Chin Wing pertinence (Xray + Pics)

[jnslf21]

Hello everyone,

I would like to request your thoughts about my jaw / chin / lower third shape harmony. Could you please assess my recession degree ?

I was looking forward a Chin Wing to get more mandibular definition/advancement (from profile), chin alignment with lips (from profile) and more jaw & chin width (from front).

My dentist told me that more complex procedures like Bimax weren’t worth it in my case (bad risk/reward ratio).

- I mouthbreath
- I had braces when I was a teenager (now Class 1 occlusion I guess)
- I am now 28(M)

Is this a pertinent procedure in my case ? Is a « renommable » surgeon (4-5 European names that we see everywhere on forums) a necessity, or is this procedure any qualified surgeon (that do Chin Wings) can properly achieve ?

What are your overall suggestions ? I tend to focus on my lower third which I see "soft and weak". (I'm satisfied with of the aspect when jutting/duckfacing : more definition & mandible advancement from all angles)

(NB : I do understand that Chin Wing is only, unfortunately, an aesthetic procedure)

(NB2 : I chewed a bit so my masseters could be slightly hypertrophied on face pic - I recently stopped because of aches - I know about TMJ issues regarding this).

Thank you very much for your advice.

[kavan]

You have a long lower '1/3rd' of the face. When I measure relative distances on your ceph in accordance to where they should be divided to see if both areas are equal, what's called the lower '1/3rd' is LONGER than the middle '1/3rd'.

Frontal view also reveals a longish looking chin. Profile view reveals a chin that could be vertically shortened and projected outward (sliding genioplasty).

Assuming you are male, a longer '1/3rd' would not be considered much of an aesthetic problem at all when the areas beside the chin are NOT as NARROW as yours. But clear as day from FRONTAL view that the narrowness to the sides of chin contribute to it looking LONGER than someone else with a WIDER area beside the chin who also had the SAME vertical length to the lower '1/3rd' as you do.

Now, from FRONTAL perspective, someone with a WIDER area beside the chin would most likely also have a longer vertical distance to an area of the MANDIBULAR BODY found between the chin and the gonial angle area when viewed on a profile ceph.

So, WIDTH beside the chin, lack thereof as seen in frontal perspective, can be a FUNCTION of a SHORT vertical distance to part of the mandibular body found between the 'back of the jaw angle' and the chin which we can view on your ceph because not only is it a PROFILE perspective but it also shows how much vertical 'SPACE' there is is between the root of the molars and the lower border of the body of the mandible. Your ceph reveals a very NARROW 'space' to the body of the mandible to the area between the roots of the molars and the border of the mandible. So, that is consistent with lack of width found to the sides of your chin.

With a chin wing, they cut from front of chin to the back of the jaw angle. The surgery involves NAVIGATING a NERVE. The nerve in your case, would be in a very 'tight' space which is the short area between roots of molars and border of the mandible. So, it's a situation where people needing  more length to the that part of the body of the mandible and need that length because of lack of enough width to sides of chin might not be good candidates for a chin wing that gives more length to the body of the mandible between roots of molars and border of it. Because a cut starting from front of chin and going all the way to the back of the jaw has to NAVIGATE a NERVE that's pretty close to where they cut.

Your ceph doesn't look like one where you are an 'ideal' candidate for a chin wing cut that 'drops down' the short vertical distance between the roots of the molars and border of the mandibular body as to make that longer where you need it to be longer in frontal view. A chin wing doctor would want a type of scan that shows how close that nerve will be to the cut. However, a chin wing doctor would certainly be in the capacity reduce the excess length of the chin where the chin itself is long and also increase the projection of the chin which would resolve to being very similar to a sliding genio to increase projection and vertically shorten.

In essence, your lower '1/3rd' is long. The length is exaggerated by lack of WIDTH to the SIDES of the chin. The lack of width to the sides of the chin is a FUNCTION of lack of vertical length to the mandibular body where the length is looked at as narrow space between the roots of the molars and the border of the mandible. To increase that vertical distance a chin wing would need to cut through the narrow area to place a graft in there. However since the NERVE is close to the path of the cut to do that, the nerve being too close to the path of the cut could preclude the type o chin wing surgery needed to elongate the part of the mandibular body where it's shortness contributes to the narrowness beside your chin seen in frontal view. They COULD give you something akin to a sliding genio that projects out the chin more and also vertically shortens it. But so could OTHER surgeons who are NOT 'chin wing' doctors.

You would need to consult WITH a chin wing doctor to FIND OUT IF they could elongate the part of the mandible beside the chin in YOUR particular case. Chin wing doctors CAN do that ONLY IF there is enough 'space' to navigate the nerve. If there is NOT, they CAN'T. If they can't, they offer a surgery similar to a sliding genio with aim to project chin outward and also upward to shorten which is something that most maxfax doctors who DON'T do chin wings can also do.

[GJ]

Agree with Kavan that your lower third looks a bit long and also a bit narrow. I also agree with your dentist about jaw surgery...not seeing how it's justified here.

I'd think a CCW genio could address the issue? Not sure. But I'd look into that at least...seems the least invasive and best risk/reward.

[kavan]

Agree with Kavan that your lower third looks a bit long and also a bit narrow. I also agree with your dentist about jaw surgery...not seeing how it's justified here.

I'd think a CCW genio could address the issue? Not sure. But I'd look into that at least...seems the least invasive and best risk/reward.

You mean a sliding genio; diagonally upward movement that both shortens and projects outward.

ETA: it would make his length look less but it won't increase width where it's narrow beside the chin .

[Rodin]

A "mini wing osteotomy" also exists that ends short of the gonial angles and is less dependent on nerve position. There are also some variations of the sliding genioplasty that may be relevant. It is possible to create a midline split and widen with a graft. Other reduction cuts to reduce vertical length also could result in an appearance of widening. Look up "zigzag" genioplasties,

[jnslf21]

Thank you for all that informative content. This is very appreciated.

Here are some subsequent interrogations :

-
Considering that :
- The chin is more and more narrow from up to down
- The sliding genio narrows the chin (from face view) when projecting it forward ((I read it elsewhere, please correct me if I'm wrong))
- *BUT* decreases the vertical chin length by shortening, thus reducing the narrowness (by cutting the narrower very bottom)

-> Will the shortening procedure produce a sort of "compensation" of that narrowness induced by forward projection procedure ?
How could we possibly pre-measure/morph this kind of movements combination, which seems kind of "complex" ?


- Looking at all that variables and possible outcomes, I'm more and more sceptical about the real gains that I'd take from this.

I'm particularly concerned about the front view more than the side one. Is a classical sliding genio/mini wing/zigzag would make a substantial difference from front ?

- Are that kind of procedures regarded as safe ? I found a lot of bad experiences all over the Internet, but obviously those cases are not representative (people that don't encounter issues are probably the silent majority).

- What's about my jaw and what I said about the aspect of the mandible when jutting ? Is that kind of result giving more definition to the jaw, undoable ?

- Is the devlopment of my narrow chin correlated with mouthbreathing ? Or is it more a genetic trait (I'm a slavic man, I saw somewhere that slavic women typically had the narrow chin, often requested for correction by surgery)

- Is it possible to solve the mouthbreathing habit by acquiring new postures with reeducation (aka mewing) ?

- (A bit on the side : considering my ceph, what makes my face quite "non-chiseled" ? I am (and always was) quite low body fat but it doesn't seem that my mandible, cheekbones, zygos are really visible. I even got some prominent jowl fat pads which are even more prominent the more skinny I get.)


I took an appointment with a maxillo-facial surgeon that does chin wings. Gonna be interesting to cross his point of view with yours !

Thank you again.

[kavan]

Firstly, when ever I take the time to address a first time poster, my objective is often to help the person SEE distance and/or geometrical relationships that are intuitively obvious to me so that they become intuitively obvious to the other person.

Let me clarify the basic concept/s I was putting forth in my post. Because none of your spin off questions here ('subsequent interrogations') reflect much receptivity to the basic conceptual information I was putting forth.

Salient Concept:

Your chin, ITSELF, is not narrow. What's narrow is the area BESIDE your chin.

Ask YOURSELF: 'Is that now intuitively obvious to you?'

If 'Yes', than that's the FUNDAMENTAL distance relationship needed to build on.

If 'No' than that would reflect inability to DIFFERENTIATE the chin ITSELF from the area BESIDE the chin.

IF 'yes' and ONLY IF 'yes' would other fundamental distance relationships also make sense to you such as:

a: Although the chin is long and a bit recessed, correcting the chin itself (by shortening it and also projecting it outward doesn't address the area BESIDE the chin. It's the narrow area BESIDE  the chin that is your key aesthetic problem. The genio won't fix that. A chin wing COULD help but ONLY IF the narrow space where the nerve is which they would need to cut through could be navigated so they could elongate the part of the mandible that is SHORT and elongate it so your frontal area beside the chin was wider. You need WIDTH BESIDE the chin so the chin does VISUALLY look as long as it does now.

Nothing in your response ('interrogations') relates to the chin wing info I gave.

That said, the relationships I explained would need to be 'digested' by you to get the best out of a consult with a CHIN WING DOCTOR.

[jnslf21]

Thank you. I'll try to be clear and efficient :


I) Chin Wing : about the nerve issue (narrowness of distance between molars and jaw)

Because of your answer, I assumed that Chin Wing was possibly out of question for me, that's why I didn't elaborated about it. My knowledge on this subject is limited, so it's hard for me to formulate technical answers with precision.

I'm looking forward to the surgeon view on this !


II) Area beside the chin

Are we talking solely about the MANDIBLE BODY then ?

I now do understand the geometrical relationship informations that you gave me, there weren't intuitively that clear. I thought that chin was the problem.


III) Non-pertinence of genioplasty

I thought that projecting chin and shortening it would virtually diminish the perceived distance between mandible and chin (making the area BESIDE the ching, WIDER). I was wrong then ! You clarified it.


IV) Thank you

Please be assured that I'm grateful that competent people give me solid advices basically for free, especially being a first poster. I took my chance to go on with peripheral questions because the usual insights that we get on that kind of subjects are quite poor and "non-rational". I was just curious to hear your opinion on that.

Have a good day !

[kavan]

Thank you. I'll try to be clear and efficient :


I) Chin Wing : about the nerve issue (narrowness of distance between molars and jaw)

Because of your answer, I assumed that Chin Wing was possibly out of question for me, that's why I didn't elaborated about it. My knowledge on this subject is limited, so it's hard for me to formulate technical answers with precision.

I'm looking forward to the surgeon view on this !


II) Area beside the chin

Are we talking solely about the MANDIBLE BODY then ?

I now do understand the geometrical relationship informations that you gave me, there weren't intuitively that clear. I thought that chin was the problem.


III) Non-pertinence of genioplasty

I thought that projecting chin and shortening it would virtually diminish the perceived distance between mandible and chin (making the area BESIDE the ching, WIDER). I was wrong then ! You clarified it.


IV) Thank you

Please be assured that I'm grateful that competent people give me solid advices basically for free, especially being a first poster. I took my chance to go on with peripheral questions because the usual insights that we get on that kind of subjects are quite poor and "non-rational". I was just curious to hear your opinion on that.

Have a good day !

I. It isn't out of the question. More of a matter of it's a question to bring forth to the chin wing doctor given that what one can achieve via a chin wing becomes questionable if the nerve is too close to the area they cut.

II. Yes. Area beside chin is mandibular body.

III. Sliding genio diminishes the problem somewhat by shortening the chin and projecting it outward. It improves the profile. But it does not make the area beside the chin wider.

IV: You're welcome