jawsurgeryforums.com
General Category => Functional Surgery Questions => Topic started by: chinnychinchin on May 28, 2014, 12:36:01 PM
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So I wanted to reward myself after having donated a kidney. I have an overbite due to an underdeveloped jaw which is why my profile is so unbalanced. I also wouldn't mind some height. I've been researching ever so fiercely later and I'm torn between a sliding genioplasty and a chin implant. I want something that looks the most natural. Also, I'm somehow able to position my lower jaw forward if I needed to, but I can also recess my chin quite a bit if I want my back teeth touching. I've attached both images of how I can position my lower jaw which can have quite a dramatic difference in appearance. So what do you guys recommend? I live in the Los Angeles area and would also like some recommendations, thanks :D This will be first surgery
Pics: http://s1295.photobucket.com/user/laundrysheet/library/Chinny%20Chin%20Chin (http://s1295.photobucket.com/user/laundrysheet/library/Chinny%20Chin%20Chin)
Password: jayleno
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Your mandible is underdeveloped and you have no chin. You will probably need BSSO and a genioplasty. You should see Arnett and Gunson for their opinion.
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Doing cosmetic surgery on the chin alone would be insane in your case.
Your lower jaw is severely recessed (possibly microgenia even?) and needs to be treated with some sort of BSSO / DO / grafts.
Nah, he doesn't have microgenia, he just has a severely recessed jaw. You're right about the surgery he needs though.
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Thank you guys for the responses, I guess it is severely recessed! Other than Arnett & Gunson, anyone else? I want to get a few consultations in from different doctors before deciding. I've also been hearing good things about are Dr. Schendel in Pacific Palisades and Dr. Mendel in Santa Ana.
Regarding the BSSO, how much do surgeries like this typically cost, and does insurance usually cover this type of procedure?
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Thanks for the info kizarq. It sounds like a long process. I've had braces for about 4 years when I was younger, do you think that will affect this? I don't have crowding and have had at least 4 teeth pulled. Also my 4 wisdom teeth have been removed. Do you think a condition like this could be connected to neck pain/aches?
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Thanks for the info kizarq. It sounds like a long process. I've had braces for about 4 years when I was younger, do you think that will affect this? I don't have crowding and have had at least 4 teeth pulled. Also my 4 wisdom teeth have been removed. Do you think a condition like this could be connected to neck pain/aches?
Hey there. Join the club - 4 teeth removed here too. Our profiles are very similar. Do you have a deep bite, too? Your lower face looks short, like mine. FYI, I was recommended a BSSO plus lefort1 with CCW rotation and a downgraft
Poor you, you got f**ked by orthos like a lot of us. You will have to 'undo' your previous ortho work - it will take about a year.
I actually recommend that you go for an implant and a little submental liposuction now, if you can afford it. It will improve your appearance while you wait for surgery, and the healing time is short - 2-3 weeks. I did it and I'm glad I did - it made a huge difference!!!! It really improved my face and confidence a lot. At the surgery you can keep the implant or get it removed and get a genio
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Tiny! Glad I found a "twin". Do I really have to expect 1 year of braces? That'll be extremely frustrating, especially at my age (28). My bite is quite deep, about 1/10" back. Do you have a before/after you can show me, very interested to see your results. Which doctor did you end up going with? Why did you need a CCW rotation? Will consider the chin implant if it really will end up being a year of orthos, wow.
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Hey there. Join the club - 4 teeth removed here too. Our profiles are very similar. Do you have a deep bite, too? Your lower face looks short, like mine. FYI, I was recommended a BSSO plus lefort1 with CCW rotation and a downgraft
Poor you, you got f**ked by orthos like a lot of us. You will have to 'undo' your previous ortho work - it will take about a year.
I actually recommend that you go for an implant and a little submental liposuction now, if you can afford it. It will improve your appearance while you wait for surgery, and the healing time is short - 2-3 weeks. I did it and I'm glad I did - it made a huge difference!!!! It really improved my face and confidence a lot. At the surgery you can keep the implant or get it removed and get a genio
If someone has had a number of extractions what can be done to prevent their face changing over time? Implants?
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Tiny! Glad I found a "twin". Do I really have to expect 1 year of braces? That'll be extremely frustrating, especially at my age (28). My bite is quite deep, about 1/10" back. Do you have a before/after you can show me, very interested to see your results. Which doctor did you end up going with? Why did you need a CCW rotation? Will consider the chin implant if it really will end up being a year of orthos, wow.
It can be faster if you opt for something like wilkodontics.
I don't know why you'd get a chin implant. Your problems go way beyond the realm of mere aesthetics. By the sounds of things there are a number of functional issues to fix. Plus, improving your actual bone structure will help with ageing. Implants also have risk of shifting, infection, rubbing away at the bone vs max fac work which produces more natural results and is by far the safer
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Tiny! Glad I found a "twin". Do I really have to expect 1 year of braces? That'll be extremely frustrating, especially at my age (28). My bite is quite deep, about 1/10" back. Do you have a before/after you can show me, very interested to see your results. Which doctor did you end up going with? Why did you need a CCW rotation? Will consider the chin implant if it really will end up being a year of orthos, wow.
- 1+ year or ortho is standard because you have to undo everything that was done before
- by deep, I mean that your upper teeth cover much of your lower teeth (in the vertical aspect)
- I need CCW because I have a steep plane, and am vertically deficient in mandible and maxilla as well as horizontally deficient in mandible
- i have not had my jaw surgery yet only implant/lipo
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It can be faster if you opt for something like wilkodontics.
I don't know why you'd get a chin implant. Your problems go way beyond the realm of mere aesthetics. By the sounds of things there are a number of functional issues to fix. Plus, improving your actual bone structure will help with ageing. Implants also have risk of shifting, infection, rubbing away at the bone vs max fac work which produces more natural results and is by far the safer
I agree, also every chin implant before and after have come nowhere close to as natural looking as jaw surgery. Also, the more I've researched, the more I've begun to see familiar symptoms that come with a severely recessed jaw such as sleep apnea and how sometimes it's been hard to breathe.
- 1+ year or ortho is standard because you have to undo everything that was done before
- by deep, I mean that your upper teeth cover much of your lower teeth (in the vertical aspect)
- I need CCW because I have a steep plane, and am vertically deficient in mandible and maxilla as well as horizontally deficient in mandible
- i have not had my jaw surgery yet only implant/lipo
I don't think I have a deep bite then. So in terms of ortho, I'm assuming they will be moving my teeth backwards to accommodate the shift in my jaw? I feel like there's not enough teeth in my lower jaw to do that... Do you have your surgery scheduled?
I've booked a consultation for next Wednsday with Dr. Schendel. I've also scheduled one with Arnett & Gunson sometime later next month. Will keep this updated with what they end up saying. Thanks everyone for the info so far, you guys have a been a huge help ;D
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Tiny! Glad I found a "twin". Do I really have to expect 1 year of braces? That'll be extremely frustrating, especially at my age (28). My bite is quite deep, about 1/10" back. Do you have a before/after you can show me, very interested to see your results. Which doctor did you end up going with? Why did you need a CCW rotation? Will consider the chin implant if it really will end up being a year of orthos, wow.
a forum member consulted with a surgeon in the Palo Alto area and apparently he offers bi-max surgery without requiring you to wear braces. He/she wasn't really impressed with his results though.
Here is the thread: http://jawsurgeryforums.com/index.php/topic,3801.msg24898.html (http://jawsurgeryforums.com/index.php/topic,3801.msg24898.html)
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Don't worry about it. Time flies, more so the older you are. I'm 37 and have been in braces for the last 9 months. The time just flew by.
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Yea I agree, been in braces for 8 months and its gone by really quick so far :)
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I actually recommend that you go for an implant and a little submental liposuction now, if you can afford it. It will improve your appearance while you wait for surgery, and the healing time is short - 2-3 weeks. I did it and I'm glad I did - it made a huge difference!!!! It really improved my face and confidence a lot. At the surgery you can keep the implant or get it removed and get a genio
That sounds quite tempting to me, too.
I've been going over millions of things in my head over recent months. I've spoke to a few orthos, but I guess I really need to speak to a maxofacial surgeon or someone next to help me get things clear in my head.
I'm sure that the ideal operation for me would be orthagnathic surgery. I have a deep bite, too.
However, I think I could get a some aesthetic improvement from submental lipo and possibly a small pre-jowel implant?
(I think I have small jaws, small chin, and the combination makes my face looks heavy and shapeless, as ther's not enough suipport for the underlying tissue)
Here's just a guess at how lipo may help me:
[attachment deleted by admin]
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1. Getting implants now while he waits could work if he has money coming out the ears. If not it'll be a huge waste because he will probably need bi max or something. ABSOLUTELY ZERO CHANCE all he will need is a sliding genio lol!
2. To the guy above me: Your face looks chubby. What is your bodyfat percentage? Try getting much lower before considering surgery
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It rarely makes sense to drop your body fat percentage unless you plan on keeping it there! I personally would never screw with your weight and/or percentage of body fat unless you think the changes will be sustainable.
Good luck with everything!
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2. To the guy above me: Your face looks chubby. What is your bodyfat percentage? Try getting much lower before considering surgery
That's the problem, and why I know that my issue is skeletal (small/rescessed jaws and chin making face look undefined and chubby)
I don't know what it is at the moment, but about 2 years ago when I was trying to get to the bottom of why my face looks fat, I got my body fat down to an extremely low percentage through HIIT, weightlifting, very strict diet etc. I had was left with a Very visible 6-pack.
Pretty much NO CHANGE in my facial appearance, though.
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That's the problem, and why I know that my issue is skeletal (small/rescessed jaws and chin making face look undefined and chubby)
I don't know what it is at the moment, but about 2 years ago when I was trying to get to the bottom of why my face looks fat, I got my body fat down to an extremely low percentage through HIIT, weightlifting, very strict diet etc. I had was left with a Very visible 6-pack.
Pretty much NO CHANGE in my facial appearance, though.
Well at least you've tried that you can discount weight as an issue. However having a chubby face doesn't mean you have skeletal issues. You could simply be holding a lot of fat there which should improve with age.
To be honest nothing about your face strikes me as being particularly off.
You could always consider buccal fat removal, as risky as it is.
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It rarely makes sense to drop your body fat percentage unless you plan on keeping it there! I personally would never screw with your weight and/or percentage of body fat unless you think the changes will be sustainable.
Good luck with everything!
This is true.
However, as a male I find it hard to understand why anyone would wish to be above about 12% body fat ;D
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Well at least you've tried that you can discount weight as an issue. However having a chubby face doesn't mean you have skeletal issues. You could simply be holding a lot of fat there which should improve with age.
To be honest nothing about your face strikes me as being particularly off.
You could always consider buccal fat removal, as risky as it is.
Yes, I guess the fat issue could potentially improve with age, although i'm not confident, and I don't really want to wait until i'm old to feel happy in my skin.
The orthos I saw confirmed that I did have a slightly recessed lower jaw - although both suggested that it wasn't severe enough to warrant jaw surgery and advised against it. Also a deep bite with a unilateral crossbite
From head on, my face looks a little jowely/heavy to me. Mouth looks downpointed and maybe a little 'sad'.When I give myself a 'facelift' by pulling the skin around my cheeks upwards, I look so much better. My chin and cheek look defined and I look normal.
I don't know what operation (other than a facelift!) could mimic that sort of result, though! ?
I can't wait to speak to an expert in facial matters. I've realised it's a bit of a waste of time talking to orthos about anything other than straight teeth. (at least here in the UK)
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This is true.
However, as a male I find it hard to understand why anyone would wish to be above about 12% body fat ;D
I have no idea what my bf is at the moment but my bodyfat is always fairly constant and I guess relatively low. Here's a pic to give an idea.
[attachment deleted by admin]
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I've noticed that people with recessed jaws (or jaws that don't project equally forward) tend to have the appearance of a puffy face. The skin actually just covers the convex contours of the bones often with very little more subcutaneous fat than average; but the convexity is perceived as a pad of fat.
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Post a ceph / X-Ray.
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Got a consultation with Dr. Jacobson, pretty hefty price for a consultation ($600) but I got a complete head scan that lasted over 2 minutes and I go back in a week to get a proper diagnosis. There's a lot of symptoms that they brought up that tie in closely to what I've been experiencing. Tiredness, neck pain, breathing problems, this definitely seems to be a problem that is more medical in nature. I also got a million pictures taken for insurance, I'm hoping that it will cover most of the costs. What are your guys' experience with insurance and this procedure?
I also have a consultation with Arnett in a few weeks, if I bring the report/scans from Schendel/Jacobson, I'm assuming they will be able to use them without me having to do another pricey consultation?
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It looks about 1 centimeter recessed, OP.
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Alright guys, would love to get some input on this.
Got a follow up to my consultation w/ Dr. Schendel and Dr. Jacobsen and just like you guys said, they recommended a BSSO but also with a genioplasty which will give me 1cm. I would also need braces on my lower teeth for 5-7 months before the surgery as well as braces a few months after the surgery.
Costs
- Ortho: $8k
- Surgery: $19k
- Total: $27k
Is this cost unreasonable or typical? Doesn't look like insurance can cover a lot since nothing is severe from a health standpoint unless someone can provide some recommendations regarding this? I also have mild sleep apnea it appears from a smaller airway, but also nothing severe. I plan on consulting with Dr. Gunson as well but what is your guys' take on this?
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ccc, do you have a dental overjet? By that I mean do you have an overbite, or do they need to create an overbite with braces? Mommaerts told me in my case I would first need lower bicuspid extractions and then a BSSO.
Do you have any x-rays?
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I have an overbite and they didn't mention that I would need to extract any teeth. The ortho will be used to create more of an overbite actually so that the bite will fit when my lower jaw is extended. Here are my xrays:
(http://i.imgur.com/TtbmoiN.jpg)
(http://i.imgur.com/8FcPb7A.jpg)
(http://i.imgur.com/RvSIans.jpg)
What do you guys make of them? :)
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I had my overbite opened too for surgery. My last ortho flared my teeth forward to cover up the remainder of my overbite and they just opened that back up to see how big it was. Are you only having lower?
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Wow. Your X ray looks SO much better than your pictures. Your lower teeth are a bit flared and your plane is quite steep, but apart from that your bite doesn't look too bad at all. At least, the vertical growth of the ramus is excellent
In your case, it's clear made a lot worse by the fact that you carry a lot of far under your chin. So whatever else you do, you might want to consider lipo for that area
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Plane looks to be upper limit of normal. I had the same first thought, the X-rays don't look half bad. Kind of the same features as my X-ray: strong ramus, steeper plane, and mental deficiency.
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Looking again I wonder if both jaws are somewhat retruded which might explain why we were misled. The relative relationship between jaws looks quite good. Also I notice how straight the C-spine is (cervical kyphosis). This can accentuate any double chin appearance.
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Looking again I wonder if both jaws are somewhat retruded which might explain why we were misled. The relative relationship between jaws looks quite good. Also I notice how straight the C-spine is (cervical kyphosis). This can accentuate any double chin appearance.
Yes, the head posture is very 'backward' and it's making the chin look worse than it is
I think both jaws are a bit retruded, but the bite looks good. You could get bimax advancement with a bit of rotation, small advancement of the maxilla (~3mm) (+maybe a tiny bit of impaction?) and larger advancement of the mandible (~7mm) but I also think you would get a really decent result from a genio and under-chin lipo. I also carried a lot of fat under the chin - even as a 90lb 15 year old I had a bad double chin. I got lipo and the result was amazing so consider it, especially as you bite is decent. Depends how bad your functional issues are. You are lucky in that you wouldn't need braces for very long, and in your case the surgical path looks pretty straightforward.
I don't think a BSSO alone is a good move because I can't see how they will create a big enough overjet to move the jaw much without doing extractions. I have a much bigger skeletal overjet and I was told the most I could get through BSSO alone was a 6mm advancement. For you it would be about 3mm, 4mm at a max - you might as well do a genio.
As for lifting the cheeks, the options are
1) cheek (midface) lift with endotine
2) cheekbone augmentation with HA or implants
3) cheekbone augmentation with deeply placed, dense filler (e.g. radiesse, perfetha subskin)
4) Korean V-lift (results last about 2 years)
5) reduction of buccal fat and/or microliposuction around the lower face
Early sagging of the cheeks is common when there is less bony support
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Thanks for all the responses! I'm happy to hear that my situation isn't as severe as originally thought, although from my consultation with Schendel/Jacobson they did mention that my case was severe, but not pretty severe. I will be doing a consultation with Gunson and another doctor in the next few weeks to see what they have to say.
I had my overbite opened too for surgery. My last ortho flared my teeth forward to cover up the remainder of my overbite and they just opened that back up to see how big it was. Are you only having lower?
Yep, only lower jaw.
Wow. Your X ray looks SO much better than your pictures. Your lower teeth are a bit flared and your plane is quite steep, but apart from that your bite doesn't look too bad at all. At least, the vertical growth of the ramus is excellent
In your case, it's clear made a lot worse by the fact that you carry a lot of far under your chin. So whatever else you do, you might want to consider lipo for that area
:D Yep, the ortho will actually be used to address the flare. Is steep plane angle bad? What are its implications?
Plane looks to be upper limit of normal. I had the same first thought, the X-rays don't look half bad. Kind of the same features as my X-ray: strong ramus, steeper plane, and mental deficiency. Looking again I wonder if both jaws are somewhat retruded which might explain why we were misled. The relative relationship between jaws looks quite good. Also I notice how straight the C-spine is (cervical kyphosis). This can accentuate any double chin appearance.
Did you already have surgery? Would love to glance at your before/after xrays to compare! Jacobson mentioned that my upper jaw did not need any advancement or it might not look good aesthetically.
Yes, the head posture is very 'backward' and it's making the chin look worse than it is
I think both jaws are a bit retruded, but the bite looks good. You could get bimax advancement with a bit of rotation, small advancement of the maxilla (~3mm) (+maybe a tiny bit of impaction?) and larger advancement of the mandible (~7mm) but I also think you would get a really decent result from a genio and under-chin lipo. I also carried a lot of fat under the chin - even as a 90lb 15 year old I had a bad double chin. I got lipo and the result was amazing so consider it, especially as you bite is decent. Depends how bad your functional issues are. You are lucky in that you wouldn't need braces for very long, and in your case the surgical path looks pretty straightforward.
I don't think a BSSO alone is a good move because I can't see how they will create a big enough overjet to move the jaw much without doing extractions. I have a much bigger skeletal overjet and I was told the most I could get through BSSO alone was a 6mm advancement. For you it would be about 3mm, 4mm at a max - you might as well do a genio.
As for lifting the cheeks, the options are
1) cheek (midface) lift with endotine
2) cheekbone augmentation with HA or implants
3) cheekbone augmentation with deeply placed, dense filler (e.g. radiesse, perfetha subskin)
4) Korean V-lift (results last about 2 years)
5) reduction of buccal fat and/or microliposuction around the lower face
Early sagging of the cheeks is common when there is less bony support
I think my bite looks decent because I was in a neutral position. When I actually bite however, my lower mandible recedes back so that the molars can get in contact (as seen in first pic). The recommendation for my procedure was a BSSO + genio which will give me a 1 cm advancement. I've been making a serious effort lately to get my bodyfat down so hopefully this will allow me to avoid lipo but that's great to hear that you had success with it. Not sure about the lifting of cheek as I'm not looking to address that.
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The recommendation for my procedure was a BSSO + genio which will give me a 1 cm advancement. I've been making a serious effort lately to get my bodyfat down so hopefully this will allow me to avoid lipo but that's great to hear that you had success with it. Not sure about the lifting of cheek as I'm not looking to address that.
1cm sounds about right for you
IMHO your cheeks look fine, just mentioned options as you said it bothered you!
If you're genetically predisposed to carry fat under the chin then dieting will not shift it. As I said, I had a huge fat chin even when I was super skiny. The recovery from lipo was not that big of a deal and the result was excellent
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Since few month i’m planning to get rid of saggy skin which makes me look older than i’m. A friend of mine has advised to consult a cosmetic surgeon ( http://www.plasticsurgeryto.ca/cosmetic-surgery/facial-cosmetic-plastic-surgery/double-chin-removal/ ) of Toronto for double chin
removal surgery in Richmond hill. Does anyone have any experience who has undergone the chin surgery ? Can anyone help me out to guide me on how such surgeries are undertaken. Any suggestions and advises would be appreciated. Thanks in advance
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I consulted Dr Li as well. He's a popular choice on the FB group right now. One had a 20mm bimax advancement even. Other than the pig nose comment from pictures, I haven't heard of any unhappy patients other than a few relapses which will happen with all surgeons. All the people I met who had the arch bars recommended getting braces instead. He does CCW rotations but only in cases that need it. The Stanford orthodontist reportedly gets the best results by far from him. It's hard to tell with pictures because you can't eliminate patient bias. That is, patients with long faces have different possible outcomes than patients who simply lack forward growth. The latter is more likely to produce pig noses.
When it comes to jaw surgery, there's really only three relevant certifications (in that order): oral surgery, plastic surgery, and ENT. Plastic surgery is nice because they have to go through medical school first so can handle more kinds of problems and receive greater training in aesthetics. Oculoplastic would be even better but I have yet to see one. I don't think ENT training adds much in practice. When it comes to jaw surgery, only a small percentage of each of these certifications will actually be relevant of course. We're not getting boob jobs here.
There's plenty of surgeons around who are trained as oral surgeons and plastic surgeons. One such name I've stumbled upon recently is Dr Moloro in Chicago, for anyone in the area. He hasn't done too many surgeries just for sleep apnea but he's done thousands of jaw surgeries and has edited a few textbooks.