jawsurgeryforums.com
General Category => Aesthetics => Topic started by: Breakingbad on December 08, 2019, 10:58:48 PM
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Hello all,
I have been researching treatment options for a few years now. Before travelling for consultations with a few maxillofacial surgeons, I wanted to ask whether I look like a possible candidate for jaw surgery.
Asking friends and family for their opinion has not gotten me useful information, with most people saying they do not see any abnormalities at all. To me though, there are obvious abnormalities in the structure of my jaw which are causing aesthetic issues.
I would describe the mid and lower thirds of my face as droopy or heavy in appearance. My bottom lip sticks out almost entirely past my lower jaw and my face generally looks pudgy, undefined and strange. I have a small overbite that my dentist always said wasn't worth getting braces for.
I'm at around 19% body fat right now but I've been down to about 13% and it didn't change much.
I'd appreciate your input!
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Here are frontal pics
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Just looks like chin augmentation would help. Doesn't look like you need full monty of bimax surgery.
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Your left side (right on the pic) seems more deficient than the right side, which is causing some asymmetry, which probably wouldn't be an issue if you had a more square facial shape. Golonial angles are quite high as well. But if you look at the profile pic, they seem okay. So it"s probably just an undefinied, oval shaped jaw/face.
I think a good jaw + chin procedure could bring you up alot.
I think your judgement is right. Lack of defined jaw and chin makes your lower third look sagging. Yeah, you could do only with chin procedure. If you want more perfection, a jaw procedure can be done.
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Your left side (right on the pic) seems more deficient than the right side, which is causing some asymmetry, which probably wouldn't be an issue if you had a more square facial shape. Golonial angles are quite high as well. But if you look at the profile pic, they seem okay. So it"s probably just an undefinied, oval shaped jaw/face.
I think a good jaw + chin procedure could bring you up alot.
I think your judgement is right. Lack of defined jaw and chin makes your lower third look sagging. Yeah, you could do only with chin procedure. If you want more perfection, a jaw procedure can be done.
Do you mean a jaw surgery where the jaw bones are cut or something more along the lines of a wraparound implant? If you meant full jaw surgery, how might that be possible since I don't have bite issues? From what I understand, I might not be able to get surgery without extractions and then braces to create an overbite, because there is no space to advance my lower jaw since my teeth are already pretty well aligned.
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Just looks like chin augmentation would help. Doesn't look like you need full monty of bimax surgery.
Do you think that could help the lip position though? It seems to me that that would result in a fold between my lower lip and chin. I think the bigger problem for me is how my jaw/chin structure is affecting my soft tissue and the contours of my face so I really want something that could help with that.
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Do you think that could help the lip position though? It seems to me that that would result in a fold between my lower lip and chin. I think the bigger problem for me is how my jaw/chin structure is affecting my soft tissue and the contours of my face so I really want something that could help with that.
Can't advise on maxfax/ bimax surgery in a non clear cut case for it such as yours where there is no X ray ceph and quite possibly no bite issues. Chin surgery can help with lip position and your lower lip is behind where it should be relative to your chin. A 'glorified' chin surgery such as a chin wing might be a possibility for including jaw alterations with it. Be ready for a possible bone graft taken from the HIP for chin wing. Other option is chin and jaw implants.
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Can't advise on maxfax/ bimax surgery in a non clear cut case for it such as yours where there is no X ray ceph and quite possibly no bite issues.
I am trying to get xrays that my dentist has on file. Do you know if just a cephalometric xray would be helpful or if something else such as a panoramic xray could be useful as well? They have a lot on file so I just want to know what's worth having.
Chin surgery can help with lip position and your lower lip is behind where it should be relative to your chin.
I think you're saying here that my lower lip is already behind where it should be relative to my chin. Did I understand correctly? That sounds strange to me because my lower lip is a lot further forward than my chin. Are you saying that's normal?
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I am trying to get xrays that my dentist has on file. Do you know if just a cephalometric xray would be helpful or if something else such as a panoramic xray could be useful as well? They have a lot on file so I just want to know what's worth having.
ceph X ray.
I think you're saying here that my lower lip is already behind where it should be relative to my chin. Did I understand correctly? That sounds strange to me because my lower lip is a lot further forward than my chin. Are you saying that's normal?
Oh man...I'm so sorry. You're RIGHT. I meant to say that your CHIN is behind your lower lip. I got it reversed. So sorry. I must have gone 'dyslexic' late at night when I addressed. So, your chin is behind your lower lip.
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Shouldn't a chin be behind the lower lip?
Even in ideal profiles that's the case.
To me your jaw angle looks too steep. You appear to have thick soft tissue, too. Given both conditions I'm not sure a genio alone would work, but you can try it first and see.
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Shouldn't a chin be behind the lower lip?
Even in ideal profiles that's the case.
To me your jaw angle looks too steep. You appear to have thick soft tissue, too. Given both conditions I'm not sure a genio alone would work, but you can try it first and see.
A little behind it but not a lot. Anyway, I reversed what I meant to say to him (late last night). But clarified on my recent post on here.
He could explore chin wings or custom chin/jaw implants.
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Do you mean a jaw surgery where the jaw bones are cut or something more along the lines of a wraparound implant? If you meant full jaw surgery, how might that be possible since I don't have bite issues? From what I understand, I might not be able to get surgery without extractions and then braces to create an overbite, because there is no space to advance my lower jaw since my teeth are already pretty well aligned.
Chin wing or wrap around jaw implants with vertical dropdown. Both could bring you up, provided a good surgeon does them.
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ceph X ray.
Oh man...I'm so sorry. You're RIGHT. I meant to say that your CHIN is behind your lower lip. I got it reversed. So sorry. I must have gone 'dyslexic' late at night when I addressed. So, your chin is behind your lower lip.
That makes more sense. You had me confused for a bit. Anyway, in that case I will work on obtaining copies of my ceph x-rays and post them here as soon as I get them. I think they might reveal something as even though my teeth line up fairly well I've noticed the following:
-I have slight crowding in my lower teeth so I think it is quite likely that they are proclined at least to some extent.
-I have very little if any tooth show at rest. When I smile naturally, my top lip covers at least a couple of millimetres of teeth below where even just the edges of the gums between the teeth would be visible. I have to use my facial muscles to lift my top lip up in order to see any gums.
-My nose is a bit upturned, and is shifted to one side with the septum deviated in a moon shape as if my nose was slightly pressed together vertically. I'm not sure if it could be related to a short and forward grown maxilla
-My bottom and top front teeth are off centre from each other by a mm or 2 and the midline of my top lip seems to be off centre from my top teeth by a similar amount as well.
-Very forward head posture and mouth breathing.
Put together with the aesthetic issues, it seems possible that something may be off about my jaw position.
Thanks for your input so far.
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Shouldn't a chin be behind the lower lip?
Even in ideal profiles that's the case.
I wouldn't want my chin to be in front of my lower lip, but I am under the impression that it is too far behind right now. Are you saying that it might not be? That would mean that it's not a part of my aesthetic issues, but I look strange and droopy from the front as well around the chin and mouth area so I've always thought it had to be a part of the problem.
To me your jaw angle looks too steep. You appear to have thick soft tissue, too. Given both conditions I'm not sure a genio alone would work, but you can try it first and see.
I guess you mean the angle with the horizontal of the line going from the bottom of the chin to the gonial angle in side profile. Is that correct?
IF it is, someone else mentioned that it seemed like I had high gonial angles as well. I guess this is directly related with my jaw angle. I think my facial hair/ the lighting makes it hard to tell in the pictures I posted though. Maybe it's easier to see in these photos.
If genio alone is an unideal solution, what do you believe the most proper solution could be?
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Chin wing or wrap around jaw implants with vertical dropdown. Both could bring you up, provided a good surgeon does them.
Where do you think the vertical dropdown should be ideally? At the jaw angles? Or everywhere along the chin and jaw line?
Thanks for your input.
Edited: quoted wrong reply
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There doesn't seem to be a (very high) golonial angle from profile. From the front, there seems to be a high golonial angle. If you decide to do a vertical drop down, you may get a trade off: a better front but a 90 degree jawangle from profile, which isn't ideal, unless you lengthen your chin as well. But with PS, the least you change to get maximum effect, the better.
Also, consider the fact that the front is always more important than profile (profile isn't thát important). So a 90 degree jawangle or close to 90 degree won't be a disaster. It will still be aestethic. Maybe with a chin procedure as well, you'll get the ideal profile too. I think your profile isn't bad right now. It still looks kind of aestethic, despite the chin deficiency.
A final note is that your left jawangle is steeper than your right jawangle, which is causing asymmetry. You'll probably need more vertical dropdown st the left side than at the right side.
If you take a wrap around implant, you might think you need alot, but I think you just need a couple of millimeters here and there at the jawangles. Bad surgeons aren't able to calculate the right dimensions. Good surgeons are able to calculate the right dimensions. One or two millimeters too much or too little, and you may get a botched job, a bloated face or almost no change. The dimensions are very very important. If you take a chinwing, you need to go to the best as well. Thing is: do you have enough bone under the nerve or is it too small to make a cut?
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There doesn't seem to be a (very high) golonial angle from profile. From the front, there seems to be a high golonial angle. If you decide to do a vertical drop down, you may get a trade off: a better front but a 90 degree jawangle from profile, which isn't ideal, unless you lengthen your chin as well.
Do you know what an ideal range would be for the gonial angle? I think mine is about 140 degrees right now but I'm not sure if I've measured correctly.
Also, you suggested a vertical drop down. However, I also noticed that my jaw angles are of a width apart that makes them not visible from the front. What I mean by that is that if I placed my index fingers right on my jaw angles and looked straight ahead, you would not be able to see them because the line of sight to them would be obscured by soft tissue which in a way 'hangs' past the jaw angles. They seem to be set about 1 cm narrower on each side than the widest point of soft tissue at the same horizontal line as the angles. Sorry if that's confusing - it's a bit hard to explain. Anyway, do you think that for that reason it would be useful to widen the angles as well. Do you know if adding height vertically at the angles gives a different effect on soft tissue vs widening?
If you take a chinwing, you need to go to the best as well. Thing is: do you have enough bone under the nerve or is it too small to make a cut?
Is there something about my jaw structure that makes you think there may not be enough room? I'm attaching a ceph xray in the next post - I'm not sure if that can give any indication.
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Hello all,
I just had an orthodontic consultation to get an opinion on how my bite looked like. I had a ceph x-ray taken there which I've attached below. They positioned my head for the x-ray using some tabs on the machine that go in the ears and on the top of the nose. I guess that means that the ceph should be properly oriented but I'm not sure.
The doctor told me that I had "Super Class I" occlusion. From what I understand this means that the lower first molar is actually further forward than it should be compared to the upper first molar. Despite this, I still have a bit of overbite and overjet.
I have 3 mm of overjet.
Based on the ceph, does anyone know if I look like a jaw surgery candidate and what kind of movements might be appropriate? Also, does it seem from the ceph like my aesthetic issues could be related to my jaw positioning?
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What a terrible xray machine, that ceph is low quality since you can't make out your individual teeth. Though it does appear you have an accentuated curve of spee (draw a line passing through the top of your teeth). At least US surgeons like to treat that with a segmental lefort. Meaning if you do go the bimax route you might be looking at the more hard core variant.
That being said, your airway appears fine. I agree with the earlier posters, try to get by with a SG or maybe chin wing.
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What a terrible xray machine, that ceph is low quality since you can't make out your individual teeth. Though it does appear you have an accentuated curve of spee (draw a line passing through the top of your teeth). At least US surgeons like to treat that with a segmental lefort. Meaning if you do go the bimax route you might be looking at the more hard core variant.
That being said, your airway appears fine. I agree with the earlier posters, try to get by with a SG or maybe chin wing.
I tried to look up "curve of spee" and I think I understand what it is. I'm wondering if it could just be appearing that way on the ceph because of my wisdom tooth on the side that the xray was taken from being wierdly positioned? My wisdom tooth on that side has been growing with the crown angled outward for a few years now and I guess that could make it appear higher up than the other teeth. It's just a thought - please correct me if that's totally wrong.
That's good to hear that my airway looks fine - makes me wonder why I mouth breathe so much.
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I don't see anything in your ceph that would justify the bimax surgery.
What you have is mostly chin RECESSION. An upward sliding genio would bring your chin closer to the red vertical, shorten the chin that looks long from the front, make the jaw angles look RELATIVELY lower (they look high because the chin from front casts LONG even though it's recessed) and decrease the overly obtuse lower lip to chin angle.
Although there are different solutions for addressing BOTH the chin and doing such things as lowering the jaw angles and flaring them out, it's important to see what the obvious and straight forward problem mainly is which is chin recession.
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That's good to hear that my airway looks fine - makes me wonder why I mouth breathe so much.
You mouth breath because you have to strain your lips to close your mouth
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You mouth breath because you have to strain your lips to close your mouth
lip strain from a recessive chin.
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You mouth breath because you have to strain your lips to close your mouth
lip strain from a recessive chin.
I think that's totally true. I've been noticing when my mouth is closed, there are little dimples in my chin from my mentalis muscle having to flex for my mouth to stay closed. They disappear when my mouth is open.
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The doctor told me that I had "Super Class I" occlusion.
Are you sure you did not misunderstand him? Because what you have is a supra class 1 occlusion on a class 2 skeleton.
This means that your lower jaw incisors are a bit "above" the occlusal plane of the lower jaw side teeth.
Anyway, that is not really important. Your treatment plan for jaw surgery would likely entail extraction of 2 lower jaw premolars, retraction of the front teeth and levelling of the lower jaw (make that supra occlusion go away by intruding the incisors while retracting them) and lower jaw surgery afterwards.