jawsurgeryforums.com
General Category => Aesthetics => Topic started by: landscape on June 19, 2018, 01:00:58 AM
-
hello, guys
my small, retruded chin and undefined jaw have bothered for a long time, but only recently i began learning why.
it all started with me feeling tired in the morning. i then suspected it could have to do with my sleep. voila: a polysomnography revealed a light/moderate OSA (mostly hypopnea), which has various causes, of course, one of them being inadequate facial development.
i visited a couple great surgeons, and both agreed orthognathic surgery would give the best aesthetic results. they could not be certain my apnea would be resolved with the procedure but said it would def help.
however, after reading a lot, i felt like orthognathic would perhaps be a bit too radical for me – besides the many risks people here are tired of hearing about, it would demand an amount of time and commitment i'm not sure i have: a year and a half in total, including pre-op orthodontic work. i have slight retrognatism, but my occlusion/overbite was compensated by orthodontic work in the past.
i then began searching for less aggressive alternatives. my current doctor suggested sliding genio as a milder alternative, and after researching some more i came across chin wing osteotomy. both seem somewhat effective for light OSA cases (according to my doc as well as pubmed). dealing with my apnea is important, but optimal aesthetics is probably more important for me at the moment.
based on my pictures, which of the three procedures would you experts recommend? would sliding genio be fine or is chin wing required? more than that, is my case such that orthognathic surgery is the only adequate option?
my insurance is gonna cover all the costs. i chose to have surgery (sliding genio) in two days but can cancel if i decide to go for orthognathic in the end.
i'll have the last meeting with the doc tomorrow and want to suggest chin wing osteotemy and bring some final insights to him, hence my post.
any input would greatly appreciated!
thanks in advance!
[attachment deleted by admin]
-
I'm all for camouflage procedures (genio/chin wing) when possible but in your case I think orthognathic surgery would be by far the best option.
I don't see how a genioplasty/cw could yield satisfactory results. You already have a very deep mentolabial fold; a genioplasty/cw would only worsen that.
Your lower jaw looks more than "slightly" retrognathic. I know the time/commitment of jaw surgery can be dissuading, but I really think it's the only worthwhile option for you.
-
Here's my opinion:
If you wish to 'crowd source' for opinions on message boards,in the act of making a decision for yourself, it's best done before you book a surgery.
Said 'crowd' also includes my opinion, in the event you seek it specifically from the crowd (which I note re; your most recent PM) in any exigency* you have created for yourself this way where your decision appears to be contingent on gathering more opinions.
exigency*: surgery already booked SOON where now contingent you have more opinions to decide to go through with it or not.
-
i agree with you, but it was not my intention to make it seem like i’m in a rush to get more answers.
i was pretty much settled on genio until i started digging further and had the feeling i might be disappointed with the choice.
-
kavan, i reposted the question in the appropriate section and more politely. you may close/delete this thread.
jawguy, thanks a lot for your comment! note taken.
-
Your post is FINE here, where it is. No need to start another.
I've had like 3 emergencies crop up (house hold accidents, repair services to call, computer problems whatever). Just ask that people don't rely on my 'timing' and/or availability to focus on their issues within a time frame where I might not be available to do so.
ETA: duplicate post on other thread deleted because you already got responses to this one and I hesitate to delete threads where others took time to respond.
-
Hard to tell but it looks like both your upper and lower teeth are flared out. Did you have any extractions? I wouldn't do a genio at all in your case first. You should look into jaw surgery first. Your lower lip sits noticeably behind your upper lip. Jaw surgery is supposed to help alleviate sleep apnea and prevent it. Perhaps there's a correlation with effectiveness and the amount of space the bone is moved.
-
Jaw surgery
-
haven, they are indeed somewhat flared out, but my bite has been compensated and is fine.
therefore, i am eligible for orthognathic surgery, but it isn’t strictly necessary.
i never had teeth removed, no. and yes, my lower lip sits behind my upper lip and that bothers me. my doc said genio could help with that slightly, but my expectations are low in that regard.
regarding sleep apnea, you are right orthognathic is more appropriate in this case, but genio and chin wing are said to help as well (various articles on pubmed show the benefits). i would preferably like to avoid the more extreme, orthognathic route, but i discard the possibility if the genio/chin wing result ends up being below my standard.
jawguy: my doc said the genio could help with the mentolabial fold actually; i brought him my concerns but he’s experienced and seems pretty sure.
do you guys think a genio could look weird on my face, considering my features? he said chin wing is too risky a procedure and still advocates my going through with the genio, still leaving the door open for an orthognathic in the future.
-
do you guys think a genio could look weird on my face, considering my features? he said chin wing is too risky a procedure and still advocates my going through with the genio, still leaving the door open for an orthognathic in the future.
Did your surgeon by any chance use software to "simulate" how the genioplasty without jaw would look?
As your doctor points out, a genioplasty now shouldn't preclude you from a jaw surgery later. However, you might end up needing a revision genio if that's the case.
-
yea, he used dolphin imaging. it looked a bit weird, but he said it’s not accurate since it doesn’t take into account how soft tissue will change after surgery, which is a very difficult thing to simulate (muscles will stretch, leading to a subtly more defined jaw and overall contour). the software acts more like smarter, data-fed liquify tool (similar to photoshop’s but surgically precise). he showed me how it works and it is unimpressive. you help it map facial features of a profile xray picture and, after that’s done, you feed it with an actual profile photo, which the application willl stretch based on certain parameters you can set – it has a list of different procedures; you add, say, 4mm to genioplasty and it’ll liquify, accordingly, that point of the map. looks a bit fake... it also doesn’t give you an idea of what the front view could be.
yea, i would need a revision genio if i decide to do an orthognathic surgery later. he said a revision is easier than doing it the first time, tho.
my main concern at this point is whether the genio will make my chin look like it doesn’t belong to my face, since the work will be done on it more or less exclusively, leaving the root causes unchanged… a developed feature in a somewhat undeveloped face, so to say.
-
To be honest, I don't really have good advice for you. I'm really struggling to see how a genioplasty could adequately address your aesthetic concerns, but I'm not a doctor. Obviously the decision is yours.
Also, why would the genio revision be easier than the first time? Wouldn't there be more scar tissue?
-
I don't think a person's lower lip is advanced forward with a genioplasty. I'm not an expert, but someone else can correct me on that. I would think the lower lip would move forward when the mandible is advanced. I know it can alleviate lip incompetence (when the lips don't meet at rest) if the patient has it and wishes to address it.
Perhaps they could do a genioplasty where they add vertical height as well and perhaps use some filler. But I can't imagine them doing anything outside of a conservative movement. What I think the surgeon(s) should tell you is that there are limitations on what it can do based on your anatomy and ultimately what works for YOUR FACE. So you should set realistic expectations for yourself and not expect to come out looking like Brad Pitt ;D
Are you non-white? I ask because I see that type of fold in lots of more ethnic populations (Hispanic, Indian & Black). I see it at the office I work at and even the media (i.e Kendrick Lamar). In person a lot of these people look fine to me, so I can't really compare you to them since we've never met, and I'm not trying to criticize your appearance since I don't have the whole picture to go off of.
-
Your whole lower third seems pretty well (aesthetically) cocked to the right, if that frontal shot is any indication. That's a bimax and rhino thing.
-
In general, we drop 2 vertical lines. One from the upper lip and one from the lower lip.
Drop from upper lip: When the lower lip is behind the drop down line from the upper lip, that's usualy an indicator that the lower jaw is recessive relative to the upper jaw.
Drop from lower lip: When the chin is noticably behind drop down line from lower lip, which is the case with the OP, that's an indicator that the chin, is recessive. The chin need not touch the vertical drop line and is fine if it is 'somewhat' to 'modestly' behind it. That's because in reality the line is a bit angled toward the chin and i'm just trying to give a GENERAL guideline here using simple lines.
In men, it's OK for the chin to get close to the drop down line. In women, it should be somewhat posterior to it.
In general, it's usually 'not OK' to bring the chin PAST the vertical drop from the lower lip in any attempt to COMPENSATE for a recessed mandible. This is particularly so if one LATER decides to have the full 'maxfax' surgery, especially if the surgery is aimed at addressing sleep apnea. That is because, the surgeon, most likely would elect to MAXIMIZE the BSSO advancement. Hence prior over compensation with the chin advancement can interfere (aesthetically) with the surgeons goals to maximize the BSSO.
So, IF genio ONLY, with option LATER down the line to have maxfax surgery, you are better off erring on the side of 'not close enough' to the lower lip vertical drop down line than 'kissing' the line and most certainly NOT advancement past the line.
Also, EVEN IF it looks like ONLY the lower jaw is recessed. Never 'bank' on a single jaw surgery as the upper jaw might have to be displaced to accommodate displacement of the lower jaw whether or not the upper jaw is already in a 'good' to 'ok' aesthetic position.
-
jawguy: i asked him a similar question, but he wanted to make things simple and didn't get into too much detail. since i still had many things to ask, he just said it would be easy to alter the genio advancement in case i decide to go for orthognathic surgery in the future. he's a professor at one of the most renowned universities in the country with a lot of international experience, so he must know a thing or two.
earlier today we met and i brought the subject of chin wing osteotomy up. he said it's a very tricky procedure and not worth the risk of permanently damage the inferior alvelar and mental nerves; that's the main reason it isn't widely accepted and practiced by the scientific community.
haven: it's not that the lower lip will be noticeably advanced, but it seems like moving the chin bone forward subtly affects its position. a mandible advancement is definitely more appropriate for significant changes there.
from what he told me, he'll advance 8mm forward and 2mm downward (since the cut chin bone has to be kept in contact with its matrix, that's the limit. otherwise, bone grafting will be required, and he wants to avoid that); he also said the style of the cut he will perform adds to the height even more, so let's assume the end result will be 3-4mm of vertical growth. no filler, for sure.
a s**tty thing to say, but he told me not to expect huge changes and to keep my expectations low, then the result might be surprising. i don't expect to come out looking like a model, for sure, and i am realistic about the fact that we are dealing with my (and not some generic) face and that its specificities impose limits that should be respected. in any case, he emphasized that orthognathic surgery would be my best choice, but, as i explained before, i'm reluctant to do it at this point and would like to bet on a less invasive procedure first to make sure that's not enough to improve my appearance and, hopefully, my apnea too.
i have partially jewish blood, haven. i uploaded a few more pictures so you can have a better idea of my overall appearance. criticism is welcome; feel free to comment on it. that's why i'm posting photos. i want know how others see it too. as i implied in a different post, i simply want to hear informed, more objective opinions to be a bit more certain that i'm in a path where i can at least expect positive changes and won't look worse than before.
anyway, i rebooked the surgery to saturday to gain decision time.
-
What is your AHI/RDI? And are you fairly young (let's say, younger than 30)? If so, I would count on your apnea getting significantly worse in the next few years. There's never a good time to get major surgery and orthodontics, but I can tell you from experience that I feel like I had a few years of my life taken from me when my apnea got worse in my early 20s.
If I would have had the opportunity to get orthognathic surgery years before my apnea got that bad, I would have done it in a heartbeat.
Personal experience aside, I think orthognathic surgery would be the best option from both an aesthetic and medical standpoint.
-
It’s a tough call. I can see where your dr is coming from, I think a genio will be an improvement but as you know it won’t be perfect. But you might be satisfied with the result and decide you don’t want to go down the uncertain road of full on jaw surgery.
I had just a genio when I was told I was borderline for full jaw surgery. It’s not perfect but it was a definite improvement and I am glad I did it.
Good luck with whatever you decide.
-
thanks for the great answers, everyone.
kava, your post was very elucidating. people (myself included) usually confuse receding chin with receding jaw; now i see they are different things, both of which are traits i carry.
i'm in my late 20s. my ahi is 27.8, which is considered moderate. i've been told it'll get worse. a month ago i began practicing correct tongue posture and i'm pretty sure it helps and will help even more down the road to keep my apnea under control.
anyway, after reading so many comments here suggesting it, i started getting used to the idea of going through orthognathic surgery already.
it would make the decision easier for me though if i could just do it straight away instead of spending a year or more in preparatory orthodontics. i would rather take care of my teeth afterwards. do you guys know if and how much that could interfere with the result of the surgery? is that even an option? i will first try the genio nonetheless and see how that improves things.
fulcanelli, was your case similar to mine? would you mind sharing before and after pictures with me? i would be grateful!
-
My post to which you are responding came in at same time another post came in. I have some more to add:
No way to tell what type of genio this guy is doing for you and I would establish how 'easy' this this is predicted to be for ANOTHER (unknown) doctor later down the line.
from what he told me, he'll advance 8mm forward and 2mm downward (since the cut chin bone has to be kept in contact with its matrix, that's the limit. otherwise, bone grafting will be required, and he wants to avoid that); he also said the style of the cut he will perform adds to the height even more, so let's assume the end result will be 3-4mm of vertical growth. no filler, for sure.
He has not told you WHAT type of genio this is and made it so 'SIMPLE' as to PRECLUDE you from even doing research on the type for which you would need a NAME of said type or a diagram of said type.
jawguy: i asked him a similar question, but he wanted to make things simple and didn't get into too much detail. since i still had many things to ask, he just said it would be easy to alter the genio advancement in case i decide to go for orthognathic surgery in the future. he's a professor at one of the most renowned universities in the country with a lot of international experience, so he must know a thing or two.
For WHOM will that be 'easier' for; HIM, someone whom we can assume is more ADVANCED than other doctors OR is he extrapolating on the capacities of a 'who knows who' other doctor later down the line. So ESTABLISH for WHOM he is speaking for, HIMSELF who will be DOING your surgery later down the line, the surgery INSURANCE will PAY for or is he extrapolating on the abilities of some UNKNOWN insurance doctor.
STOP! Ask YOURSELF if you are EXTRAPOLATING his abilities where it might be easy for HIM to adjust to another doctor (unknown to you and him at this point in time). Like why would you extrapolate his abilities (which relate to him, himself doing and undoing things with ease) to PREDICT how easy his work would be for another unknown doctor to undo?
He didn't explain to you what type of genio it was. So, you have NO INFORMATION as to the type NAME of the type of genio even to do your own research as to how 'easy' it is to undo. There are ways to simplify a general concept as I've done. So I would ask WHY a TEACHING professor would not do so. The art of teaching is being able to break down and simplify a complex concept. From what you convey, he hasn't done that and it does NOT simplify things for you to keep you in the lurch as to what type of genio it's called and to rely on the old: 'Because I'm the doctor and I said so.'
Disregard this question ONLY IF he is speaking for HIMSELF and HE will be the one DOING either your full maxfax surgery later down the line OR if he is offering to UNDO HIS surgery later down the line so the other doctor doesn't have to deal with revision genio OR he
demonstrates he has ample familiarity with which ever doctors who COULD be doing your surgery later down the line and enough so to PREDICT their capacities.
As to what is 'easy' for a maxfax doctor, later down the line perhaps one that the INSURANCE pays for in the even you later opt in favor of the full maxfax...you know what that is?
A VIRGIN FACE, virgin bone structure that does not need to be UNDONE to do something else.
ETA: ETA:
As far as what he told you about the chin wing procedure, he told you RIGHT. For example, for people with very STEEP mandibular plane angles (like banana type jaw) who also have little 'room' between the teeth roots and the border of the mandible, between which the NERVE traverses AND the cut is made, it gets more tricky to make a high angled cut through a small passage. Even if no nerve damage, it can just resolve to a glorified genio where one does not see much improvement at all to the back of the jaw area because they have a type of contour to begin with that does not lend itself to what they were hoping to get out of it.
thanks for the great answers, everyone.
kava, your post was very elucidating. people (myself included) usually confuse receding chin with receding jaw; now i see they are different things, both of which are traits i carry.
i'm in my late 20s. my ahi is 27.8, which is considered moderate. i've been told it'll get worse. a month ago i began practicing correct tongue posture and i'm pretty sure it helps and will help even more down the road to keep my apnea under control.
anyway, after reading so many comments here suggesting it, i started getting used to the idea of going through orthognathic surgery already.
it would make the decision easier for me though if i could just do it straight away instead of spending a year or more in preparatory orthodontics. i would rather take care of my teeth afterwards. do you guys know if and how much that could interfere with the result of the surgery? is that even an option? i will first try the genio nonetheless and see how that improves things.
fulcanelli, was your case similar to mine? would you mind sharing before and after pictures with me? i would be grateful!
-
people (myself included) usually confuse receding chin with receding jaw; now i see they are different things, both of which are traits i carry.
I haven't looked at / done the ceph analysis, but I'm not sure how much of a receding chin (microgenia) you have. At least part of the reason your chin sits behind your lower lip is that your lower lip is "artificially" forward due to the proclination of your lower incisors (compensating for your skeletal discrepancy).
It would be interesting to see how much genio movement your doctor would plan if you were also doing the orthognathic surgery.
anyway, after reading so many comments here suggesting it, i started getting used to the idea of going through orthognathic surgery already.
it would make the decision easier for me though if i could just do it straight away instead of spending a year or more in preparatory orthodontics. i would rather take care of my teeth afterwards. do you guys know if and how much that could interfere with the result of the surgery? is that even an option? i will first try the genio nonetheless and see how that improves things.
More recently (due to advances in the hardware fixation -- the plates that hold your jaws together after the surgery), the surgery-first approach has started to gain traction. This would involve getting braces on, then surgery shortly after, then more time in post-surgery ortho. That said, I don't know if you'd be a candidate, since according to this 2015 overview (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4314839/) criteria include "Normal to mild proclination/retroclination of incisors." I'd ask your surgeon.
Also if you do think you're going to pursue orthognathic surgery I would avoid the genio on Saturday. You'd likely need a revision genio (reduction), and reduction movements are typically less predictable/reliable than expansion. Plus, you'd have scar tissue, old hardware, etc. Not to mention you're putting yourself through an extra surgery.
-
Your surgeon just wants to collect some easy cash.
-
If you're concerned about your sleep apnea you should look into jaw surgery. It might not completely alleviate it as your doctor claims but it will be a good preventive measure to keep it from potentially becoming severe if you do nothing.
You should probabaly take longer to decide and see which options you have regarding jaw surgery procedures.
Are you Américan? There are plenty of CA based surgeons that get mentioned here.
-
i should clarify some things in defense of my doctor:
i was the one who approached him asking for the quickest solution. i'm temporarily in my home country (where i have a excellent health insurance), but i live somewhere else. i've been postponing my trip back with the intention of solving health issues that have plagued me for a while and were clearly affecting my well-being. staying here for such an extended period of time (the few years required by orthognathic surgery) is out of question. if i'm eligible for sfa (thanks for the article, jawguy, i just wrote my surgeon regarding this), it'll be easier to review my current decision. i could maybe come back at the end of the year with everything planned beforehand and go through the operation.
haven, i'm (south) american!
-
update:
seems like i'm not a candidate for sfa. kinda disappointed. i decided to go for the genio first and see how that goes.
-
i should clarify some things in defense of my doctor:
i was the one who approached him asking for the quickest solution. i'm temporarily in my home country (where i have a excellent health insurance), but i live somewhere else. i've been postponing my trip back with the intention of solving health issues that have plagued me for a while and were clearly affecting my well-being. staying here for such an extended period of time (the few years required by orthognathic surgery) is out of question. if i'm eligible for sfa (thanks for the article, jawguy, i just wrote my surgeon regarding this), it'll be easier to review my current decision. i could maybe come back at the end of the year with everything planned beforehand and go through the operation.
haven, i'm (south) american!
I think you could clarify whether or not HE (who you are sure of can easily UNDO your genio) is going to be YOUR doctor who does the full surgery later down the line OR will another (unknown doctor at this point in time) be doing it. IF SO, please clarify why the genio doctor can easily PREDICT that undoing his work will be 'easy' for the next doctor.
-
Well good luck. Be sure to let us know how it goes.