Chin Wing or Chin Shield: Considerations and your opinion (with scans)

[Tomasjohn]

Hey dear forum!

Content:

• Starting point
• Further considerations
• Questions to you
• Scans

Starting point
My (initial) aesthetic concerns regarding the lower third was "just" my recessed Chin (see images)
I researched the different procedures to address the situation and concluded the following:

• Jaw surgery is out of scope. I have no functional issues and a good life. I am also not (or don't feel) utterly ugly. So the risk/reward is not worth it in my opinion
• I don't want to change my jaw line/angles. My goal is just to bring the chin to a horizontal line with the lower lip 
• Because of (2) i found that a chin wing is not a good solution
• Because i don't want the submental fold to increase drastically i thought a chin-shield genioplasty is the optimal solution

Then i had a consultation with one of the well known doctors that do the chin-wing and thus also the chin-shield.
He said the following:

• He did not recommend to do only the chin-shield because of the steep-off it could produce.
• He said he could advance my chin (through the chin wing including the shield cut) without making the submental fold worse. He "recommended" (eyeballed) about 1cm
• He said a big advancement like this (or also more then 8mm) would likely look unnatural if you only move the chin (door knob)
• He said i am a candidate for the chin-wing (nerve position is fine)

Further considerations

My thought's so far. If i missed something you think is important, please let me know.

• Asymmetry and Chin Wing: Right half of face appears overall significantly lower then left half (see scan). I think with the chin wing the doc could lower the left border of mandible more then right side and balance things out. I did not ask him yet. But i also fear that asymmetry could be much worse than before.
• Asymmetry and Chin Shield: Maybe only doing the chin shield (only movement of chin) on top of my asymmetries could even look worse.
• Lower gonial angles and Chin Wing: I don't want to lower (by lowering the back of the mandible more than the front) the angles. I did not measure anything, but i think the angles are already quite low.
• Blunting of gonial angles with Chin Wing : I have no idea how bad the "blunting" would hurt my aesthetics. Yes, i know why they are somewhat blunted (makes sense).
• Face Shape from the front: I think if we look from the side the CW results do look very good (natural), male and female alike. They do a very good job in bringing the chin forward. But i can not process how the Chin Wing would change my face from the front. I have seen the changes in the before/afters and generally i think they have a more round and boxed shaped look to the jaw in the afters. But all depends on the starting point and the movements. So i find it overall very hard to assess how a certain change would impact and also benefit (or not) my face from the front. The same is true for the chin-shield!

Questions to you

Your thoughts about only doing the chin-shield when looking at my scans?

What is your opinion about the chin wing when you look at my jaw structure, also considering the points i make above?

How can i plan better. Sounds silly, but what steps in the planing process should i NOT leave out before undergoing surgery?





Scans
Edit: I deleted the Attachments.


I sincerely thank everyone who reads this and replies to my post!!

[kavan]

Just have time to look at your scans but not to address all of your content. Hope the following helps somewhat:

Your scans reveal you could probably have a chin wing AND a chin shield; BOTH. That is to say you don't have an overly high sloped mandibular border that would make it more difficult for them to cut through all the way to the back of the jaw as to lower the border of it (for which a graft from the hip would be needed). Although your scans don't show where the nerve is, there does look like there is enough room for them to avoid it while doing the chin wing cut in order to 'drop down' the border of mandible.

The chin shield comes into play when in addition to the 'drop down' to the mandibular border, the mandibular border is displaced FORWARD to advance it or even if you no drop down but just forward advancement. In the case of forward advancement of the mandibular border, a chin shield would be used to camouflage the lip to chin GROOVE that could become MORE accentuated with forward advancement of the mandibular border. Hence, that's why I say you could have BOTH if you so elected to do so. If all you wanted to do was to  camouflage your overly acute chin groove, you could get only the chin shield. However, if you elected to get the chin wing to advance your mandible border forward, you would probably need to get the shield along with it.

[Tomasjohn]

Hey kavan

Thanks for your prompt answer!

The chin shield comes into play when in addition to the 'drop down' to the mandibular border, the mandibular border is displaced FORWARD to advance it or even if you no drop down but just forward advancement.

This is what the doctor recommended and should be possible according to him. With or without dropdown.

If all you wanted to do was to camouflage your overly acute chin groove, you could get only the chin shield.

My initial plan. But not specifically to camouflage the groove but to bring the chin in the "correct" position relative to the lower lip. Horizontally this would be 7mm - 10mm. Offcours - any improvement to the groove is desired.


Just to clarify: I believe CW+CS (a chinwing with horizontal movement in most cases i guess) will have the superior outcome if we only look from the side and especially
look at the chin. Because there can not be a step-off for example. But because of all the other variables i am not sure yet which approach is better.

[GJ]

Chin wing and chin-shield are things I know little about so I'll say nothing at all. Luckily for you Kavan chimed in with some thoughts. But hopefully some other members who know about those procedures can contribute.

Good on you recognizing you don't need jaw surgery, though. Even the chin issue looks minor.

[kavan]

Hey kavan

Thanks for your prompt answer!
This is what the doctor recommended and should be possible according to him. With or without dropdown.
My initial plan. But not specifically to camouflage the groove but to bring the chin in the "correct" position relative to the lower lip. Horizontally this would be 7mm - 10mm. Offcours - any improvement to the groove is desired.


Just to clarify: I believe CW+CS (a chinwing with horizontal movement in most cases i guess) will have the superior outcome if we only look from the side and especially
look at the chin. Because there can not be a step-off for example. But because of all the other variables i am not sure yet which approach is better.

The chin shield is NOT meant to advance the chin. It's the chin wing 'forward movement' of the mandibular border which is meant to advance the chin forward. The chin shield is meant to improve the groove.

[Tomasjohn]

The chin shield is NOT meant to advance the chin. It's the chin wing 'forward movement' of the mandibular border which is meant to advance the chin forward. The chin shield is meant to improve the groove.

OK the doc explained it to me differently. I will also refer to this Post: http://jawsurgeryforums.com/index.php?topic=7427.0

But also: If you move the chin through the advancement of the whole mandibular border you should also be able to do so with only moving part of it (the chin) i guess.

I tought the chin visor is the one to only improve the groov but not sure.

[kavan]

OK the doc explained it to me differently. I will also refer to this Post: http://jawsurgeryforums.com/index.php?topic=7427.0

But also: If you move the chin through the advancement of the whole mandibular border you should also be able to do so with only moving part of it (the chin) i guess.

I tought the chin visor is the one to only improve the groov but not sure.

OK, the osteotomy shown in the link would work in a chin advancement and would improve the groove between chin and lip. There was another procedure, also referred to on here (years back) as a chin sheild where a part of the hip was harvested to fill in the groove which was the one I thought you were referring to. But thanx for SHOWING the photo for reference.

[Tomasjohn]

OK, the osteotomy shown in the link would work in a chin advancement and would improve the groove between chin and lip. There was another procedure, also referred to on here (years back) as a chin sheild where a part of the hip was harvested to fill in the groove which was the one I thought you were referring to. But thanx for SHOWING the photo for reference.

You are right about the hip harvest! The space behind the bone is filled. There is a video that shows the chin shield in a chin wing procedure and you can see that they use some material to fill the space behind the cut (behind the shield).
See this video at 13:55: https://youtu.be/CcWdDOpOtgs

Anyone knows what material this is ? Looks funky haha. My doc said he would use bone harvest.

[kavan]

You are right about the hip harvest! The space behind the bone is filled. There is a video that shows the chin shield in a chin wing procedure and you can see that they use some material to fill the space behind the cut (behind the shield).
See this video at 13:55: https://youtu.be/CcWdDOpOtgs

Anyone knows what material this is ? Looks funky haha. My doc said he would use bone harvest.

If material not your own bone, then some of the chin wing doctors use (I think) a product called 'Bio-Oss' which is 'xeno' graft meaning it comes from bone product from either someone or something else's bones. You could google further and find out more about that product.