jawsurgeryforums.com
General Category => Aesthetics => Topic started by: CaptainButtnaked on December 15, 2020, 03:11:54 AM
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Hi guys. I really need some help. I'm pursuing at least a sliding genioplasty for aesthetics reasons. I don't have any pain or bite problems. I have no problems with teeth alignment. I simply hate how my chin looks in comparison with my maxilla and brow ridge & would like my chin to be longer (More Height) and more forward grown.
Your opinion on this is welcomed
I’ve yet to see any surgeons as I have no idea where to start.
I’m based in Australia but any suggestions of surgeons in Europe & Turkey are still highly appreciated
This isn’t something I wish to skimp on. I’m more then happy to budget and pay for the result I want.
Seeing this post has given me inspiration in creating this one - https://jawsurgeryforums.com/index.php/topic,6963.0.html
So similar to his thread I’ll provide pictures of both my real bite & Jutting forward into a more “Ideal” position.
my real bite:
https://imgur.com/Gf8ZpNB
https://imgur.com/7O8KgtW
https://imgur.com/BGfVmAz
https://imgur.com/QeGBzgc
jutting forward (close to what I want to achieve, hopefully will be better):
https://imgur.com/sQFqg6F
https://imgur.com/s7OFhKg
https://imgur.com/DZNFs8P
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You don't need a genio, but it might look okay to have a larger chin given your structure. Your groove is pretty flat, too, which is good if you want advancement.
Not sure of a surgeon over there. I don't think Australia has anyone who is known to be reliable.
Dr. Z in Europe might be worth considering.
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You really need some bony imaging to assess the shape of the chin and relationship of the lower incisors to the mandibular plane and chin. A genioplasty is no substitute for having the mandible in the correct position in the first place if it is deficient. There are some pretty good jaw surgeons in Melbourne. Stephen Gibbons and Andrew Hegge come to mind. Johan Reyneke in Cape Town has written books only about genioplasty
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You don't need a genio, but it might look okay to have a larger chin given your structure. Your groove is pretty flat, too, which is good if you want advancement.
Not sure of a surgeon over there. I don't think Australia has anyone who is known to be reliable.
Dr. Z in Europe might be worth considering.
Hey
Thanks for the reply, appreciate it.
Could you elaborate more on what you mean? & what your opinion on what is needed?
I agree with a larger chin looking better with my facial structure.
I have a strong brow ridge & forward grown maxilla yet a lack lustre lower third. These ratios give the appearance of having a large nose, yet it is, in fact, my chin that is too small.
A surgeon I have been considering is Dr Paul Coceancig. He is seems very competent & his before and after speak for themselves.
From what I've gathered on this forum he has been on here and is highly narcissistic.
A friend of mine has had a consult with him, and won't touch you with out scans
This is reasonable but his asking price for scans and a consult is $3000 AUD. Is this reasonable?
Cheers
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No that's not reasonable for scans.
Coceancig used to post here, and he wrote me privately to make threats. I have zero respect for the guy. You are of course free to use whoever you want, and maybe he's best for you etc, but I saw major red flags with his personality.
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No that's not reasonable for scans.
Coceancig used to post here, and he wrote me privately to make threats. I have zero respect for the guy. You are of course free to use whoever you want, and maybe he's best for you etc, but I saw major red flags with his personality.
Legit just rang his office.
350 for consult.
3150 for a scans.
They won’t tell you the cost of the procedure.
My friend works in sales and is pretty cluey.
Says Paul won’t show his hand until you fork out the money for the scans and referred to him as a hustler.
Legit my only other option or someone I’m going to consider is Andrew Hegge.
Can’t find contact details for him though.
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Genio is like $2000, just go do it. Try Kevin Spencer.
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Legit my only other option or someone I’m going to consider is Andrew Hegge.
Everything you wrote sounds right with stories I've heard, and my experience with him.
There's likely more options. SMSOMS recommended looking into Stephen Gibbons in addition to Hegge. Did you contact them both?
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Everything you wrote sounds right with stories I've heard, and my experience with him.
There's likely more options. SMSOMS recommended looking into Stephen Gibbons in addition to Hegge. Did you contact them both?
Tried contacting Stephen Gibbons clinic multiple times. His receptionist must suck.
Anyway...
Had scans done and booked in for a zoom consult with Professor. Heggie on 13/01/21.
Trying to compile questions to ask him to ensure I'm getting the best surgeon for me.
So far I got...
Have most of your patients who have undergone genioplasty's been male or female? (Ideally male for my case)
Are you familiar with Ideal Ratios of the thirds of the face? (Ideally, all thirds are the same height, My upper and middle are the same height. The lower third is shorter)
How much height can you add to my chin? (As mentioned above, ideally in proportion)
How much advancement can I receive?
Will you be using bone grafts to prevent steps?
If you or any other users know of any good questions to ask your surgeon to get an ideal result, please let me know.
Cheers.
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I can give you some conceptual info.
1: The rule of ' 1/3rds' was first put forth by Leonardo and Dürer (master artists) as a guideline for drawing a normal face. It was not meant to be the sin qua non for ideal beauty or handsomeness.
2: As to the lower '1/3rd' subnasa to base of chin, the FARKAS ratios for Anthropometry can be used which are norms based on scientific measurements of different types of people; races, ethic groups, male/female, age, etc. A shorter lower '1/3rd' is within the norm of some groups, eg. Eastern Europeans.
3: The chin is measured (relatively) in it's own right INDEPENDENT of jaw advancement. For example, if you drop a straight vertical line from your lower lip and if the chin is very close to it or actually ON that line, there is NO (aesthetic) NEED for independent chin advancement. A vertical line on your TILTED picture is one parallel to the hang of the curtain in the background. With reference to that, your chin is not recessed. (ref= https://imgur.com/BGfVmAz)
4: When you jut out the jaw, you are moving BOTH the jaw and the chin outward along somewhat of a downward diagonal. Yes, your chin will cast both more prominent and longer (because it's moving outward and down along a downward diagonal). But the act of doing so is NOT an independent diagnostic for isolated chin advancement. (Because it's movement is DEPENDENT on jutting out your JAW. You are not moving your chin independent of also moving the jaw)
5: The basic visual diagnostic for relative lower jaw recession (independent of the chin!) is to drop a vertical (again, a line parallel to the hang of the curtain in your tilted profile photo) from the upper lip. If the lower lip is BEHIND it (which yours is), it's a basic indicator that the lower jaw is relatively behind the upper jaw. Another way to 'see' this is to look at the lips in frontal. When your upper lip looks BIGGER than your lower when your jaw is NOT jutted out but when your lower lip looks more 'equal' to your upper lip when your jaw IS jutted out, it's because jutting the jaw out brings the lower lip MORE into the FOREGROUND. So, that should at least give you some clue that isolated chin displacement is NOT going to reproduce the visage of jutting out your jaw.
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The above is just a conceptual method as how to SEE things correctly as to not fool yourself into thinking you're 'seeing' an isolated genio by how you are posturing your jaw. Of course, that does not preclude a surgeon from accommodating a request for a longer and more advanced chin. I would suggest you go into the consult with the basic conceptual info I've mentioned above, jut out your jaw for him/her and simply ask IF what he/she sees on your CEPHS allows for a displacement that would come close to it. That would be the very OBVIOUS question for you to ask.
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I can give you some conceptual info.
1: The rule of ' 1/3rds' was first put forth by Leonardo and Dürer (master artists) as a guideline for drawing a normal face. It was not meant to be the sin qua non for ideal beauty or handsomeness.
2: As to the lower '1/3rd' subnasa to base of chin, the FARKAS ratios for Anthropometry can be used which are norms based on scientific measurements of different types of people; races, ethic groups, male/female, age, etc. A shorter lower '1/3rd' is within the norm of some groups, eg. Eastern Europeans.
3: The chin is measured (relatively) in it's own right INDEPENDENT of jaw advancement. For example, if you drop a straight vertical line from your lower lip and if the chin is very close to it or actually ON that line, there is NO (aesthetic) NEED for independent chin advancement. A vertical line on your TILTED picture is one parallel to the hang of the curtain in the background. With reference to that, your chin is not recessed. (ref= https://imgur.com/BGfVmAz)
4: When you jut out the jaw, you are moving BOTH the jaw and the chin outward along somewhat of a downward diagonal. Yes, your chin will cast both more prominent and longer (because it's moving outward and down along a downward diagonal). But the act of doing so is NOT an independent diagnostic for isolated chin advancement. (Because it's movement is DEPENDENT on jutting out your JAW. You are not moving your chin independent of also moving the jaw)
5: The basic visual diagnostic for relative lower jaw recession (independent of the chin!) is to drop a vertical (again, a line parallel to the hang of the curtain in your tilted profile photo) from the upper lip. If the lower lip is BEHIND it (which yours is), it's a basic indicator that the lower jaw is relatively behind the upper jaw. Another way to 'see' this is to look at the lips in frontal. When your upper lip looks BIGGER than your lower when your jaw is NOT jutted out but when your lower lip looks more 'equal' to your upper lip when your jaw IS jutted out, it's because jutting the jaw out brings the lower lip MORE into the FOREGROUND. So, that should at least give you some clue that isolated chin displacement is NOT going to reproduce the visage of jutting out your jaw.
-----------------------------
The above is just a conceptual method as how to SEE things correctly as to not fool yourself into thinking you're 'seeing' an isolated genio by how you are posturing your jaw. Of course, that does not preclude a surgeon from accommodating a request for a longer and more advanced chin. I would suggest you go into the consult with the basic conceptual info I've mentioned above, jut out your jaw for him/her and simply ask IF what he/she sees on your CEPHS allows for a displacement that would come close to it. That would be the very OBVIOUS question for you to ask.
If I drop the scans in imgur can you give me a better idea of what I should be aiming for?
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If I drop the scans in imgur can you give me a better idea of what I should be aiming for?
I would say it's quite enough to spend time giving what should be some useful information, getting neither acknowledgement nor thanks that it was of any help. So NO to the offer of the next thankless job.
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I would say it's quite enough to spend time giving what should be some useful information, getting neither acknowledgement nor thanks that it was of any help. So NO to the offer of the next thankless job.
Haha. Yep.
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A word on Dr Coceancig, included in the $3000 he charges for scans is all the pre surgery planning costs eg ceph analysis, oral photographs. If you elect against surgery after paying the $3k you obviously wont receive these, likewise if he refuses treatment after getting you to pay $3k. The price for a CT scan is around $450 in Australia. Don't be scammed. Read some of his google reviews and doctor reviews, quite illuminating and alarming.
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I would say it's quite enough to spend time giving what should be some useful information, getting neither acknowledgement nor thanks that it was of any help. So NO to the offer of the next thankless job.
Apologies.
My reply was abrupt and thoughtless, and I came across as an entitled punk.
Since reading what you posted previously about my chin projection and my lower jaw (Also my upper jaw which I will get to later) my head was in a bit of spin, was honestly pissed off and it has taken a while to set my ego aside. Which ultimately is for the best.
What I thought was going to be a simple genioplasty has now turned into either a mandibular osteotomy or double jaw surgery which not only cost more but both have longer rehab and preparation time with the potential for braces.
Regardless after researching it further I think you're 100% right. My chin already has forward projection and would not likely gain much from a sliding genioplasty.
Aside from aesthetics, my family from my father's side (Myself included for snoring) all suffer from sleep apnea, bad snoring and bad nose breathing with bad sinuses. which are all symptoms of a recessed jaw, they also have the facial features to back this theory up.
Out of the two surgeries Mandibular Osteomy and double jaw surgery I'm opting out for the double jaw surgery. This is because my teeth already align and have never had chewing issues. It would mean a lot if you could give me your interpretation of my scans.
https://imgur.com/a/8U48qo2
It'd mean a lot if you could give me some feedback and your opinion on what you think an appropriate direction to go is.
Cheers.
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For my consult on the 13/01/21. This is what I've come up in terms of preparations. These will be the examples and questions I will present in the consult.
Health
Goal: To relieve negative health symptoms
Chance are if you or someone your know snores their jaws are probably recessed
Negative symptoms/Health Complications – Bad Nasal breathing, Bad Sinus, Snoring & possible sleep apnea
Aesthetics
Goal: To improve aesthetic appearance of my lower third through improving chin height & chin projection.
Ideal Chin to philtrum Ratio (AKA Chin Height) – 2.0 to 2.3 (Overpowered chins aren’t a flaw in males)
https://imgur.com/a/vw9ghMJ (To provide examples for the surgeon)
What type of chin height improvement is realistically possible in my case?
Ideal Chin Projection - Chin in line with nasion on Frankfurt plane
https://imgur.com/a/RUqHO4F (To provide examples for the surgeon)
What type of projection is realistically possible in my case?
Will my lower lip sit higher or lower after surgery? (You want to avoid it becoming lower at all costs)
Can you provide me with examples of genioplasty’s and double jaw surgery you’ve performed on male patients?
Will I require braces to perform double jaw surgery?
What steps can be taken to reduce or eliminate step off?
How to prevent relapse in case of double jaw surgery?
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Apologies.
My reply was abrupt and thoughtless, and I came across as an entitled punk.
Since reading what you posted previously about my chin projection and my lower jaw (Also my upper jaw which I will get to later) my head was in a bit of spin, was honestly pissed off and it has taken a while to set my ego aside. Which ultimately is for the best.
What I thought was going to be a simple genioplasty has now turned into either a mandibular osteotomy or double jaw surgery which not only cost more but both have longer rehab and preparation time with the potential for braces.
Regardless after researching it further I think you're 100% right. My chin already has forward projection and would not likely gain much from a sliding genioplasty.
Aside from aesthetics, my family from my father's side (Myself included for snoring) all suffer from sleep apnea, bad snoring and bad nose breathing with bad sinuses. which are all symptoms of a recessed jaw, they also have the facial features to back this theory up.
Out of the two surgeries Mandibular Osteomy and double jaw surgery I'm opting out for the double jaw surgery. This is because my teeth already align and have never had chewing issues. It would mean a lot if you could give me your interpretation of my scans.
https://imgur.com/a/8U48qo2
It'd mean a lot if you could give me some feedback and your opinion on what you think an appropriate direction to go is.
Cheers.
This is an APPROXIMATION. It's ONLY an approximation. It isn't an exact ceph analysis. The GREEN contour line is an APPROXIMATION of what I THINK you might want; the lower jaw along with the lower lip to come 'forward' either along the inclination of the MPA or along a higher inclination than the existing 20 deg. but NOT a LOWER one. Your OP and MPA angles don't suggest CCW rotation.
Your DESIRES reflect AVOIDANCE of double jaw surgery 'because your teeth are (already) aligned'. You mention a (possible) MEDICAL reason (apnea) for surgery.
The REALITIES of maxfax surgery, especially when apnea is included in the mix often do involve double jaw surgery. In the event a SINGLE JAW (lower) only can be accommodated, 'forward' advancement would involve the lower teeth moving with it and out of place with the present alignment IF adjustments to the teeth (bite) were not made to accommodate a single jaw advancement and sometimes that involves plucking out 2 pre-molars in order to push some of the lower front teeth backwards in order to accommodate a single lower jaw advancement.
Another issue in maxfax surgery involves a DESIRE for ONLY one thing along with an AVOIDANCE of another thing; wanting to hold one thing CONSTANT (for it not to change) but for ONLY an ISOLATED thing to change. Sometimes those desires are on target with a surgery to accommodate. Other times not. That sort of thing is explored with a maxfax surgeon who can evaluate ALL of the measurements and has the tools to do a DISPLACEMENT analysis as to whether or not desire for 'this' but avoidance for 'that' can be accommodated.
That said, the GREEN contour line APPROXIMATES what you might want with a single lower jaw surgery. It does NOT predict whether or not that can be accommodated in the absence of doing anything to the upper jaw, nor does it predict a single jaw surgery in the absence of adjusting the teeth to achieve it. IF the green contour line reflects close to what you'd like to achieve, it could be used as a very BASIC APPROXIMATION to ask a surgeon IF 'something like that' can be done with single lower jaw surgery.
What I said in my first post to you still holds: There is no preclusion for having an isolated genio request accommodated by a surgeon. It's just that a jaw JUT OUT doesn't replicate one.
Disclosure: This feedback reflects the 'some' I can give in the time I have to volunteer to do so with reference to reply #14 in this thread. It is not an invitation to give feedback for 'all' of what you want to ask your surgeon in reply #15 in this thread.
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The SNA and SNB values on that ceph seem very high (~90 degrees) which would normally indicate prognathism, despite not appearing so in profile. This seems like it would be due to variation in the nasion position or sella position in the skull base. The skull base angle appears lower than published norms. Does anyone know anything about cases like this? Steiner analysis does not seem to be accurate here and I have seen a couple similar scans before.
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The SNA and SNB values on that ceph seem very high (~90 degrees) which would normally indicate prognathism, despite not appearing so in profile. This seems like it would be due to variation in the nasion position or sella position in the skull base. The skull base angle appears lower than published norms. Does anyone know anything about cases like this? Steiner analysis does not seem to be accurate here and I have seen a couple similar scans before.
That is basically correct. My approximation was 88 SNA, 86 SNB, 2 ANB where as norms are: 82 SNA, 80 SNB, 2 ANB. But this isn't something where his face should be pushed backwards due to that. Besides, no one actually 'sees' them the face. I drew them in to look at ANB which was normal. My very basic paint program doesn't allow me to selectively remove them. The green contour line relative to the red vertical is what those of us without X ray eyes see on someones profile.
ETA: Because the S-N line is pretty much a pure horizont and I think most people's S-N line is about 7 degrees inclined away from a pure horizont, THAT'S what is increasing the SNA and SNB angles. But I think they make adjustments for what he has. Like if we subtract 7 degrees, he fits into the norms.
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This is an APPROXIMATION. It's ONLY an approximation. It isn't an exact ceph analysis. The GREEN contour line is an APPROXIMATION of what I THINK you might want; the lower jaw along with the lower lip to come 'forward' either along the inclination of the MPA or along a higher inclination than the existing 20 deg. but NOT a LOWER one. Your OP and MPA angles don't suggest CCW rotation.
Your DESIRES reflect AVOIDANCE of double jaw surgery 'because your teeth are (already) aligned'. You mention a (possible) MEDICAL reason (apnea) for surgery.
The REALITIES of maxfax surgery, especially when apnea is included in the mix often do involve double jaw surgery. In the event a SINGLE JAW (lower) only can be accommodated, 'forward' advancement would involve the lower teeth moving with it and out of place with the present alignment IF adjustments to the teeth (bite) were not made to accommodate a single jaw advancement and sometimes that involves plucking out 2 pre-molars in order to push some of the lower front teeth backwards in order to accommodate a single lower jaw advancement.
Another issue in maxfax surgery involves a DESIRE for ONLY one thing along with an AVOIDANCE of another thing; wanting to hold one thing CONSTANT (for it not to change) but for ONLY an ISOLATED thing to change. Sometimes those desires are on target with a surgery to accommodate. Other times not. That sort of thing is explored with a maxfax surgeon who can evaluate ALL of the measurements and has the tools to do a DISPLACEMENT analysis as to whether or not desire for 'this' but avoidance for 'that' can be accommodated.
That said, the GREEN contour line APPROXIMATES what you might want with a single lower jaw surgery. It does NOT predict whether or not that can be accommodated in the absence of doing anything to the upper jaw, nor does it predict a single jaw surgery in the absence of adjusting the teeth to achieve it. IF the green contour line reflects close to what you'd like to achieve, it could be used as a very BASIC APPROXIMATION to ask a surgeon IF 'something like that' can be done with single lower jaw surgery.
What I said in my first post to you still holds: There is no preclusion for having an isolated genio request accommodated by a surgeon. It's just that a jaw JUT OUT doesn't replicate one.
Disclosure: This feedback reflects the 'some' I can give in the time I have to volunteer to do so with reference to reply #14 in this thread. It is not an invitation to give feedback for 'all' of what you want to ask your surgeon in reply #15 in this thread.
Just finished the consult.
Spoke to him about what I wanted to achieve some that looked like the jutting, ideal height etc. (Obviously lips won't allign)
Said I had a good base to perform it and can achieve what I want with the genioplasty.
He showed me something similar to what you did with my scans the only difference being no lip movement.
Thanks again for accepting my apology and taking the time to edit that scan.
I plan to go a ahead with the genioplasty and access my next plan of attack for looksmaxxing.
Cheers
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Best of luck.