high angle, but it looks within norms, and your bite looks good.

I e-mailed you some soft tissue pics. Yeah the additional genio would be there just to further visualy "lengthen" the mandible to escape the moonface look. You are right that my left condyle is a bit smaller (as you can see in other soft tissue pics). What does it mean that my incisors are splayed? Heard it never before  is it bad?

To make clear i am doing it mostly for Aesthetical reasons:

• since i have roundish appearance which even my friends noticed (despite having a normal/low body fat percentage).
• a gummy smile which is minor when just slightly smiling but clearly visible when laughting or smiling "harder". But i think you can see on the x-ray thats the cause of the downward grown maxilla

[kavan]

I don't imply to pin down exact mm movements when opining and opining at all is not an invitation to PM me for individualized focus. So, please do note that.

On the assumption that the CCW offered to you includes a posterior downgraft, that would be of benefit to reduce the inclination of both the OP and the MPA which are on the steep side but not overly so. However, I would call the EXTENT of the proposed displacements into question on the basis that it appears an a attempt is being made to 'balance' your profile with an inherent IMBALANCE; your overly protrusive brow area.

With regard to 'aesthetics only' or 'just doing this for aesthetics', the proposed displacements appear to be on the excessive side, ESPECIALLY the CHIN. I suspect those displacements are an attempt to 'balance' the profile with an excessively protrusive brow bone which, in it's own right, is the SALIENT aesthetic IMBALANCE of your profile. IMO, no aesthetic improvement can be had by attempting to balance the parts of the face/bone structure with another part that DEVIATES from the norm EXCESSIVELY. You risk overall aesthetic imbalance.

I would suggest looking into a procedure called 'Brow bossing'. Although it is one commonly done for facial femme surgeries, the technique is the same (but to lesser extent of reduction) for males still wanting to look masculine. The brow bone is cut and the inner aspect of it is reduced. The outer aspect of it has to remain intact (as in NO burring it down from the outside of it) in order to protect the sinus area. Brow bossing procedure is in the venue of surgeons who perform 'facial femme' surgeries. They are the subset of surgeons versed in the technique of reducing that area. The same technique can be used to reduce overly protrusive excess YET to MAINTAIN a masculine brow projection. So, the suggestion here is not towards feminizing the brow but only to remove the excess that is far beyond a good male aesthetic.

[jshelp]

I don't imply to pin down exact mm movements when opining and opining at all is not an invitation to PM me for individualized focus. So, please do note that.

On the assumption that the CCW offered to you includes a posterior downgraft, that would be of benefit to reduce the inclination of both the OP and the MPA which are on the steep side but not overly so. However, I would call the EXTENT of the proposed displacements into question on the basis that it appears an a attempt is being made to 'balance' your profile with an inherent IMBALANCE; your overly protrusive brow area.

With regard to 'aesthetics only' or 'just doing this for aesthetics', the proposed displacements appear to be on the excessive side, ESPECIALLY the CHIN. I suspect those displacements are an attempt to 'balance' the profile with an excessively protrusive brow bone which, in it's own right, is the SALIENT aesthetic IMBALANCE of your profile. IMO, no aesthetic improvement can be had by attempting to balance the parts of the face/bone structure with another part that DEVIATES from the norm EXCESSIVELY. You risk overall aesthetic imbalance.

I would suggest looking into a procedure called 'Brow bossing'. Although it is one commonly done for facial femme surgeries, the technique is the same (but to lesser extent of reduction) for males still wanting to look masculine. The brow bone is cut and the inner aspect of it is reduced. The outer aspect of it has to remain intact (as in NO burring it down from the outside of it) in order to protect the sinus area. Brow bossing procedure is in the venue of surgeons who perform 'facial femme' surgeries. They are the subset of surgeons versed in the technique of reducing that area. The same technique can be used to reduce overly protrusive excess YET to MAINTAIN a masculine brow projection. So, the suggestion here is not towards feminizing the brow but only to remove the excess that is far beyond a good male aesthetic.

Thanks for your insight and sorry for the pm, i just value your opinion

Yeah after i contacted some surgeons it seems that the  the proposed displacements where to extrem.

But overall the surgeons which i contacted so far agreed that i have a biretrusion of maxilla and mandible. But one also statet that the Xrays were taken in a incorrect head position and advice me to do a webmeeting with him.

I didnt know that the brow projection was that big of a problem. So you would advice in adition to a bimax (with ccw) a 'Brow bossing'?

[jshelp]

Some User even adviced completly against bimax:

With CCW rotation the chin advances more than the lower incisors and the upper incisors advance linearly and the posterior teeth come down decreasing the occlusal plane. The mandible gets longer at pogonion but the teeth do not come as far forward as the chin and the advancement of the maxillary teeth gets absorbed by the soft tissue the most noticeable thing is the lower lip drops back and the chin comes forward.  I think in your case the two most prominent features will be your chin and brow.

I have a consultation tommorow with a surgeon i am curios what he advice. After hearing that many people advice me against bimax i am bit sceptical now :/

[kavan]

Thanks for your insight and sorry for the pm, i just value your opinion

Yeah after i contacted some surgeons it seems that the  the proposed displacements where to extrem.

But overall the surgeons which i contacted so far agreed that i have a biretrusion of maxilla and mandible. But one also statet that the Xrays were taken in a incorrect head position and advice me to do a webmeeting with him.

I didnt know that the brow projection was that big of a problem. So you would advice in adition to a bimax (with ccw) a 'Brow bossing'?

I would advise to explore brow bossing first as to avoid a situation where they OVER ADVANCE the jaws to 'balance' with an out of balance brow bone area.

[jshelp]

I would advise to explore brow bossing first as to avoid a situation where they OVER ADVANCE the jaws to 'balance' with an out of balance brow bone area.

I reasearched brow bossing and to be honest i would not feel confortable doing it. I dont know eye are is the only are where i got sometimes complimented for and i dont wanna change somethink in this regard. Also on soft tissue pics or in general when i look in my face it never bordered me.

I was just unhappy with my jaw since there was no definitation at all and it looks like there is to much soft tissue (sagging skin) and not enough projection.

I consulted some surgeons who all agree that my maxilla and mandible is a little bit receded and recomend me ccw+genio.

One surgeon i had consultation with showed me based on a soft tissue photo that my chin is behind my "nose-point" (but i think he took my brow as another reference point)

Do you think my chin would be over advanced when its in line with my nose point+brow?
I dont wanna go get multiple surgeries (which have risks at its own) where i need spend alot of money+time

I just unhappy with my lower third which i was willing to improve

edit: the surgeon also said that he simulate soft tissue changes with a programm so he can avoid uncanny results

[kavan]

I reasearched brow bossing and to be honest i would not feel confortable doing it. I dont know eye are is the only are where i got sometimes complimented for and i dont wanna change somethink in this regard. Also on soft tissue pics or in general when i look in my face it never bordered me.

I was just unhappy with my jaw since there was no definitation at all and it looks like there is to much soft tissue (sagging skin) and not enough projection.

I consulted some surgeons who all agree that my maxilla and mandible is a little bit receded and recomend me ccw+genio.

One surgeon i had consultation with showed me based on a soft tissue photo that my chin is behind my "nose-point" (but i think he took my brow as another reference point)

Do you think my chin would be over advanced when its in line with my nose point+brow?
I dont wanna go get multiple surgeries (which have risks at its own) where i need spend alot of money+time

I just unhappy with my lower third which i was willing to improve

edit: the surgeon also said that he simulate soft tissue changes with a programm so he can avoid uncanny results

OK, you don't have to get the brow bossing procedure. BUT just DON'T let them project the chin point out as much as the brow is pronounced out. For example, if you drop down a straight vertical line from the brow area, you DON'T want the chin point to meet that line. That would be OVER ADVANCEMENT and it would give you a profile kind of like a CRESCENT MOON, you know, something where there are 2 prominent points sticking out and the rest looks relatively recessed. So, you don't want the lower jaw area + chin to be advanced out as much as the brow area is.

Your nose 'point'? I don't know what that means. We speak of the ROOT of the nose which is found BELOW the brow bone and where the nose bone STARTS. Below the root of the nose is the BRIDGE of the nose. The root of your nose is WAY BEHIND your brow area. Doesn't matter that I don't know what you mean by 'point of nose + brow. What I mean is DON'T get have the lower advancement line up with the brow area. I think the doctor who gave the large advancements did that.

You can still have the CCW and double jaw advancement though to the extent those areas are recessed IN THEIR OWN RIGHT. But the advancement should be INDEPENDENT of where your PROTRUSIVE brow area is. Also, it's highly UNLIKELY your chin needs to be advanced. I think that was also a factor in the prior doctor's OVER ADVANCEMENT where he may have been trying to line up the chin with the brow.

[jshelp]

OK, you don't have to get the brow bossing procedure. BUT just DON'T let them project the chin point out as much as the brow is pronounced out. For example, if you drop down a straight vertical line from the brow area, you DON'T want the chin point to meet that line. That would be OVER ADVANCEMENT and it would give you a profile kind of like a CRESCENT MOON, you know, something where there are 2 prominent points sticking out and the rest looks relatively recessed. So, you don't want the lower jaw area + chin to be advanced out as much as the brow area is.

Your nose 'point'? I don't know what that means. We speak of the ROOT of the nose which is found BELOW the brow bone and where the nose bone STARTS. Below the root of the nose is the BRIDGE of the nose. The root of your nose is WAY BEHIND your brow area. Doesn't matter that I don't know what you mean by 'point of nose + brow. What I mean is DON'T get have the lower advancement line up with the brow area. I think the doctor who gave the large advancements did that.

You can still have the CCW and double jaw advancement though to the extent those areas are recessed IN THEIR OWN RIGHT. But the advancement should be INDEPENDENT of where your PROTRUSIVE brow area is. Also, it's highly UNLIKELY your chin needs to be advanced. I think that was also a factor in the prior doctor's OVER ADVANCEMENT where he may have been trying to line up the chin with the brow.

Ah okay i get your point and i agree that if my chin would be on line with my brow (while everthink else is behin that line) would create a weird look.
The doctor who gave me the initial advancement was a plastic surgeon and not a maxillofacial doctor, so i used the measurments only as a first inital gues what could be done.
The maxillofacial surgeon who i am problay want to get surgery with was talking about a 3-4mm maxilla advancement with a ccw+genioplasty (the exact movements and if a additional genio is needed would be decided based on the 3d face analysis he do based on ceph data).

But he also created a line trough my brow and subnasale point (this is what i meaned with nose point, sorry for misconception) and wanted to adjust my chin on the same line.

So i would probaly get a straight face. Do you think this would also creat a "CRESCENT MOON" appeareance? Since the mouth should be advancement forward too which should balance this our or i am wrong?

So you would also advice me to stay away from a genioplasty independed from the 3d simultation? I mean i would welcome it since it would save me money+recovery+risk

[kavan]

Ah okay i get your point and i agree that if my chin would be on line with my brow (while everthink else is behin that line) would create a weird look.
The doctor who gave me the initial advancement was a plastic surgeon and not a maxillofacial doctor, so i used the measurments only as a first inital gues what could be done.
The maxillofacial surgeon who i am problay want to get surgery with was talking about a 3-4mm maxilla advancement with a ccw+genioplasty (the exact movements and if a additional genio is needed would be decided based on the 3d face analysis he do based on ceph data).

But he also created a line trough my brow and subnasale point (this is what i meaned with nose point, sorry for misconception) and wanted to adjust my chin on the same line.

So i would probaly get a straight face. Do you think this would also creat a "CRESCENT MOON" appeareance? Since the mouth should be advancement forward too which should balance this our or i am wrong?

So you would also advice me to stay away from a genioplasty independed from the 3d simultation? I mean i would welcome it since it would save me money+recovery+risk

Correct line= B.

ETA: You risk C if they line up your brow with your chin projection.

[jshelp]

Correct line= B.

ETA: You risk C if they line up your brow with your chin projection.

But isnt the projected brow even justify more chin rescesion while technically still have "straigh face=B line"
Here is a sketch what i mean:
And to avoid C there will be additional maxilla+lower jaw advancement which should bring the lips forward too?
And since my chin is behin my lip, shouldn't than a chin movement be acceptable too or do i miss somethink?

[kavan]

OK. Here's my LAST try.

Again, my message has been to AVOID dropping a straight vertical from YOUR particular forehead protrusion as to have the chin point meet that line.

That ONLY works for balance when the brow is NOT as protrusive as yours. For example it worked in example; 'B' BECAUSE the illustration showed a a NORMAL forehead projection.

I adapted the illustration to show a very PROTRUSIVE forehead brow bone projection (like yours!), dropped a vertical from that so the chin point met the vertical.

AGAIN: Doing that in YOUR case would yield a CONCAVE looking profile.

END OF STORY.

[jshelp]

OK. Here's my LAST try.

Again, my message has been to AVOID dropping a straight vertical from YOUR particular forehead protrusion as to have the chin point meet that line.

That ONLY works for balance when the brow is NOT as protrusive as yours. For example it worked in example; 'B' BECAUSE the illustration showed a a NORMAL forehead projection.

I adapted the illustration to show a very PROTRUSIVE forehead brow bone projection (like yours!), dropped a vertical from that so the chin point met the vertical.

AGAIN: Doing that in YOUR case would yield a CONCAVE looking profile.

END OF STORY.

Okay i get your point, sorry for the beginning missunderstanding from my side.

But overall would you personaly agree that a jawsurgery would be beneficial for me (from a aesthetical point)?