jawsurgeryforums.com
Before/After Photos => Overbites => Topic started by: streo on August 17, 2012, 02:32:41 PM
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So I thought I'd spin off another thread over here in overbites. I'm finding this topic quite interesting/encouraging as I myself will be having a 3-4 mm genioplasty, which I thought was small. But CK had mentioned on more than one post that Arnett/Gunson do a 4mm MAXIMUM genioplasty (I'm assuming advancement).
Any information or explanation as to why this is the case?
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I have an extremely shallow labiomental groove, so I think I would need a significant larger genioplasty. I also don't want to end up with a prominent jaw and a weak chin, because that tends to look really bad. The opposite -- slightly recessed jaw, prominent chin -- looks much better, in my opinion.
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I have ZERO problem deferring to the surgeons in this case. Honestly this information really puts me at ease!
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Some perspective...the headphones that ship with an iPod has a jack that is 3 millimeters in diameter. Although I have yet to experience it, I know millimeters are like miles on the face, and I'm having a hard time believing that this will make much of a difference and that going larger than this is "bad planning".
But then again, I'm not a doctor...I've only spent a few minutes a day reading on subject matter to which doctors devote their entire life.
But still!!!
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any surgeons share the view that 4mm genio is the maximum, anything beyond is evidence of poor planning prior to surgery?
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any surgeons share the view that 4mm genio is the maximum, anything beyond is evidence of poor planning prior to surgery?
I thought about this quite a bit and the reasoning goes that if the occlusion in the front of the mandible/maxilla is ideally corrected, then the genio itself should "average out" in some way as far as maximum advancement. This is just my speculation and not based on any surgeon's input.
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The reason 4mm is generally the max is because the soft tissue in the chin starts to thin if the advancement is larger than that. It says this on A&Gs website.
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The reason 4mm is generally the max is because the soft tissue in the chin starts to thin if the advancement is larger than that. It says this on A&Gs website.
but everyone's soft tissue is different, right?
and also, do other surgeons share this POV?
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True, its prob just a general guideline
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I read in one of their articles that 60% of their patients were female.
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hmmm. the chin just seems like an essential feature, im not sure if an advanced jaw can still create the effect of a stronger chin. also, i think the real difference is gender, females tend to have softer tissue than men and a lot of showcased AG are female.
This is a very interesting thread and I have several observations to make.
For people with retrusive lower jaws (i.e. a weak looking jaw but perhaps no MAJOR functional problem, i.e. a class 1 or 2 occlusion) I have personally consulted with some maxillofacial surgeons and cosmetic surgeons who have suggested that a simple genioplasty would solve my cosmetic problems. In some cases the surgeon suggested a genioplasty with some grafting of bone from the hip to fill out the space. This produces the benefit NOT ONLY OF STRENGTHENING THE CHIN, but a genioplasty when advanced can also lengthen the appearance of the jawline itself.
Another advantage of a genioplasty(over a chin implant for example) is that not only can you project more horizontally with a genioplasty, but you can also vertically lengthen the chin through a genioplasty. If you go over to the "makemeheal" forums which are primarily devoted to cosmetic sugery you will find under "genioplasty" examples of several patients who have benefitted comsetically from genioplasty and they look really good, in some cases much better than patients who have had jaw surgery.
Clearly, this has to do with the the fact that they had their genioplasties performed by cosmetic surgeons(trained in the procedure) who were primarily concerned with aesthetics (genioplasties serve little to no functional benefits). In fact, the ps I consulted with(he was also a craniofacial surgeon and was trained in doing jaw surgery too) actually drew out on a piece of paper what he said was the "most attractive" chin shape on most people society calls "pretty boys". I got a good chuckle out of that, but he was actually right when I looked at magazines afterwards. It was a somewhat protrusive chin with a soft curve and now I see it in the profiles of most male models. Apparently he said he could create that chin through a sliding genioplasty and intergrafting a bit of bone or bone filler into the gap. I've seen some of his after results and they were pretty awesome(on both men and women). His chin advancements were sometimes close to 15mm --and he never indicated anything about problems with this...though I haven't done a long term follow up on his patients.
It seems to me that if a genioplasty can indeed improve or help the cosmetic outcome of a jaw surgery it should be done. Also, it seems Arnett and Gunson are some of the most advancement surgeons in terms of using grafts etc. so hopefully they can create the same types of effects as the surgeon I consulted with. I guess you probably just have to ask.
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for those of you interested, this was the doctor and here are some examples of genioplasties(only genioplasties) he's performed. I'm guessing these are all upwards of 4mm projection --some of these people look like they had jaw surgery! But they haven't. And he showed me even better pics in his office (of only genioplasties).
I' myself will be getting jaw surgery because I do want to improve some functional things, but I'm also concerned about aesthetics and I think as CK mentioned it does seem to play a pretty important role in aesthetics.
http://www.plasty.ca/chin_reshaping_before_and_after_photos.html (http://www.plasty.ca/chin_reshaping_before_and_after_photos.html)
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the genioplasty clearly improved everyone, but it's amazing what it did for the red-haired guy, he went from average, slightly odd looking to handsome, even model calibre. I think he also had a slight straightening of his bridge, but nothing more extensive(the tiip of his nose is unaltered, i'm not even sure about the bridge, but the chin really put the face together!)
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Those are some impressive results no doubt. But I do think lip support is a very important cosmetic consideration and when you only advance the chin, an already weak mouth can look even more so. But...if your problem is merely a weak chin, a genio is probably a good choice.
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I've seen excellent results with large genioplasties and poor results from A/G where patients ended up with overprojected jaws and weak chins (e.g. http://i.imgur.com/dHywt.jpg (http://i.imgur.com/dHywt.jpg)). I think the 4mm max genioplasty rule is nonsense.
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I've seen excellent results with large genioplasties and poor results from A/G where patients ended up with overprojected jaws and weak chins (e.g. http://i.imgur.com/dHywt.jpg (http://i.imgur.com/dHywt.jpg)). I think the 4mm max genioplasty rule is nonsense.
Well...for what that girl had to work with, her result is incredible. Chin may seem a bit "off" but overall an amazing transformation.
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Well...for what that girl had to work with, her result is incredible. Chin may seem a bit "off" but overall an amazing transformation.
I don't know -- I really think another surgeon could have done a better job. She had great features to start with (skin and hair especially), and I really think she could have ended up with a beautiful result if her lower jaw had been advanced a lot less and her chin a bit more.
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Looking at her xrays on her blog, her overjet was enormous so I think a jaw advancement that large may have been necessary to restore function.
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I don't know -- I really think another surgeon could have done a better job. She had great features to start with (skin and hair especially), and I really think she could have ended up with a beautiful result if her lower jaw had been advanced a lot less and her chin a bit more.
I agree here with Heavyweight that the genioplasty could have been performed so as to have lead to a more aesthetically pleasing outcome. Actually, the surgeon I consulted with said that the genioplasty should lead to a slight S -shape in the chin to give projection and a slight undulation, but not too deep a suculus. He actually showed me this very pic of a model to show what he meant even though he said this model has quite a prominent lower jaw
her chin/jawline are the aesthetic ideal(given a certain standard of western beauty I realize, i don't want to get into that debate lol), but I do know that such a chin could have easily been achieved on the woman
Heavyweight shows, because it would have just required a bit of lower advancement and modelling with an HA graft or paste to give that S shape. She would have turned out much better IMO.
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The redhead's jaw looks even more crooked after his genio.
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The redhead's jaw looks even more crooked after his genio.
That's a good point actually and points to the need for actual jaw surgery! The genio probably had to stay in line with the jaw, but certainly it did do wonders for the guys profile and also made his nose look more in proportion to the rest of his face.
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I'm not sure what "the soft tissue starts to thin" means exactly. Some people have very slack skin around their chin and neckline, so as for the Fialkov patients, the jawline area is firmed up after the genio --i.e. the tautness provided is welcomed. I may not understand what you mean by this. Sorry, English is not my first language if I am confused by this...
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I agree here with Heavyweight that the genioplasty could have been performed so as to have lead to a more aesthetically pleasing outcome. Actually, the surgeon I consulted with said that the genioplasty should lead to a slight S -shape in the chin to give projection and a slight undulation, but not too deep a suculus. He actually showed me this very pic of a model to show what he meant even though he said this model has quite a prominent lower jaw
her chin/jawline are the aesthetic ideal(given a certain standard of western beauty I realize, i don't want to get into that debate lol), but I do know that such a chin could have easily been achieved on the woman
Heavyweight shows, because it would have just required a bit of lower advancement and modelling with an HA graft or paste to give that S shape. She would have turned out much better IMO.
Guys, I really think you need to go to this girls blog and read about her case. She did have a genioplasty in addition to upper and lower jaw surgery. Also, she had truly severe functional problems (complete condylar resorption). A&G are specialists in this and their focus was to give her a functional bite since she literally had no condyles. Cosmetically, I think that is the best result she could have hoped for and A&G were her best option short of total joint replacement.
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Guys, I really think you need to go to this girls blog and read about her case. She did have a genioplasty in addition to upper and lower jaw surgery. Also, she had truly severe functional problems (complete condylar resorption). A&G are specialists in this and their focus was to give her a functional bite since she literally had no condyles. Cosmetically, I think that is the best result she could have hoped for and A&G were her best option short of total joint replacement.
What girls blog?
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Guys, I really think you need to go to this girls blog and read about her case. She did have a genioplasty in addition to upper and lower jaw surgery. Also, she had truly severe functional problems (complete condylar resorption). A&G are specialists in this and their focus was to give her a functional bite since she literally had no condyles. Cosmetically, I think that is the best result she could have hoped for and A&G were her best option short of total joint replacement.
Thank you. Some on this forum seem to dismiss the fact that there is actual medicine being practiced in some of these doc's offices.
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Thank you. Some on this forum seem to dismiss the fact that there is actual medicine being practiced in some of these doc's offices.
I don't see how her condition necessitated a 35mm advancement. Arnett probably based that number on what he thought was aesthetically ideal.
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I don't see how her condition necessitated a 35mm advancement. Arnett probably based that number on what he thought was aesthetically ideal.
AG have done these procedures thousands of times and have more experience with their planning skills than some of us have been alive. To cut open someone through the mouth, break skull bone with saws/chisels, reset the bone, and then stitch that person up in the hopes that they will in many ways be better is not an easy task. Posting comments on the internet - not so tough!
EDIT: I suppose I'm a bit agitated with the discussion on this thread mainly because another patient who has shared their experience is now being judged as far as their permanent results are concerned and this is probably happening without their consent or knowledge. Stay classy people...
EDIT #2: I'm not interested in getting into a battle on these points, so I'm out of this discussion!
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AG have done these procedures thousands of times and have more experience with their planning skills than some of us have been alive. To cut open someone through the mouth, break skull bone with saws/chisels, reset the bone, and then stitch that person up in the hopes that they will in many ways be better is not an easy task. Posting comments on the internet - not so tough!
True, but thousands of other surgeons can do this. A surgeon's skill is obviously extremely important, but so is his aesthetic sense.
EDIT: I suppose I'm a bit agitated with the discussion on this thread mainly because another patient who has shared their experience is now being judged as far as their permanent results are concerned and this is probably happening without their consent or knowledge. Stay classy people...
She made her pictures publicly available on the internet, and these analyses of surgeons' cases have been very helpful to me and, I'm sure, many others as well.
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What girls blog?
yes, sorry I too am missing the link to her blog. please provide
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Well, the cases on their website and in their articles are usually great, and some are amazing. However, the results I've seen on blogs haven't been too impressive. I was pretty much sold on A/G until I developed a better understanding of what kind of results I wanted.
Interesting, I'm open to skepticism and debate certainly as I am not yet committed to a surgeon. I have an appointment with Dr. Arnett in December to get a treatment plan from him to compare to the one my current surgeon has given me. I simply want to do as much research as possible. I too was under the impression that Dr. Arnett was the most skilled at the aesthetic outcome. But I too have seen several results which have also put that into question for me. So I'm cautiously optimistic but skeptical about their aesthetic expertise.
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yes, sorry I too am missing the link to her blog. please provide
http://melissassmile.yolasite.com/ (http://melissassmile.yolasite.com/)
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Thank you treevernal for speaking sense! I mean what is this nonsense about 'another surgeon could do a better job' on that girl's case. She had miraculous-looking results considering how she started out. Quite honestly it's completely nuts to make those kind of definitive statements about a surgeon's work unless you yourself are a qualified surgeon. I mean who knows what the limitations were in her case? All this 'she would have looked better with a bigger genio' is immaterial since a bigger genio was likely not possible/ stable in her case and frankly it does the girl a disservice. She looks great to me. Helpful discussion is one thing- disrespect of a fellow patient's pictures is quite another. I wanted to post my results to inform others but honestly this feels like the poor girl is being ripped apart and I am not keen to be subject to that sort of unsupportive opinionated commentary.
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Guys, I really think you need to go to this girls blog and read about her case. She did have a genioplasty in addition to upper and lower jaw surgery. Also, she had truly severe functional problems (complete condylar resorption). A&G are specialists in this and their focus was to give her a functional bite since she literally had no condyles. Cosmetically, I think that is the best result she could have hoped for and A&G were her best option short of total joint replacement.
males and females can be quite different when it comes to results, even if they have the same exact condition and pre-operative status.
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i have to say i don't understand how going beyond 4mm is somehow evidence of an incompetent surgeon. i wish i had access to that textbook. i really think some AG patients could benefit from more projection.
are you saying this with respect to your own outcome? if so, i'm assuming that's an answer to the first question.
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are you saying this with respect to your own outcome? if so, i'm assuming that's an answer to the first question.
I'm especially interested in all this because if the only advantage with A/G is the use of HA paste (other than their purported expertise) and the HA paste itself is high reasorbable and doesn't really create the kinds of strong angular contours and prominent cheekbones etc. that a patient might want. Then there's really no reason to go to A/G if your interest is mostly cosmetic. If you have serious, serious functional problems then it makes sense if they're the only ones who can fix your problem, but for those of us who are more borderline on that issue, I'm concerned.
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Hi CK, so I've been reading this thread now with great interest and have gone back and looked at tons of Gunson/Arnett before and afters and I should honestly say one thing. HW is right about the over pronounced jaw with the still relatively small or unemphatic chin. And also, I've seen quite a few examples of APE-FACE --and this is an outcome I want to stay away from LIKE THE FRIGGIN PLAGE. Specifically, ape-face is when the area between the crimson of the top lip and the base of the nose seems elongated and is somewhat concave or "full" after surgery.
Do you have either of these problems? 1) a lack of a strong chin profile from either the front or side and 2) any or slight "ape-face" features ??? I realize you are reticent about giving specifics, but I honestly feel there are so many A/G patients who would fit this profile it would hardly give away anything specific about you. Please elaborate from your experience if you can. Thank you.
well, this goes beyond the topic of the thread, I was really interested in how many other surgeons consider 4mm as the maximum genio, anything beyond that (6mm for example) is evidence of "poor pre-operative planning." Is, not often, sometimes, possible...is. i think the rule may apply better to women then to men, based on the limited number of before/afters I have seen. But everyone has an opinion.
i dont really know what an ape-face actually is.
I don't want to say too much because I'm still healing. It wouldn't be fair to go around making strong judgments at this point. Feel free to move these types of questions to my thread but I can only say so much.
I'm especially interested in all this because if the only advantage with A/G is the use of HA paste (other than their purported expertise) and the HA paste itself is high reasorbable and doesn't really create the kinds of strong angular contours and prominent cheekbones etc. that a patient might want. Then there's really no reason to go to A/G if your interest is mostly cosmetic. If you have serious, serious functional problems then it makes sense if they're the only ones who can fix your problem, but for those of us who are more borderline on that issue, I'm concerned.
As far as the HA paste, I have a few opinions on that but I want to keep this thread on topic.
i didn't amend my original post, I would say I was a pretty typical patient. I had a lot of functional problems and would have had surgery eventually.