jawsurgeryforums.com
General Category => Functional Surgery Questions => Topic started by: mike888miller on November 02, 2015, 11:06:29 AM
-
Hi
I'm mike. i am looking at bsso with rotation plus sliding genio vs chin wing, in order to move my jaw forward 8mm and up 8mm and in case of the chin wing to also widen the rams by up to 10mm or jaw implants potential as a second step.
i have been consulting with a number of docs in Europe and Korea. my bite is good.
keen to hear any thoughts on the limitation of chin wing vs bsso.
have attached some pics, showing pre and idealised post. i realise that there is fatigued and or excess tissue under the chin, this issue would not improve as much as in the morph, although i would expect there to be more of a noticeable improvement in the case of the bsso.
best
mike
[attachment deleted by admin]
[attachment deleted by admin]
-
bump
-
Your results won't get close to that morph lol.
You need to see a surgeon about this one I think cos your chin looks well projected but there's excess skin, which seems to be a contradiction of sorts.
Liposuction would be a less invasive option, your jaw looks fine but you'd need double jaw surgery i think to make any sort of difference.
-
Chin wing won't do that. And I've seen too many problems with chin wing. Seems unpredictable what result is.
-
Chin wing won't do that. And I've seen too many problems with chin wing. Seems unpredictable what result is.
Could you tell us about these problems?
-
I don't know much about chin wings and their complications but I think a genioplasty would bring you a step closer to the morph. Check out the woman in the picture I have attached; she had a genioplasty and ramal (jaw) implants.
[attachment deleted by admin]
-
I don't know much about chin wings and their complications but I think a genioplasty would bring you a step closer to the morph. Check out the woman in the picture I have attached; she had a genioplasty and ramal (jaw) implants.
I've read, however, that implants in the face feel weird and your body can sometimes reject them so that's something to consider before getting something like this done.
-
thanks for the feedback
@sean - lol you are absolutely right, actually i messed up that morph and went overboard, i attach a better morph, which is based on agreed beauty ideas (7 degrees angle between chin > top of nose > upper lip , i currently have 15 degrees)
@schrodiger - exactly, to achieve this morph i need about 12 to 14mm additional forward projection which is more than chin wing / genio (which is like a more basic chin wing) can do. my bite and facial proportions are fine which is why i am shying away from the bsso.
@aleina - the excess skin is tricky, the genio and implants will improve it a little bit, but to fix it i would need to do a mini facelift which i don't want to do yet, i was told that lipo will not fix it as the issue is excess and flaccid skin as well as muscle.
i am also getting ramal implants. i hope that the combined skin displacement of the geni and implants will help with the saggy skin, kind of like a poor mans facelift.
-
revised morph with less forward projection
[attachment deleted by admin]
-
Could you tell us about these problems?
Result is unpredictable. It is not that predictable how much extra projection you will get. Even if you are told it is. Because of the nature of the procedure.
It can only give limited mm extra projection, not dramatic change like implants can do.
You will not get a sharp angle with the chin wing. Problem is that the ramus won't get longer with it. You don't get nicely defined jaw angles.
Chin often gets longer from front too (but depends upon rotation: when there is more rotation then this does not happen) : some like the longer chin, some not. (I have written it before but a shorter chin is more youthful).
I have seen problems with asymmetry (again: unpredictable). In some results more then in the other, but not predictable.
Unsure how stable the procedure is longterm. How long have the few surgeons that do this been doing this? Longterm studies do not exist as far as I know since the procedure has not been done that long. Other surgeons say that too. Few scans I have seen do not show complete bone growth in gap.
Patient was hit against lower jaw and even after 6 months after the surgery apparently it still shifted. And if it shifts, it is not like an implant a bit out of position but you have a big issue.
-
Result is unpredictable. It is not that predictable how much extra projection you will get. Even if you are told it is. Because of the nature of the procedure.
It can only give limited mm extra projection, not dramatic change like implants can do.
Projection is generally limited to around 1cm forward. This is based on tension created. If the patient needs more a second chin wing can be done after 12 months.
You will not get a sharp angle with the chin wing. Problem is that the ramus won't get longer with it. You don't get nicely defined jaw angles.
This depends entirely on the starting point. Even then, the entire wing can be segmented to create a more defined gonial angle. so it's possible to re-shape the jawline to a degree. It's just it won't take someone with micrognathia and give them a big jaw as there simply isn't the starting point to allow that. Ramus can get longer too because you're dropping mandibular border then grafting the gap.
Chin often gets longer from front too (but depends upon rotation: when there is more rotation then this does not happen) : some like the longer chin, some not. (I have written it before but a shorter chin is more youthful).
Not true. Chin height can be predicted pre-op.
I have seen problems with asymmetry (again: unpredictable). In some results more then in the other, but not predictable.
Asymmetries will only be as much is normal and natural. It isn't an implant, it's real bone which is always going to be asymmetric. Even then, given the wing can be segmented some asymmetries can be controlled for. In fact, that is one use of a chin wing - to correct asymmetries of the jawline when bite is ok. I've seen several patient examples of people with severely asymmetric jawlines on one side of the face be corrected to look totally normal post-op. Predictability is there with the chin wing too since a simple scan will show the asymmetries and can be discussed and planned with surgeon.
Unsure how stable the procedure is longterm. How long have the few surgeons that do this been doing this? Longterm studies do not exist as far as I know since the procedure has not been done that long. Other surgeons say that too. Few scans I have seen do not show complete bone growth in gap.
The procedure is of course stable just like sliding genios because there is no muscular forces on the bone. I haven't spoken to a single surgeon who thought otherwise. Even ones who didn't offer chin wing said it was going to be stable. As for complete bone growth I don't know, at what stage were these scans taken? Bone will grow back stronger than before, gaps should be filled using bone grafting. My own scans show I had perfect healing.
Patient was hit against lower jaw and even after 6 months after the surgery apparently it still shifted. And if it shifts, it is not like an implant a bit out of position but you have a big issue.
Have no idea about this exact case but individuals do heal at different rates. Still, at that stage post-op with any osteotomy the bone will have fused and begun re-modelling. I'm not sure how it could have "shifted" as you say. Especially when it's fixated the way it is. I'd need to see proof of this claim.
-
Projection is generally limited to around 1cm forward. This is based on tension created. If the patient needs more a second chin wing can be done after 12 months.
You did not see me deny you can get a second chinwing. But who would want to go into such a big surgery and plan immediately to get it done two times to have the projection wanted anyway. That also makes it twice the price too and twice post surgery illness and swelling.
This depends entirely on the starting point. Even then, the entire wing can be segmented to create a more defined gonial angle. so it's possible to re-shape the jawline to a degree. It's just it won't take someone with micrognathia and give them a big jaw as there simply isn't the starting point to allow that. Ramus can get longer too because you're dropping mandibular border then grafting the gap.
Not every surgeon that does the chinwing want to segment the wing or does that regularly. Z. said he often feels it is not needed and seems not to do it often. Only for very visible asymmetry he said.
So you are dropping the mandibular border but sliding it forward: with that you are not vertically elongating the ramus and making a sharp jaw angle. It doesn't make a long vertical ramus as you see it in males with sharp jaw angles. It change the angle of the jaw angle and the ramus and steepness of it. Not vertical elongation. Unless surgeon segments mandible border. But read above what Z .said about that and segmenting can also cause stepoffs
Not true. Chin height can be predicted pre-op.
I do not say either that you can not predict a bit if the chin will elongate. I said it can elongate. And this has been complaint at other forum. Since not all surgeons want to say beforehand how many mm change they will give since they say they can only see in surgery what looks good. So it then is not predictable what the change to the height of the chin will be too.
Asymmetries will only be as much is normal and natural. It isn't an implant, it's real bone which is always going to be asymmetric. Even then, given the wing can be segmented some asymmetries can be controlled for. In fact, that is one use of a chin wing - to correct asymmetries of the jawline when bite is ok. I've seen several patient examples of people with severely asymmetric jawlines on one side of the face be corrected to look totally normal post-op. Predictability is there with the chin wing too since a simple scan will show the asymmetries and can be discussed and planned with surgeon.
I read about and saw image of only one patient that had asymmetry corrected but only because the chin wing was done to part of the mandible in paper of A Triaca. Please show me other ones. Never did I see correction of asymmetry when whole mandible got chinwing. I did see several patients here and other that say they have asymmetry after complete chinwing with Zarrinbal. Some very evidently. Look it up yourself. Perhaps you are the Lucky one. Who was your surgeon? Perhaps he does the segmenting. Again, Z. said he hardly does segmenting and that it can only give better outcome if there is big asymmetry, with less big assimetries segmenting can cause new asymmetries.
You can not mold mandibular bone like clay or pretend it has no asymmetries like implant.
The procedure is of course stable just like sliding genios because there is no muscular forces on the bone. I haven't spoken to a single surgeon who thought otherwise. Even ones who didn't offer chin wing said it was going to be stable. As for complete bone growth I don't know, at what stage were these scans taken? Bone will grow back stronger than before, gaps should be filled using bone grafting. My own scans show I had perfect healing.
No muscular force on the mandibular angle and chin? Are u kiddin' me? You might want to read about the masseter muscles amongst it! Strongest muscle in face if not in human body!
Have no idea about this exact case but individuals do heal at different rates. Still, at that stage post-op with any osteotomy the bone will have fused and begun re-modelling. I'm not sure how it could have "shifted" as you say. Especially when it's fixated the way it is. I'd need to see proof of this claim.
This was told to me by the surgeon who does the chinwing himself in consult and that he planned new surgery on patient to correct. That it would require full chin wing again. Why would he make this up? Doesn't make sense to me.
Perhaps you want to read the positives only. If you had good result: cheers to you mate. And is good to hear. Who was your surgeon? We all need good result. But look around also on other forum and it is not Always like that.
-
schrodinger: have you consulted with anyone yet regarding implants?
-
schrodinger: have you consulted with anyone yet regarding implants?
I have consulted for sliding genio, chinwing, implants.
About chinwing I said it can not elongate ramus vertically. I have difficulty explaining in English. Chinwing can elongate the ramus, but not without changing the steepness of the ramus since the lower border of the mandible slides forward. So if the border of the mandible is rotated the ramus is elongated but the steepness is changed too since the mandible border is slid forward. So you never get the sharp vertical shaped jaw angle, and the vertically orientated elongated ramus. The nice long vertical orientated ramus you see in men with strong jaw angle: you won't get it with the chinwing. Unless the mandible border is segmented with the surgery, but as I wrote it, Z. said he hardly does it. Segmenting the border will give stepoffs too and can give more asymmetry if not meticulously done.
Implants have their own negative points. But I do not agree it is the devil as some say. Many people have had implants in one or other place of their body and lived with them for decades. Also face implants. And if there is complication it can be removed and reinserted. Without long recovery, mostly days or week of recovery, often can be done under local anesthesia. The bone cutting surgery is big surgery which asks lot of recovery from the body.
However I would not choose a chin implant (I would not consider it). I would chose sliding genioplasty.
But mandible implants I find most of the time give far better and more predictable result then the chinwing. Infection rate is low. I do not understand why people are so against it here. It can give an artistically far better result. It is more predictable. You can change the outward rotation of the jaw angle, you can change the slope of the jawline. The chinwing by far has not that versatility. Also not when done two times. Unless you would also have the jawline shaved. But still have to find first patient wanting to do that too
But Optimistic has good result from chinwing so it is possible. I have seen a few good results, but also lot of not so remarkable results. The few good results: some had 2 surgeries. The difference was then good, but never as sleek as with jaw angle implants. And that is logical. Someone would have to have perfect foundation, good jawline slope, already good ramus, not too little sideward projection of jawline, outward rotated jaw angles at least a bit from the start, nicely shaped chin (although chin portion can be segmented too but not often done and still surgeon is limited to what you have), and then get a segmented chinwing to really get that masculine jawline with vertical oritentated ramus as very goodlooking of men often have. I still have to see first patient with such basis.
I also saw results that I found not good. I would love to see Optimistic's result and know who did his surgery. As said we all want good result so if I'm wrong, I would not mind, I would want to know. But technically chin wing can not give such artistically molded result as implants. You are not molding the bone, you are changing the shape only in segments and when the chinwing is not segmented only in a big segment that still has same fundamental shape. Whereas with implant you can change entire shape and your basis hardly matters.
-
I will give a more detailed response sometime soon for you all.
What are your thoughts on CT Bone implants by the way? To me these seem like maybe the best yet? Lower infection rate, high degree of boney in-growth, 3d printed. One would think this means there is no change for long-term shifting or infection either, and no chance for it to erode the bone as it is essentially becoming part of the host bone.
-
although i did not follow your points 100pc , i agree fully about what you are saying on ramus, and in fact the chin wing docs (i have met most of them) actually agree fully, the most aggressive of them told me she could do about 1cm widening, which would result in .7cm or so being visible, if you get the biggest of the shelf implants you can get more.
i have not once seen an example of a chin wing that has resulted in the patient having a wider, more masculine jaw. and i have check most of the focums and have specifically asked for this from the doctor.
there is no free lunch in life, if you want a wider, steeper jaw you will have to run the risks that come with having an implant, i think infection rate is around 10pc and that of permanent nerve damage is 5pc. personally it is a risk i am willing to take. i wonder if the doctors give you a discount in case he has to redo the surgery? could he reuse the implants? of the shelf they cost around 700 for the pair so it is not the end of world.
i think the more interesting discussions for us are of the shelf vs custom implants
i see the pro for custom mainly if you want to integrate the chin implant, if you have major asymmetry or extreme requirements.
the negative must clearly the cost, i think it is about 4k difference but do not have many data points, maybe people here have more.
-
morph jaw widening attached . any feedback appreciated
[attachment deleted by admin]
-
morph jaw widening attached . any feedback appreciated
Please don't take this as an insult as it's 110% not my intention...
To me your face looks like someone who is recoiling their head back against the neck. It looks like you'd need double jaw surgery to advance both jaws forward. If this is the case I'd try to get as much advancement as possible (ante face). After this you could look at chin wings and implants to improve jaw angles. I just don't see this working any other way.
-
I have consulted for sliding genio, chinwing, implants.
About chinwing I said it can not elongate ramus vertically. I have difficulty explaining in English. Chinwing can elongate the ramus, but not without changing the steepness of the ramus since the lower border of the mandible slides forward. So if the border of the mandible is rotated the ramus is elongated but the steepness is changed too since the mandible border is slid forward. So you never get the sharp vertical shaped jaw angle, and the vertically orientated elongated ramus. The nice long vertical orientated ramus you see in men with strong jaw angle: you won't get it with the chinwing. Unless the mandible border is segmented with the surgery, but as I wrote it, Z. said he hardly does it. Segmenting the border will give stepoffs too and can give more asymmetry if not meticulously done.
Triaca did exactly this to me. Segmenting and grafting. Result was significant improvement in ramal length and jaw angles. "Step off" existed, however quite natural and similar to any gonial angle in my opinion. Looking on a CT scan it was quit nice, certainly well formed and remodelled. However!!!! This could be my genetics. Maybe I heal well? People complained of step-offs from BSSO with grafting and yet I had a segmented chin wing with perfect healing. Perhaps the results don't replicate so easily?
In any case I just want to say it can be done. The limitations you mention to exist of course. If you want to go forward 1cm then the ramal angle is going to suffer as it's brought forward so much. That would be like 1cm forward, plus segment and 1cm backwards. 2cm total gap. Its too much tension for one surgery. In these instances you can segment a bit, do some bone grafting, see what happens. In such extreme cases then yes I can see a case for implants, but I would still personally advocate getting chin wing first and ramal implants later. To me that would be a good compromise should grafting not work out for you. Especially if CT Bone is used. I like those implants a lot.
Implants have their own negative points. But I do not agree it is the devil as some say. Many people have had implants in one or other place of their body and lived with them for decades. Also face implants. And if there is complication it can be removed and reinserted. Without long recovery, mostly days or week of recovery, often can be done under local anesthesia. The bone cutting surgery is big surgery which asks lot of recovery from the body.
Chin wing recovery certainly sucks like any jaw surgery, but two weeks is not a massive deal. At just a few days post-op I was feeling pretty good. Just made sure I had enough liquid meals to keep me sustained and some nice snacks like pasta, scrambled eggs etc. The point I make here is that I don't feel recovery should be a consideration, only the result. The recovery is not bad enough.
However I would not choose a chin implant (I would not consider it). I would chose sliding genioplasty.
Agree. There is also chin visor osteotomy for labiomental fold. Triaca invented this I think, and it's impressive :)
But mandible implants I find most of the time give far better and more predictable result then the chinwing. Infection rate is low. I do not understand why people are so against it here. It can give an artistically far better result. It is more predictable. You can change the outward rotation of the jaw angle, you can change the slope of the jawline. The chinwing by far has not that versatility. Also not when done two times. Unless you would also have the jawline shaved. But still have to find first patient wanting to do that too
Sure, if it's custom why wouldn't it? The result will be way more predictable. But there are too many disadvantages such as infection, displacement, bone erosion that you simply don't get with a chin wing osteotomy. Furthermore, what predictability do you want with a chin wing? For my operation we discussed changing jaw shape, width, angle, mandibular plane, everything. Because once you are talking about segmenting a wing osteotomy almost anything is possible (within limits no doubt). If I find a before photo I might PM you just to show you the difference. For me it was DRAMATIC. I also believe in Dr Mike Mew. So after 6-12 months post-op if one started chewing hard gum the masseters would enlarge and provide maybe even more width to the face.
But Optimistic has good result from chinwing so it is possible. I have seen a few good results, but also lot of not so remarkable results. The few good results: some had 2 surgeries. The difference was then good, but never as sleek as with jaw angle implants. And that is logical. Someone would have to have perfect foundation, good jawline slope, already good ramus, not too little sideward projection of jawline, outward rotated jaw angles at least a bit from the start, nicely shaped chin (although chin portion can be segmented too but not often done and still surgeon is limited to what you have), and then get a segmented chinwing to really get that masculine jawline with vertical oritentated ramus as very goodlooking of men often have. I still have to see first patient with such basis.
My results are n=1. Not reliable. All I can say is my result was good. My opinion is simply that chin wing depends on starting point. It's an osteotomy that can replace an implant, but if there is a tiny jaw to begin with there is nothing that can be done to make him have a model jawline without implanting. I also believe it's better than a sliding genio because it's more natural to be moving the lower jaw as a mass forward, instead of a tiny bit of bone near the chin. It's why I'd always opt for chin wing and implants over sliding genio and implants.
But yeah, if you have a good starting point chin wing can do something nice.
I also saw results that I found not good. I would love to see Optimistic's result and know who did his surgery. As said we all want good result so if I'm wrong, I would not mind, I would want to know. But technically chin wing can not give such artistically molded result as implants. You are not molding the bone, you are changing the shape only in segments and when the chinwing is not segmented only in a big segment that still has same fundamental shape. Whereas with implant you can change entire shape and your basis hardly matters.
I'll consider the pictures if you are actually considering this as a surgery, otherwise I'm not too interest in voyeurs ;)
Remember though with a chin wing the following is possible:
- Advancement
- Rotation (flatter mandibular plane)
- Segmentation (widening posterior position of mandible for flared jaw angles)
- Bone grafting (to smoothen cuts and add bone to areas around ramus and gonial)
- As jaw is rotated and advanced it'll look bigger already
- chin visor can be done at the same time to improve labiomental fold
- and maybe more I'm forgetting right now
And don't forget all this can be done with your bone healing to "like new" with no infection, a natural result to look and touch.
If you seek perfection you need God or machine ;) Like 3D printed implants (CT Bone). So if you demand "I MUST HAVE THE PERFECT JAWLINE" and your starting point sucks, and you don't care about complications of an implant, maybe chin wing isn't for you. But to my view it's the better option for anyone who needs to alter chin and jaw position without affected occlusion.
I don't want to sound like I work for someone as I learned surgeons pay people to post crap on forums, but just to say if you haven't read his studies they explain a lot. If you don't find let me know I think I have some saved still.
I've now had a second chin wing - waiting on result. The ramal angle is always a concern and if it's still a problem maybe I'll do implants too. After my first one it was ok, but not "perfect" for reasons I explained above and tension. Looking at my face however, not a scan, nobody would say I had a steep angle. But again, I think I had a good starting point. Chin was recessed but jaw and ramus were never that bad. Quite decent really.
-
opti -
how much advancement, angle reduction and widening did dr t achieve for you.
which pic are you referring to? i appreciate the feedback, we re all here for an honest exchange of knowledge, fake flattery would do harm, so thx again.
i did try to keep my head parallel so that the foto would not be flattered by kyphotic i.e. forward head posture.
-
opti -
how much advancement, angle reduction and widening did dr t achieve for you.
which pic are you referring to? i appreciate the feedback, we re all here for an honest exchange of knowledge, fake flattery would do harm, so thx again.
i did try to keep my head parallel so that the foto would not be flattered by kyphotic i.e. forward head posture.
I refer to the pictures of you in profile. Face seems flat.
The surgeon is total s**t and a con man who photoshops his results, but look up Prof Sailer to see what I mean. I think you would need to advance both jaws as far forward as possible to get the look you want.
If you didn't move the upper jaw forward I'm not sure you'd get much advancement of the mandible, and consequently still have loose skin etc. Futhermore, bimax surgery could open up airways more.
As for my surgery I can't tell you specifics as I've had a repeat operation. I'm currently recovering so couldn't provide meaningful photos. My first op I can say dropdown was pretty significant and jaw angles improved a lot. Chin advanced about 1cm. I'll privately send photos if you are interested when I'm feeling better.
-
better yet google sailer and scam - the guy has set up a foundation for african cleft victims, out then he pays himself massive consulting fees etc out of that fund. he also charges 50k for a bsso. having said all that, i fully agree with his ante face aesthetic approach, like his after pics, respect the fact that he is one of the small number of docs in europe that are comfortable with implants and bs, has a lot of experience and is referenced by peers, but i just don't have that kind of cash.
what did you mean with drop down?
-
this is my x ray of the airway passage, seems like there is enough space?
[attachment deleted by admin]
-
@schrodinger
Now you make me real curious about the chin wing. I am especially interested in these augments as you put it:
- Segmentation (widening posterior position of mandible for flared jaw angles)
- Bone grafting (to smoothen cuts and add bone to areas around ramus and gonial)
But for this kind of augmentation, can the results really rival implants?
-
Bump
As chin wing makes the ramus angle more obtuse, would it be possible to get a chin wing and then ramus implants for a complete jawline?
-
That is what I find most dissatisfactory about the chin wing (I called it banana shaped jaw angles, which they seem to me: they are not sharp). Also the jawline seems almost shortened horizontally in most results I've seen, but that must just appear that way visually. Since in most cases the jawline/wing is not horizontally shortened (some cases left out, Brusco wrote a paper about that): it just moves forward making the jaw angle obtuse as you said.
But I want to see more chin wings with more surgeons since I still like the idea of it and I hope different surgeons have very different results. It's just a pity that most results I've seen thus far are disappointing :-\.
The goal seems to defeat the purpose if you still take jaw implants later. Then you might as well get a genioplasty with jaw implants that give drop down. I'm considering going the genio route too.
I've seen results that indicate that widening is possible, the implants would only be to make the ramus angle more sharp and not to replace the chin wing procedure.
Here are some Chin Wing results, what do you think?
http://www.pyramide.ch/KlinikPyramide.CorporateWebsite/media/PyramideCorporate/PDFs/Centers/ZKG/Journal_fuer_Aesthetische_Chirurgie_Januar_2011_Triaca.pdf
-
I'm interested in Chin Wing because my mandible could be moved further forward, widened and my ramus is a bit short as well. I thought I could do it in one go, with my own bone since I still have a decent foundation so to speak.
I'll take pictures and ask for advice I think, just gotta buy a camera