jawsurgeryforums.com
General Category => Functional Surgery Questions => Topic started by: needadvancement on November 11, 2014, 11:05:06 AM
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Hey there, I posted here before but I got some x-rays after my orthodontist visit. Basicely my problems are aesthetic(I nose breathe, chew, sleep etc. normally. only some crowding on my lower palate thats difficult to clean but that's all) my issues are with my protruding mouth and my short nonexistent chin. I was told that my jaw is a bit recessed both upper and lower are narrow which I'm confused by. Maybe my width is all due to the muscles attached to the jaw?
here's some pictures of the outside look:
https://imgur.com/a/dy0J9#0
and the x-rays and teeth:
https://imgur.com/a/jjB1Q#0
never realised how prominent my brow ridge is and thats what makes my mandible look even more recessed. am I correct in this?
Anyway they told me that they are gonna be able to fix the look of my mouth without extractions(a relief for me). I am thinking about getting a sliding genioplasty after that in the future. I was told here that a SG would not work for me though because I have a deep m. fold above the chin already. I am not sure what the effects would be if I did get a SG but with mostly lengthening and some projection. That's the most invasive surgery I'm willing to get, I don't wanna do a whole jaw surgery+2years braces type of thing, I don't seem to have functional problems associated with recessed jaws. I just want a chin..
So what would be your advice, and also more comments on the x-rays and the rest of my face development would be interesting too. I'd appriciate it.
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Your case is very difficult.
Hip graft or distraction of the alveolar crest isn't suitable for you, nor is BSSO. Fillers are more suitable, but are expensive and temporary.
You need to address both the sublabial fold and chin at the same time.
As far as I can see, your best option is a custom made chin implant. Second best option is an osteotomised chin advancement/chin implant with an implant for sublabial fold. I don't think you can avoid implants because your sublabial fold is quite severe and autologous solutions are probably inadequate.
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Your case is very difficult.
Hip graft or distraction of the alveolar crest isn't suitable for you, nor is BSSO. Fillers are more suitable, but are expensive and temporary.
You need to address both the sublabial fold and chin at the same time.
As far as I can see, your best option is a custom made chin implant. Second best option is an osteotomised chin advancement/chin implant with an implant for sublabial fold. I don't think you can avoid implants because your sublabial fold is quite severe and autologous solutions are probably inadequate.
What about "chin visor"?
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What about "chin visor"?
Yeah, I forgot about that. Good shout.
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^I can't find anything on google, or actually the chin wing surgery comes up for that term. Could you elaborate on chin visor?
Your case is very difficult.
Hip graft or distraction of the alveolar crest isn't suitable for you, nor is BSSO. Fillers are more suitable, but are expensive and temporary.
You need to address both the sublabial fold and chin at the same time.
As far as I can see, your best option is a custom made chin implant. Second best option is an osteotomised chin advancement/chin implant with an implant for sublabial fold. I don't think you can avoid implants because your sublabial fold is quite severe and autologous solutions are probably inadequate.
I see, kind of what I was dreading. The thing with implants is what I've read about the risks and how it can move/damage and I have a certain lifestyle where I worry that things could go wrong there. That's why I like the idea of sliding genio since eventually I'll have my own bone grow and form a new chin.
I'm just wondering, I still don't quite understand about the sublabial fold and the effects of it after an augmentation. Would it look terrible or is it a functional thing?
Thanks.
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^I can't find anything on google, or actually the chin wing surgery comes up for that term. Could you elaborate on chin visor?
I see, kind of what I was dreading. The thing with implants is what I've read about the risks and how it can move/damage and I have a certain lifestyle where I worry that things could go wrong there. That's why I like the idea of sliding genio since eventually I'll have my own bone grow and form a new chin.
I'm just wondering, I still don't quite understand about the sublabial fold and the effects of it after an augmentation. Would it look terrible or is it a functional thing?
Thanks.
I don't know much on chin visor, but it would address your fold, which needs addressing because of aesthetics not function. Any more chin advancement would look terrible imo, especially when smiling.
I saw a guy who had surgery in Italy on lookyourbestuk forum and had genio with sublabial implant and looked very good. Implants in the chin area are supposed to be more immovable than jaw implants fwihh.
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I've read that with this fold, a SG would not make it worse if most of the advancement is done vertically (and I need downward chin length a lot more than forward projection imo) is this accurate?
Also I've been looking on google but can't really find it, I'm curious to see if there are photos of people who have a very deep fold and possibly worsened ones after sugery, would be very helpful if someone could find and post any.
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Chin visor is described here:
http://www.pyramide.ch/KlinikPyramide.CorporateWebsite/media/PyramideCorporate/PDFs/Centers/ZKG/Journal_fuer_Aesthetische_Chirurgie_Januar_2013_Brusco.pdf
AFAIR, you had camouflage orthodontics (upper jaw extractions) to fix an overbite when you were younger? IMO, then get jaw surgery and get it over and done with. I've seen cases like yours online and in real life - squarish face with an overbite and a very horizontally long but vertically short chin. As if nature is trying to compensate for a short mandible. The whole process won't take 2 years, probably 18 months at the very most. And that time will fly whatever you do. Look for orthos using Suresmile. Supposedly it cuts down treatment time dramatically. But of course prefer a competent ortho first and foremost.
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@plosko:
I am counting two premolars in his upper arch. what makes you say he had extractions ?
@OP
You need CW Rotation Advancement (Bimax). Read this:
Low occlusal plane - brachycephalic patients
http://www.scielo.br/scielo.php?script=sci_arttext&pid=S2176-94512012000400028
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@plosko:
I am counting two premolars in his upper arch. what makes you say he had extractions ?
You're right, I confused him with someone else.
@OP
You need CW Rotation Advancement (Bimax). Read this:
Low occlusal plane - brachycephalic patients
http://www.scielo.br/scielo.php?script=sci_arttext&pid=S2176-94512012000400028
Right again.
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Yes I did not have any extractions except for the two lower wisdom teeth last year which was necessary.
@plosko:
I am counting two premolars in his upper arch. what makes you say he had extractions ?
@OP
You need CW Rotation Advancement (Bimax). Read this:
Low occlusal plane - brachycephalic patients
http://www.scielo.br/scielo.php?script=sci_arttext&pid=S2176-94512012000400028
Thanks, I've read it but I don't have al the knowledge you guys have yet so I don't quite understand, it seems the patient in the photos had a chin too prominent and got it fixed, doesn't seem to be like my case..Could you elaborate more on what you posted please?
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it seems the patient in the photos had a chin too prominent and got it fixed, doesn't seem to be like my case..Could you elaborate more on what you posted please?
you also have a chin that is too prominent, it is just masked because of the backwards (class 2) lower jaw.
the important thing are the occlusal and mandibular plane angles, which are flat (both you and the girl). that's why you need clockwise rotation of the entire complex, simply advancing your lower jaw would make you look like that girl preop.
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you also have a chin that is too prominent, it is just masked because of the backwards (class 2) lower jaw.
the important thing are the occlusal and mandibular plane angles, which are flat (both you and the girl). that's why you need clockwise rotation of the entire complex, simply advancing your lower jaw would make you look like that girl preop.
I think I see what you're saying now. However, would this adress the severe lack of chin height though? The girl already had adequate chin height before(imo) so seems like they had enough to work with already.
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I found some pictures of people with similar issues and they had a SG and it looks quite good imo.
(http://s4.postimg.org/s23mr8dd9/lgp_1.jpg)
This guy was very similar to me, the short prominent chin with the deep fold and a broad jaw. The results he got look amazing(the page doesn't mention other surgeries so I'm assuming this is all from a SG), his fold seems to have decreased and the transition from chin to the rest of the mandible looks natural. So can it be true what I said before, that a genioplasty could work on me if the majority of the movement is done vertically?
Theres some more on this page(warning-graphic pictures)
http://www.lovethatface.com/cosmetic-facial-surgery-richmond-va/lower-facial-procedures/chin-surgery-lower-facial-implants/
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^ That guy's nose and lips look different. Are you quite sure he didn't have upper jaw work? Looks like it's been advanced.
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^I am not sure, I'm just going by what the page of the website is saying. I think his mouth looks the same on the side shot, but the picture below where you see the front I think he may be jutting his jaw down a little bit to make his chin look even longer. Don't some surgeons use this sort of minor optical illusion to enhance the results a tad bit more?
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Also I forgot to ask, I have a cleft chin and ideally I'd want it gone, would these chin augmentations get rid of it? It's not that big of a deal but it'd cool if I could kill two birds with one stone.
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I wouldn't get anything done. Maybe you don't have an ideal profile, few people do. I think if anything you have some maxillary prognathism and thick subnasal tissue (if that makes sense). Your profile reminds me of my own in some ways (we also both have prominent brow ridge, though we have very different issues (I have steep plane and class II jaw relationship).
If you get something done, do a chin visor / wing. You don't have the profile of someone with sleep apnea, with a fairly acute cervicomental angle (this is helped by your predominantly forward growth pattern)
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I wouldn't get anything done. Maybe you don't have an ideal profile, few people do. I think if anything you have some maxillary prognathism and thick subnasal tissue (if that makes sense). Your profile reminds me of my own in some ways (we also both have prominent brow ridge, though we have very different issues (I have steep plane and class II jaw relationship).
If you get something done, do a chin visor / wing. You don't have the profile of someone with sleep apnea, with a fairly acute cervicomental angle (this is helped by your predominantly forward growth pattern)
Do you mean in terms of surgery don't get anything done? Because my orthodontist assured me that the forward growth of the subnasal tissue is caused by my front teeth tipping forward and that it can be improved with braces pulling them in. If I look at my brother who looks a lot like me with mostly the same genetics, he does not have this protrusive looking tissue and I can see from his teeth that his are in a straight line. All of this is what convinced me to get the braces.
You may be right, maybe I won't get any surgeries at all if I'm happy with the results from the braces for my profile(honest, surgery is a scary idea still, so I'm carefully considering it). For years I have felt subconcious about my mouth, I do weird things with it sometimes when I'm out in public like bite on my lips etc. I will update later on how I'm feeling about it.
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I'm no expert by any stretch, but google "cephalogram" and get a feel for what other people's x-rays look like. I would say your upper incisors appear well within normal limits. If anything, I think people look worse with their upper teeth pulled back... You can end up with a nose hump and increase in your nasolabial angle. In fact I think you might even end up with a MORE prominent nose. Allow the others to weigh in on this.
If I were you I would NOT get braces for the purpose of pulling your upper incisors back. They play a role in upper lip support. Perhaps you have an element of maxillary prognathism, but I firmly believe that pulling the teeth back at this stage is to your detriment. We all have different growth patterns and a band-aid fix of one component only is unlikely to lead to satisfactory results.
Again, the above is only my non-expert opinion.
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I wouldn't get anything done. Maybe you don't have an ideal profile, few people do. I think if anything you have some maxillary prognathism and thick subnasal tissue (if that makes sense).
I have to disagree with you on this one. He doesn't have maxillary prognathism, he has an Anteinclination of the Maxilla. This means his Maxilla has basically grown in a CCW Vector where the back is lower than the front which causes upturn of the nose and this illusion of thick subnasal tissue. Right now his dentition compensates for that as his maxillary and mandibular incisors have overerupted to meet regardless.
I know this because I have the exact same thing going on (I will have a slight anterior open bite once fully decompensated). This is a jaw deformity in its own right but it is visually way less offensive than having a hyperdivergent (loooooooong) face.
In addition to that he has mandibular anterior-posterior deficiency for which he needs a BSSO of the mandible.
And lastly his chin bone hasn't grown downwards because the mandible adapted to the ccw growth vector of his maxilla, so he needs genioplasty as well (moving it back and down).
So, while OP doesn't have the obviously retarded long face mouth breather double chin look, he is just as deformed - medically speaking. A chin wing wouldn't fix even 10% of his issues because his entire lower face is way too short because of his growth pattern - his lower mandibular border is parallel to the floor for god's sake.
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@dantheman. I see, I will make sure to present these questions to my orthodontist the next visit. Braces can surely have an impact on the look of the face, I certainly don't need a trade off where my other features would worsen, but how could it possible create a nose hump at this age? lol.
@notrain. Ok after a lot of googling I think I'm finally starting to understand my facial development and deficiencies. But I'm not sure if it's accurate to desribe it all as complete deformities as I don't have any health problems due to this at all except for some minor crowding in the lower mandibular incisors. In fact my oral posture is near perfect, and indeed my face is quite broad and normal looking from the front, it's just the comically short chin that ruins my face. I would like to hear your opinion on the orthodontic treatments I will persue next year if you can, do you think I can improve the issue of the subnasial tissue with braces? And without risking other issues like dantheman theorised?
Thanks to both.
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Notrain, SNA > 90 degrees. This is prognathism by definition. Yes, ultimately there is a hypodivergent growth pattern but that can just be genetic and by no means is it definitively pathological. I also don't see how one concludes that the incisors are over erupted, as if this were the case his mandibular plane would be steeper and there would be a greater disparity between his mandibular and occlusal planes.
I also was under the impression that upturning of the nose is caused by vertical maxillary excess, or just do to genetics...
Ultimately, I agree that clockwise rotation seems plausible, but unless there are functional issues, why would one pursue this? I'm sure there are many brachycephalic celebrities out there.
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Notrain, SNA > 90 degrees. This is prognathism by definition. Yes, ultimately there is a hypodivergent growth pattern but that can just be genetic and by no means is it definitively pathological. I also don't see how one concludes that the incisors are over erupted, as if this were the case his mandibular plane would be steeper and there would be a greater disparity between his mandibular and occlusal planes.
he does have excessive curve of spee (two plane occlusion) in his lower jaw and the tip of the maxillary incisors is lower than the chewing surface of his molars. I don't want to draw on OPs ceph and post it here without permission. EDIT: you have seen my ceph. I am brachycephalic with a flat mandibular and occlusal plane as well and my mandibular incisors are severely overerupted - as are the upper incisors.
I also was under the impression that upturning of the nose is caused by vertical maxillary excess, or just do to genetics...
If the anterior part of the maxilla is turned upwards, then the nose turns upwards too. It's visible on his ceph (in my opinion)
Ultimately, I agree that clockwise rotation seems plausible, but unless there are functional issues, why would one pursue this? I'm sure there are many brachycephalic celebrities out there.
He came here because he wants to look better. If he wants to accomplish lengthening his lower face, he needs CW rotation. I agree that it is not necessary but who am I to tell people what they should be doing with their money and body ?
@needadvancement
don't get ortho treatment without surgery. it will only worsen your appearance. if you don't want to get jaw surgery, a chin wing is indeed your best bet. but it will not yield close to the same result as bimax cw advancement. i would consult with surgeons and make a decision sometime next year.
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@notrain feel free to do so, you have my permission. Also could you elaborate on how ortho would worsen my appearance? Keep in mind they will not extract any teeth. They're gonna fix the crowding and straighten the rest, I think it's only my incisors where a noticable change could be made. Also I forgot to mention, when I come in in a couple of weeks they have a digital method where they can see the future results on the computer, I think could be very helpful if it's a realistic preview of what the results could be. It's called Insignia.
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nonextraction ortho would be fine. I thought they were going to extract the 4 first premolars in each jaw and pull the rest back. but you should be aware that the aesthetic improvement of moving teeth around is quite small - you will not look much different. especially the chin will not change at all from doing this.
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Well I am counting and hoping on the braces lessening the subnasial protrusion, which in turn would actually make my chin look more prominent. I have actually photoshopped this on pictures of myself several times, and I can safely say this would improve my profile.
Indeed the chin itself won't change, that is why I may consider a SG lengthening in the future. I am really hoping that the plan that I have come up with(ortho+genio) could mask my deficiences and improve my lower half of the face. It would be a great success because again, I do not have any breathing/chewing problems etc. Avoiding an evasive jaw surgery+specific ortho would be my goal.
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I don't want to dissuade you, but I highly doubt you will notice much if any change to your profile with non-extraction orthodontics. Have you gotten a second opinion from another ortho?
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No I haven't, even a consultation is quite pricy at the moment. Well I am not banking on a big change, I realise other people may not notice it but I definitely would notice any change on myself. They say every milimeter on facial features matters, and if I could just get my upperlip pulled back maybe even 2 milimeters it would already be a good change for my lips placement(I would accept that over extractions that do give a major change). I guess this is something I'm doing for myself. I'm definitely going to press this issue at my next visit, I would expect a competent orthodontist to be truthful with me, so he should not get my hopes up either.