jawsurgeryforums.com
General Category => Aesthetics => Topic started by: mediumdrinkofwater on December 04, 2021, 07:43:22 AM
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Hey guys, im new on this forum.
I had a chin wing about 6-7 months ago with dr. Z, to correct my recessed chin. In addition to that I had/have an underbite of 4mm, so the mandible seems to be a little recessed. To counter this i decided to go with the chin wing, since it seemed like a easy solution to the problem. He ended up moving my chin forward by 4mm.
My chin was also quite asymmetrical before the surgery. So he made some movements to create more symetry. Not quite suire if that worked either. My chin is still a little asymmetrical, however its not that apparent and it does not really bother me that much.
The results are mixed, while it looks much better from the side and diagonal angle, I dont feel good about the front view. I have the feeling it massively blunted my jaw angles, making it seem rounder.
I would like to get some advice on what I can do now. What options I have to fix the gonial angles. I will provide pictures soon.
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I'm not positive, but I seem to remember a surgeon telling me they can shave the bone to shape them. I know that's pretty worthless, but maybe start google searching in that realm. Others here will probably know more, too.
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Here are some photos. Please provide feedback on what you think about the result and what I should do. All pictures were done with my iphone 8. Im 26 years old btw.
https://imgur.com/a/cF0Me4a?fbclid=IwAR2CBI2cVnyPscl1cdaWkbyUKdYeNdz2KhZULaIbWDURzheOXPhohhOqQhY
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I'm not positive, but I seem to remember a surgeon telling me they can shave the bone to shape them. I know that's pretty worthless, but maybe start google searching in that realm. Others here will probably know more, too.
The other day I was reading a surgeon's take on chin bone shaving for aesthetics and he stressed that it should not be done because they have to fully detach the muscles and soft tissue from the bone which would damage them and ruin the outer look. But I don't know if the same counts for the jawline angles though.
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I've read about some people here getting a chin wing with Dr. Z twice, where the first time it was done to widen all around and bring the chin forward, and then the second time to shave bone and improve the contours of the jawline. I think that's what StupidJaws had done and the end result looked really good to me. Maybe you could look for his posts and think about doing that.
It's hard to give feedback on the result without before photos. You look good overall but I do see what you're saying about the roundness.
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It sounds like you didn't do enough research before getting a chin wing. I say that because blunted jaw angles is a common trade-off in the sense that it's something to EXPECT and pretty much non-avoidable.
Think about it: They cut through the entire mandibular border and right through the posterior jaw angles and move all forward. That means in addition to your CHIN being moved more forward, the lower border of your posterior jaw angles are ALSO going to move forward. That's what you're seeing in frontal view. Again, that's normal for the chin wing you got and are describing.
The 'fix' for this is a SECONDARY chin wing procedure. What they do, is cut through the initial incision cut and GRAFT a piece of bone (harvested from the hip area) onto the posterior jaw angle as to compensate the 'empty space' to it created from the initial chin wing.
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It sounds like you didn't do enough research before getting a chin wing. I say that because blunted jaw angles is a common trade-off in the sense that it's something to EXPECT and pretty much non-avoidable.
Think about it: They cut through the entire mandibular border and right through the posterior jaw angles and move all forward. That means in addition to your CHIN being moved more forward, the lower border of your posterior jaw angles are ALSO going to move forward. That's what you're seeing in frontal view. Again, that's normal for the chin wing you got and are describing.
The 'fix' for this is a SECONDARY chin wing procedure. What they do, is cut through the initial incision cut and GRAFT a piece of bone (harvested from the hip area) onto the posterior jaw angle as to compensate the 'empty space' to it created from the initial chin wing.
Are you confident the second surgery will do the trick? Are there any other cases that did this, apart from SJ. Did SJ plan to do 2 cws from the start?
Is the second surgery less complicated by nature, since there are no movements made as in the first surgery where the chin was moved 4mm.
Is a procedure where there is no forward movement of the chin referred to as a side wing? What exact movements would be required for me to get similar jaw angles as SJ (after 2 cws and before the filler)
Is the empty space you refer to not already filled with new bone?
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Hey,
first of all: Thank you for posting pictures. I think your chin/jaw does not look bad at all btw. But can you please also provide before photos. Otherwise it is hard to judge the result.
In general: I don't know how bad your asymmetry was but I think a chin wing for only 4mm (only forward?) movement was not the optimal solution. Ching wing allows for great horizontal movement without step off and other limitations the genioplasty has. But if one only needs 4mm I think the genioplasty has less asthetic risks than the chin wing.
But if a jaw angle is VERY steep then i think a Chin wing could also be better just for small movements. Most very good before/after I have seen online for male patients had a very steep jaw angle and then they had the mandible border dropped at the back as well as moving it forward. They had no visible angle from front view to beginn with, so the outcome was a improvement - even when looking a bit roundish.
As to your case: A second surgery would probably not be less complicated. In my opinion it is best to treat every surgery as a "high" risk. Especially if you already look good.
To assess the outcome better: Please provide before photos and if you have scans from after the surgery.
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I'm sorry I dont want to reveal too much about me. The before pics do not really matter as of right now. The fact is that my gonials are rounded, which they were not before. Yes you are right, i did not do enough research before, which i strongly regret. However, it seems that I have two options now:
1. Go for a second chin wing. This is heavily based on a former user called stupid jaws, who managed to get a very good result after 2 chin wings following a substandard bimax. I require more information on the second chin wing. I'm not really quite sure how this can benefit my jaw angles.
2. The second option is that I simply undo the chin wing. I will ask the surgeon to remove the implanted hip graft and restore my old look and jaw angles. If I do this and fully restore my old look I might opt for a high bsso to fix my 4mm overbite, since my issue is a mildly recessed mandible in the first place. By doing this I should be able to get my chin-wing profile back and avoid jaw angle issues right?
What do you guys think (@kavan)?
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I'm sorry I dont want to reveal too much about me. The before pics do not really matter as of right now. The fact is that my gonials are rounded, which they were not before. Yes you are right, i did not do enough research before, which i strongly regret. However, it seems that I have two options now:
1. Go for a second chin wing. This is heavily based on a former user called stupid jaws, who managed to get a very good result after 2 chin wings following a substandard bimax. I require more information on the second chin wing. I'm not really quite sure how this can benefit my jaw angles.
2. The second option is that I simply undo the chin wing. I will ask the surgeon to remove the implanted hip graft and restore my old look and jaw angles. If I do this and fully restore my old look I might opt for a high bsso to fix my 4mm overbite, since my issue is a mildly recessed mandible in the first place. By doing this I should be able to get my chin-wing profile back and avoid jaw angle issues right?
What do you guys think (@kavan)?
Rather than undo the whole chin wing your doctor maybe could just move a segment of the mandible border back to its original position at the angle and fill the new gap in with bone graft. I think that would be the best solution if it is possible.
I saw a post-op scan once (don't know where, sorry) where the mandible border was cut in two segments (from the gonial angle to the chin). Then the two segments where then laterally moved outwards at the gonial angles. I don't know if this is possible if you already had a chinwing.
Edit: Found the scan. See attachment. Last photo on bottom.
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I think the results look pretty good. Doubt I'd notice anything unless you mentioned it. Maybe just give it more time?
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Yes, i will wait a few months more. Are there any known cases on here where someone "undid" a chin wing in the way I described?
The thing is that i have an overbite of 4mm and dr.z forwarded my chin by 4mm as well. So by that logic I should be able to get the same result meaning the same mandibular length if I did a mandibular distraction osteogenesis right, but without the round gonials? Is that correct? On top of that I would avoid another invasive surgery.
Of course a bsso would be the optimal solution, which I should have gotten in the first place.
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Are you confident the second surgery will do the trick? Are there any other cases that did this, apart from SJ. Did SJ plan to do 2 cws from the start?
Is the second surgery less complicated by nature, since there are no movements made as in the first surgery where the chin was moved 4mm.
Is a procedure where there is no forward movement of the chin referred to as a side wing? What exact movements would be required for me to get similar jaw angles as SJ (after 2 cws and before the filler)
Is the empty space you refer to not already filled with new bone?
Denial of further advice.
Reasons: Entitlement issues.
1:'Jumped' my signature (Please. No PMs for private advice. Board issues only.) for such. No 'invitation' on my part to PM me.
2: Used my initial response, where I mentioned NOTHING about 'SJ', as a SPRINGBOARD for me to address questions about 'SJ'. NOTHING in my post could be construed as an 'offer' by me to instruct the OP as to 'exact' movements he should have based on SJ. Hence, entitlement to something I wasn't inviting in the process of giving the OP some initial feedback.
3: The 'fix' (and by that I mean redress) for blunted jaw angles is a SECONDARY chinwing. The OP should not expect that my conveying that info to him is contingent that I PREDICT the outcomes of the surgery as to be 'confident' it will do the 'exact' thing he wants it to do or the exact thing he has in his mind's eye, wishes to see in the mirror or wishes to reproduce whatever SJ had done. All I need to be confident about here is that it's a SECONDARY chin wing procedure that is the redress for the blunted back angles.
In closing, there was nothing in the GENERALLY useful info I offered the OP for him to entitle himself to the type of info/feedback he expected subsequent to it. He wanted to know what options he had to address the blunted jaw angles and was told he had the option of getting a SECONDARY chin wing procedure. He's entitled to explore that option with his chin wing surgeon regarding further articulation/definition to the jaw angles and especially so if SJ's outcome is to be used as reference.
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Correct. The venue is secondary chinwing procedure.
Rather than undo the whole chin wing your doctor maybe could just move a segment of the mandible border back to its original position at the angle and fill the new gap in with bone graft. I think that would be the best solution if it is possible.
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The former user mentioned sj, thats why I mentioned him... Sorry about the pm, i didnt read your signature.
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Correct. The venue is secondary chinwing procedure.
Is this a side wing? I dont understand why dr.Z would not have done this in the initial surgery, to avoid blunting of the angles?
What i might do instead now is undo the chin wing and bsso in one procedure. Meaning putting the mandible back in its place and then doing a bsso in one surgery, to fix the 4mm overbite.
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Is this a side wing? I dont understand why dr.Z would not have done this in the initial surgery, to avoid blunting of the angles?
What i might do instead now is undo the chin wing and bsso in one procedure. Meaning putting the mandible back in its place and then doing a bsso in one surgery, to fix the 4mm overbite.
It's done in a SECONDARY SURGERY. It can be referred to as a side wing. As I said prior, to perform the whole advancement, they cut all the way through the back of the jaw angles and advance the WHOLE segment. Blunted angles addressed in a secondary surgery. End of Story.
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I am sorry to hear, that Z didn't clarified everything to you in your consultation. That is his job to do that. That is a violation against german federal laws, especially if the surgery is an elective one. In the german bimax facebook group you can read more about this and some law cases about that.
Like kavan said before, it is unfourtnately an effect of chin wing and well-known for a surgeon. I would confront him directly with that and ask for a revision. What kind of revision, you would have to decide.
Probably he will do it for a much lower cost or even for free, if you really make your point clear and remind him of his duty.
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I would not focus to much on terminology like side-wing etc. I don't think there is an official definition of what a side wing is. You can start the cut anywhere at the mandible border and basically move the segment(s) in every direction (forward, back, outwards) - the question is if it makes sense and if its safe enough. So its best do discuss this with the surgeon.
About the initial surgery (my theory could be wrong): If they would not cut all the way through the back of the jaw angles they would most likely be limited with vertical movement of the segment and correction of asymmetry (depending on the case!!). But if you only get forward movement then i guess it is more possible not to cut all the way back through the angles.
But I think even when the cut does not go through the angle but stops a little bit before the angles the face still can get a bit more round. Take a look at dr.bruscos instagram/imgur page. Look at the female patients there and look at the cut and the outcome. I would like to hear what other users think about that. Sometimes the asymmetry is really noticeable in the after photos.
Each procedure has pro's and con's. Sometimes there is a clear path to take and there is the "perfect" surgery for you but most of the times there will be a trade off. A genio can also have a negative impact on the face from the front.
Again: For only 4mm horizontal movement I think movement of the whole mandible border is not a good solution. It would be so interesting to see before/after because you say that you got very blunted angles from just 4mm. But I also understand that you don't want to post them!
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Yes, looking back, a chin wing was not the right solution and I should not have aped in the way I did. I am also not ready to do a second chin wing, since I feel it’s just too unpredictable and there are not enough references.
Fortunately it is possible to reverse the surgery and restore the old face. I will go the safer and longer route of pursuing a orthodontic treatment to fix my overbite of 4mm, in order to get the face that was always intended for me.
Does anyone know how the front view of the Face from the chin wing and high bsso differs? How are the gonial angles affected by a bsso in comparison to a cw?
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I would not focus to much on terminology like side-wing etc. I don't think there is an official definition of what a side wing is. You can start the cut anywhere at the mandible border and basically move the segment(s) in every direction (forward, back, outwards) - the question is if it makes sense and if its safe enough. So its best do discuss this with the surgeon.
This is correct. I would add that the border of the chin is part of the mandibular border. Also, the BASIC segment is one that cuts through the chin all the way back to the gonial angles. I say basic segment because that's the one someone should familiarize themselves with first if they expect any explanation as to cuts through the basic segment as to what can be done with different cuts in secondary surgery. I've included a simple chinwing diagram that shows the basic segment. As to when it's not safe to cut all the way through from front to back (as illustrated in the diagram), it's when the jaw bone is too steep and or the nerve would be too close to the cut. As to a second procedure, if the first one was safe, the second one would tend to be also because they go through the SAME cut. However, I tend to think that risks could go up if they have to remove prior bone grafts. If no removal of bone grafts,the secondary procedure is one like you mentioned prior. The release the (whole) segment (via the prior cut they made to release the first time). A vertical cut is made to part of the segment which allows them to put the jaw angle back where it was (and also flare it out for more definition prominence). From there, they fill in the vacant space between the moved jaw angle part and the rest of the segment. They fill in with a graft from the hip area. I agree, safety and risks should be discussed with the surgeon. However, safety is different aesthetic effect or aesthetic preference. If a patient was incapable of expressing to the doctor such things as; 'more flare, articulation to the back jaw angles' or making clear what he was aiming for, it wouldn't matter how 'safe' the surgery was.
About the initial surgery (my theory could be wrong): If they would not cut all the way through the back of the jaw angles they would most likely be limited with vertical movement of the segment and correction of asymmetry (depending on the case!!). But if you only get forward movement then i guess it is more possible not to cut all the way back through the angles.
But I think even when the cut does not go through the angle but stops a little bit before the angles the face still can get a bit more round. Take a look at dr.bruscos instagram/imgur page. Look at the female patients there and look at the cut and the outcome. I would like to hear what other users think about that. Sometimes the asymmetry is really noticeable in the after photos.
Your theory is CORRECT. If they didn't cut all the way through the back jaw angle and just left it there, they would not be able to do what you are saying. I would add that if they didn't cut all the way back through the jaw angles and just left them there where they were and just moved the rest of the segment forward, the back jaw angles would not look the same RELATIVE to the forward displacement of the rest of the segment. That's because the mandible gets wider and wider the further back you go. So they are moving a WIDER width more forward which will increase the width of the FRONTAL face (usually a desired goal of the CW). However, if the back jaw angle is LEFT BEHIND, a WIDER width to the front of the face would result in the back jaw angle looking more NARROW via RELATIVE COMPARISON. That's why I think a good thing to move the WHOLE basic segment and not leave the jaw angle area behind. Could even explain what you're seeing in Brusco's photos when jaw angle is left behind, a type of roundness to frontal face. (Only when the patient's jaw is too steep and/or the nerve too close to the cut for safety do they have to leave the posterior part of the mandible where it is.
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Again: For only 4mm horizontal movement I think movement of the whole mandible border is not a good solution. It would be so interesting to see before/after because you say that you got very blunted angles from just 4mm. ......
Not sure I would agree entirely with that part. For example, the CW is a good solution for someone wanting some additional movements that can be done during the first CW, like 'dropping down' the border for more facial height or wanting more WIDTH to the front of the face which one can get with even a 4mm advance of the basic segment. However, it's not a good solution for someone wanting only an isolated genio or someone just landing in the doctor's office who's done no basic research, not even looking at a basic diagram before hand of the cut made and the segment it creates where to most people it would be OBVIOUS that part of the back jaw angles would be changing their position with the advancement of the segment. As to blunting with a small 4mm movement of the whole segment, the perception of blunting would still be there if they left the jaw angle area behind for reasons I stated above. width is being transferred forward. So, if the back angles are left behind, a wider width than that of prior would also make the jaw angles look blunted by relative comparison.
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I am sorry to hear, that Z didn't clarified everything to you in your consultation. That is his job to do that. That is a violation against german federal laws, especially if the surgery is an elective one. In the german bimax facebook group you can read more about this and some law cases about that.
Like kavan said before, it is unfourtnately an effect of chin wing and well-known for a surgeon. I would confront him directly with that and ask for a revision. What kind of revision, you would have to decide.
Probably he will do it for a much lower cost or even for free, if you really make your point clear and remind him of his duty.
I don't recall calling it an 'unfortunate' effect. It's something that can be expected, well, at least by someone with basic observational skills who at least, included in their research looking at a very basic diagram of the chin wing cut. Only if they were lacking in basic observation capacity or didn't bother to even track down a basic diagram of the chin wing cut would they be unable to figure out before hand that part of the jaw angles would be moving forward. So, personally, I wouldn't hold Z's feet to the fire based on the OP not having the observational skills needed. My 'interlude' (and exit from more dialogue with him) resulted from his not observing what's in my signature and then expecting answers to all the details of SJ's surgery when I said NOTHING about SJ in my post. In this case, I'm not holding Z's feet to the fire.
Diagram included.
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I am sorry. I shouldn't say "like kavan said", because after that I didn't repeat literally what you said, but pointed out again, that it is an effect of the chin wing.
I didn't criticize you about stopping to talk with him further. I just wanted to point out, that you already said, that blunted jaw angles are a result of chin wing procedure. Nothing more.
You can think from your point of view (maybe because of moral or different culture background), that this is the fault of the patient not to do their resarch. That's okay, nothing wrong. I am just giving OP some advice. Even if he did some mistake, there are law which is protecting him.
Anyway for everybodyelse who undergo a procedure in germany: the law in germany is very strict about elective surgery. So I can only recommend OP to seak out legal consule. Surgeons in germany lost cases for similiar things, like not explicit telling the patient about a breast implantat surgery, that the result may be different from what they discussed before. The surgeon has always somehow to prove, that he really told this.
But since germans don't really like to sue, except when the neighboors apples from the tree are falling on their garden, many surgeons just have luck.
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I am sorry. I shouldn't say "like kavan said", because after that I didn't repeat literally what you said, but pointed out again, that it is an effect of the chin wing.
I didn't criticize you about stopping to talk with him further. I just wanted to point out, that you already said, that blunted jaw angles are a result of chin wing procedure. Nothing more.
You can think from your point of view (maybe because of moral or different culture background), that this is the fault of the patient not to do their resarch. That's okay, nothing wrong. I am just giving OP some advice. Even if he did some mistake, there are law which is protecting him.
Anyway for everybodyelse who undergo a procedure in germany: the law in germany is very strict about elective surgery. So I can only recommend OP to seak out legal consule. Surgeons in germany lost cases for similiar things, like not explicit telling the patient about a breast implantat surgery, that the result may be different from what they discussed before. The surgeon has always somehow to prove, that he really told this.
But since germans don't really like to sue, except when the neighboors apples from the tree are falling on their garden, many surgeons just have luck.
Well, nice to see you back on board Gadwins. Thanx for clarifying.
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I would add that if they didn't cut all the way back through the jaw angles and just left them there where they were and just moved the rest of the segment forward, the back jaw angles would not look the same RELATIVE to the forward displacement of the rest of the segment. That's because the mandible gets wider and wider the further back you go. So they are moving a WIDER width more forward which will increase the width of the FRONTAL face (usually a desired goal of the CW). However, if the back jaw angle is LEFT BEHIND, a WIDER width to the front of the face would result in the back jaw angle looking more NARROW via RELATIVE COMPARISON. That's why I think a good thing to move the WHOLE basic segment and not leave the jaw angle area behind.
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This an important point for everyone (relative comparison of width after a segment is moved forward). I have never read this before. Glad it got mentioned!
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Rather than undo the whole chin wing your doctor maybe could just move a segment of the mandible border back to its original position at the angle and fill the new gap in with bone graft. I think that would be the best solution if it is possible.
For this procedure, the initial hip bone graft from the first surgery would have to be removed right? Are there higher risks of blood supply issues with having an additional bonegraft in the mandible?
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For this procedure, the initial hip bone graft from the first surgery would have to be removed right? Are there higher risks of blood supply issues with having an additional bonegraft in the mandible?
I honestly don't know about the blood supply and I am not 100% sure about the following: I would say that if you wait long enough you don't have to remove anything because the bone is healed.
Because Most bone grafts are expected to be reabsorbed and replaced as the natural bone heals.
This could be informative for u: https://jawsurgeryforums.com/index.php/topic,8432.0.html (https://jawsurgeryforums.com/index.php/topic,8432.0.html)