jawsurgeryforums.com
General Category => Functional Surgery Questions => Topic started by: SJay on February 27, 2016, 12:25:30 PM
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Hi,
So, as some of you may remember, I was asking for a lot of advice about sliding genioplasty a few months back. Thanks to everyone who chipped in, for all the advice and info. Anyway, I'm going ahead with it, with Dr Gunson, next month. We did the measurements, and I think my chin is around 10mm off where it should ideally be, my bite is fine and there are no major vertical issues. The plan is to advance the chin 6-8mm forward and couple of mm up, plus use HA for the step off, which will probably still leave me a little recessed but that's fine, it will be a lot less noticeable.
I'm quite nervous, worried about creating a deep mentolabial fold and ruining the contour of my jaw from the front, which is okay as it is. Dr Gunson has ensured me the fold created will not be deeper than say 5mm and he won't give me a pointy chin. So I'm just going to place my trust in him. SGSeeker got a fantastic result with him a few months back, so I'm hoping mine will turn out the same.
Anyway, here are my before pics. I'll post some afters, well after. Wish me luck!
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With up do you mean that you're gonna reduce the vertical height of your chin?
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I believe so, very slightly. I think they naturally look longer once they're advanced anyway.
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Hi,
So, as some of you may remember, I was asking for a lot of advice about sliding genioplasty a few months back. Thanks to everyone who chipped in, for all the advice and info. Anyway, I'm going ahead with it, with Dr Gunson, next month. We did the measurements, and I think my chin is around 10mm off where it should ideally be, my bite is fine and there are no major vertical issues. The plan is to advance the chin 6-8mm forward and couple of mm up, plus use HA for the step off, which will probably still leave me a little recessed but that's fine, it will be a lot less noticeable.
I'm quite nervous, worried about creating a deep mentolabial fold and ruining the contour of my jaw from the front, which is okay as it is. Dr Gunson has ensured me the fold created will not be deeper than say 5mm and he won't give me a pointy chin. So I'm just going to place my trust in him. SGSeeker got a fantastic result with him a few months back, so I'm hoping mine will turn out the same.
Anyway, here are my before pics. I'll post some afters, well after. Wish me luck!
About how much is the sliding genioplasty going to cost ?
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I'll pm you.
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Your profile will look better. I do wonder about the shortening though - your height seems okay as is and shortening would potentially make the resulting labiomental fold worse.
You're lucky in that you already have nice jaw definition (and everything else... cheeks, forehead, maxilla) and your gonial angles keep the skin tight enough, so this is the one thing that will really improve your aesthetics.
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Thanks for your comments. I don't think the plan is to actually purposefully shorten, I think that's just how the cut and slide works, and since chins generally look longer afterwards, if you lose 1 mm or 2 then it will look the same after? That's my understanding, perhaps I should talk with Dr Gunson about it again before the surgery.
My chin looks awful on profile, so I'm hoping so. I'm confident it will improve the profile, but just don't want to screw anything else up in the process. Anyway, Dr Gunson is obviously an excellent surgeon, so I'm in capable hands and have to trust his judgement.
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You are very good hands- Am having my surgery late May, but have heard that he and Dr. Arnette are the Cadillacs of Oral Surgeons. :)
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So I had the genioplasty yesterday, with Dr Gunson at Goleta Valley Cottage hospital. It was a straight forward 7mm advancement, no change to the height of the chin, and some HA grafts to smooth out the cut. We did discuss the use of more HA further back to smooth the gonial notches which exist in my mandible. They have never bothered me too much so I opted not to for now, I may try some filler first and then if I like it remove them later. I'm only 24 hours post-op so I have a considerable amount of swelling, making the chin look a little fatter and more puffy, which is more obvious from the front. Anyway, here's a pic of my profile at 1 day out. I'll add more images as the swelling resolves.
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^Great, you must be glad. It will be interestin to see your progress in teh upcoming weeks.
Also I actually think those notches on your jawlines look pretty good. Just my opinion I don't think you should get surgery on them but trying fillers is a good idea.
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Thanks! I actually quite like them too, they give the jaw a more natural shape. I'm glad I didn't go ahead with it, and I can always do it later when the swelling has resolved, if needs be.
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Did he say the reason he couldn't advance it more?
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I was actually 9mm recessed, so we could have gone forward another 2mm. However, I did not want to create a deep mento-labial fold. When we discussed this, I did say that I'd rather be left slightly recessed than end up with a pointy chin.
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Have you got any pics from the front?
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It's quite swollen from the front (I only had the surgery yesterday). I'll upload more images from different angles in a couple of weeks, when the swelling settles.
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Okay, so I'm in desperate need of a shave now, but I'm worried I might displace my chin. To those of you who've had a genioplasty or jaw surgery, how long did you have to wait before shaving? Also, if you have any tips or work arounds, I'd be glad to hear them. Thanks!
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If anything you should have grown a beard to hide the swelling(That's what I'm planning) or does your work require you to be clean shaven? Also how's the pain at this point? I would imagine that's a bigger issue for shaving than displacing your chin.
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The pain is absolutely fine. I was in pain when I first woke up from the surgery, but they gave me a little morphine and that seemed to do the trick. I've also been taking tremadol since leaving the hospital and haven't been in any pain since, my chin is just really fat and puffy from the swelling. The swelling seems to keep getting a little worse each day, but they did warn me that it would peak on day 3 or 4, so hopefully things will improve from here on in. I won't be returning to work for another week or so, so that's not a worry, it's just that I'm not a massive fan of beards, at least not on my face. Stubble is fine, but it's way beyond that now.
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Okay, so I seriously need a shave and a hair cut (just got off the plane from Santa Barbara), but here are the 2 week post op photos. I know I'm still slightly recessed as I was 9mm off and only opted for a 7mm advancement, but I'm happy enough with it. My lip has also thinned out a bit and I kind of wish I'd also had the paste to smooth out the back of the jaw and remove the genial notches. But Dr Gunson said we can do it at a later date if needed.
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I see the step-off, I think, but that looks like one of those things no one would notice but yourself (or maybe an SO). I haven't seen your before but looks like a great result. Hopefully your lower lip will return in time. Any numbness or tightness?
Off topic, but is that bridge height more in line with what you thought I should have had? Personally I feel like my face is so recessed that a 'strong' nose with a dorsum and radix like that would almost leave me where I started. Your lower face half allows that nose to 'fit in'. But anyway, don't mean to derail your thread here..
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Your result looks good and I wouldn't worry about paste for any notches. I don't see anything.
I will say though that I was thinking another 2-3 mm would have been perfect, and reading that Gunson recommended 9mm and you did 7mm, I would advise anybody else to trust him 100% if having surgery with ihim. I'd like to have seen 9mm to 10mm in your case.
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@ditterbo: I've not really had any numbness, but I know some people can't feel their lower teeth for a short time after... perhaps I got lucky! My lower face still feels a little tight and I have trouble saying 'thanks' (so I'm going with 'thank you' for now), the 's' at the end just comes out at as a 'sh'. Dr Gunson said this will return to normal soon. Regarding the nose, I prefer higher bridges, especially on men, and I wanted a nose which would suit my face as I aged. I think a lower bridge can look good on some younger guys, if they've got other pretty features, but I'm not so sure the look works as we age. Hey, that's just my opinion and I guess we all have different preferences.
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@kjohnt: I think another few mm would have improved the profile, but I was scared of ending up with a pointy chin when viewed from the front and a deep mento-labial fold. I just didn't want to chance it, I had a really bad rhino a couple of years ago (which I've had revised now) and I tread a lot more carefully as a result. But sure, Dr Gunson certainly knows what he's doing, he gave me the option and did warn about the possible consequences of a more significant advancement. I can genuinely recommend him to anyone considering a similar surgery.
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Did the genio make your chin wider from the front view?
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I don't think there's been too much change from the front. Here are some images for comparison.
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I don't think there's been too much change from the front. Here are some images for comparison.
You are looking good, but to be honest you already had a good jawline to begin with excluding the chin.
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I don't think there's been too much change from the front. Here are some images for comparison.
The genio has given you such a quality result. Nice sharp defined chin and jawline. You said you reduced the height by a couple mm's, but at the moment it looks longer than the before pic, I presume thats the swelling though.
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Thanks. In the end, we just did a straight forward 7mm advancement, and yeah I do think my chin now looks a little longer from the front... they usually do if the chin isn't also moved up. Moving the chin up would have apparently caused issues with my lips though.
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Was this done without having to add bone grafts between the chin bone and empty space?
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We didn't use any bone grafts. It was a straight forward horizontal advancement with HA paste to smooth out the step off, and also a little paste to prevent the creation of a deep mento-labial fold. This is something which I was quite concerned about, in fact I even went as far as asking Dr Gunson to give me a flat chin, but he explained it would look unnatural and that the chin should have a subtle S curve to it.
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We didn't use any bone grafts. It was a straight forward horizontal advancement with HA paste to smooth out the step off, and also a little paste to prevent the creation of a deep mento-labial fold. This is something which I was quite concerned about, in fact I even went as far as asking Dr Gunson to give me a flat chin, but he explained it would look unnatural and that the chin should have a subtle S curve to it.
Yes, I have no mentolabial fold and it is not good. I want one.
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I don't think there's been too much change from the front. Here are some images for comparison.
Looks friggin amazing man, congrats. Very handsome and masculine jawline and balanced profile. Gunson did a great job. Personally, I want a bit of a pointy exaggerated chin, but yours is completely in line with your face and look fantastic. You should be over the moon.
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Thanks, I'm glad I did it. I just wish I'd done it sooner, before messing with my nose, which is something I'd definitely recommend to anyone considering the two procedures.
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We didn't use any bone grafts. It was a straight forward horizontal advancement with HA paste to smooth out the step off, and also a little paste to prevent the creation of a deep mento-labial fold. This is something which I was quite concerned about, in fact I even went as far as asking Dr Gunson to give me a flat chin, but he explained it would look unnatural and that the chin should have a subtle S curve to it.
And if you got the 9mm's done, would you then have needed bone grafts for the empty space?
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Bone grafts were never discussed, so I suspect not.
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Apparently the osteoblasts will just do their thing and bone will fill up the gap. Dr G just said I need to make sure I don't take a blow to the face in the next six months, and everything should be good.
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Say I did decide I wanted another few mm at a later date, does anyone know if it's possible to do a second genio once the bone has fully healed. Remove the previous screws and slide forward another 3 or 4 mm? I'm just wondering, if the bone fills in the gap, then once you're healed it's like you were born with a larger chin, and then there's nothing to stop you doing it again, and again, and again... in theory. So, theoretically, there's no limit to the advancement that can be achieved with genioplasty, if done in stages? Not that I want several, maybe just a few more mm, but I'm interested if this logic is correct.
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That's the modus operandi with chin wings - 2 are better than one. I don't see why that wouldn't be the case with genioplasty as well. I guess the main question is what such large genioplasties do to the lower lip.
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Say I did decide I wanted another few mm at a later date, does anyone know if it's possible to do a second genio once the bone has fully healed. Remove the previous screws and slide forward another 3 or 4 mm? I'm just wondering, if the bone fills in the gap, then once you're healed it's like you were born with a larger chin, and then there's nothing to stop you doing it again, and again, and again... in theory. So, theoretically, there's no limit to the advancement that can be achieved with genioplasty, if done in stages? Not that I want several, maybe just a few more mm, but I'm interested if this logic is correct.
Yes, you can do multiple Genioplastys before or after the bone has healed
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After you're done healing and you're still thinking about it just try the fillers on your chin to see what it looks like.
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Good to know. I'm happy enough with it, but it is a bit off and it's nice to know that it's at least a possibility. Thanks for all your input.
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One month post op!
Generally very happy, my chin is still off but provided it doesn't get significantly smaller (I think the swelling has gone), I'm going to stick with it. Though I probably will get the gonial notch removed, I never noticed it before but now Dr G pointed it out, it's all I can see.
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Looks great, the gonial notch I think you could get used to over time, if you don't obsess over it. Unless your lower lip was always ahead of your upper, there's probably some swelling remaining.
..I haven't seen enough SG results, but based on that gonial notch, it seems to me as though he moved half your lower jaw forward.. Like as if he did a mini chin wing. That can't be right though? The notch just looks really far back along your jawline in that shot.
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Yeah, my lower lip has always been ahead of my upper. I always had a very full lower lip, in fact, I had lower lip reduction several years ago, which improved it, plus the genio has also moved it in a little more.
The notch is nothing to do with the surgery, the bone was cut far away from this region, it's just the way my jaw grew. And it was always there, it's just that I never thought it was strange until it was pointed out.
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Hi Sjay, can you upload a pic of you before and after showing your genio results. I tried to find the pics you uploaded before but they seem to have disappeared
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I took them down, ha, figured you guys had probably seen enough of me! But I'll put them back, more up to date ones (about 5 weeks post op now).
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Looking good man! I wonder if the results are changing for weeks untill the bones heal, aside from the swelling i mean. Would you say the difference post-op was 'instant'? Again, I know it would be hard to tell due to swelling but still..
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And front...
Yeah, it was instant! It was probably a bit bigger the first couple of weeks due to the swelling, but if I gently touch it now it feels quite firm again. And it looks quite tight, so I think the skin is sitting on the underlying structure now without much swelling... I really don't want to lose any more projection, so I'm hoping it's not going to change much.
To be honest, the swelling really wasn't much of an issue. I could go out in public the day after, and I did. I walked straight through down town santa barbara to Dr G's office, and no one really blinked an eyelid.
I just couldn't pronounce a few words at first, and it was a bit awkward smiling etc, but that's all good now!
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Maybe you're lucky, I've seen cases where people got some major swelling from this surgery. I took a week off from work just to be safe. Mine is coming up in about 6 weeks :P
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Maybe. Hope your surgery goes well, best of luck with it!
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you've got such a solid jaw line. I have to say I'm jealous
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Thanks. It's a definite step in the right direction.
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I bet your confidence level as multiplied 10 times. Have you got any before and after Ceph X-Rays?
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Ha, I wish! I've not got the after ceph. Dr Gunson did take one the day after surgery to check everything was in place, but I never got a look at it. Here's the before, taken back in January, just before I had my braces out. It actually looked better in that ceph than it did in reality, somehow.
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^It's because your head is tilted back more than usual when you take the x-ray which strengthens the chin. I had the same impression after seeing my ceph photos.
Anyway your before and after is looking like a very good improvement so far. It amazes me just how much change can be made with a couple of mm's.
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Thanks. You've got a nice strong and long ramus. It was defo the right decision not to take any height off the chin.
It does look like your head was dilted back, so the ceph looks like your chin is inline with the lowest part of your forehead bone, but with the 7mm advancement your chins probably in the same position with out your head being tilted back