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91
Aesthetics / Genioplasty / Jawline Implants / Chin-Wing Osteotomy for Jawline Definition.
« Last post by Charlie on December 14, 2024, 05:13:30 AM »
Hi All,

Basically my chin is weak, and my jawline is non existent, almost melting into my neck.

I've had liposuction which has helped slightly, but obviously hasn't touched any structural issues I may have.

Functionally my bite is good, I don't suffer with apnea etc, so this is coming from a purely aesthetic point of view.

Would a Genioplasty with Jawline Implants be a good solution here? Or even a Chin-Wing Osteotomy

Thanks in advance for any help!

Pre Lipo: https://imgur.com/a/vgl584U

Post Lipo: https://imgur.com/a/Iq6pKPG
92
Aesthetics / Re: Suggested movements?
« Last post by kavan on December 13, 2024, 01:58:58 PM »
I don't think it's a good idea to be asking for directives from others if you already have a surgery booked. Better idea to have some GENERAL grasp of how things work before attempting to talk specifics via medical terms with your doctor. Here goes:

A '1 to 1' ratio is a distance relationship that someone already has or doesn't have to start with. It refers to a horizontal distance between 2 landmarks on the eye vs. vertical distance from mid-pupil line to the opening between the lips. Surgery isn't going to change that type of distance relationship. (It's one that is looked at in the FRONTAL perspective.)

From your profile perspective, it doesn't look like you have a 'long' face. If it looks 'long' to you in the frontal perspective, that would be due to the slack under your chin (due to recession) giving appearance of extra length in the frontal perspective. Slack there would tend to be mitigated with lower jaw and chin advancement. 'What type of genio' would depend on the extent of CCW (if that is done) and also extent of advancement. There is option for an UPWARD SLIDE if appearance of a shorter lower 1/3d of face is needed and option for a downward slide if more length to lower 1/3rd of face is needed. Also, sometimes the lower jaw advancement along with the CCW-r can set the chin point at optimal height with no genio.

You have bi-max protrusion. But targeted correction for that is more common in Asian countries than elsewhere. It involves removing not only pre-molars but also the tooth bearing bone above the tooth which allows the protruded part to be pushed backwards. Once the protrusive part is moved backwards by removing a track of tooth bearing bone that houses a pre-molar, THEN they can move the jaws forward without exaggerating more protrusion. That type of protrusion can make the chin look more recessive via RELATIVE comparison in which case you would need a significant advancement of the lower jaw/chin to MASK it. eg. a CCW rotation.

93
Aesthetics / Re: Suggested movements?
« Last post by GJ on December 12, 2024, 02:56:02 PM »
Your appearance is going to change a lot. If you want this "corrected", you'll need CCW rotation. In terms of your teeth, the ortho probably should have retroclined them for a CCW movement. Was that done?

Cants are tricky to fix. I wouldn't expect perfection there.
94
Functional Surgery Questions / Re: Segmented DJS vs Expansion then DJS
« Last post by GJ on December 12, 2024, 02:52:50 PM »
Are you talking about a 3 piece? It's riskier for sure, and the biggest risk being necrosis of the maxilla via loss of blood flow. Surgical skill is a factor, of course...you want someone well trained who's done it a lot. I think Gunson has.
95
Functional Surgery Questions / Re: Segmented DJS vs Expansion then DJS
« Last post by thedude on December 11, 2024, 10:16:26 PM »
Segmental is more invasive and probably carries a greater risk of tooth injury. Still pretty rare I think but surgical skill is going to be a big factor. It also doesn’t expand the nasal aperture (front skeletal opening of the nose) like traditional expansion techniques.

It’s a big timesaver though and there is no gap to close. 
96
Aesthetics / Suggested movements?
« Last post by Estephany2507 on December 11, 2024, 05:06:53 PM »
Hi everyone! Hope you’re doing well!

I'm a 27F, and I have my bi-maxillary surgery + genioplasty scheduled for next week. This week, I have an appointment with my surgeon to review the movements he will perform during the procedure.

I’d like to be prepared for this meeting and would love to hear your recommendations based on what you can see in the photos. As you can see, I have a Class 2 bite + Long Face Syndrome + Gummy smile. My premolars were extracted when I was 12 years old during my first orthodontic treatment, and my wisdom teeth were removed a few years later to prevent them from pushing my other teeth. Clearly, that wasn’t the right approach for my situation, so a few years later, I was able to start over with a new treatment to prepare for orthognathic surgery.

I'm now very close to surgery, and I have high expectations along with some anxiety, as I'm worried that my surgeon might take a conservative approach to my case. I want to be as clear as possible with him in medical terms to communicate my expectations for the surgery. That's why I'm reaching out to hear all your recommendations regarding my case.

My expectations/questions for this surgery are:

1) Achieve a 1:1:1 ratio in my face, while maintaining good jaw projection (can this be achieved only with CCW rotation?).

2) Correcting my slightly canted smile.

3) My upper teeth are also very protruded, is there a specific technique that can achieve a better jaw projection without making my upper teeth look more protruded?

4) Which would be the best movement for my genioplasty?

I am also very interested to know whether my situation requires any unconventional methods to achieve the best results to discuss this with my surgeon. For example, I've seen a case where a patient with a long face and a gummy smile underwent a quadrangular osteotomy, which significantly changed her appearance (Reference link to that case: https://www.reddit.com/r/jawsurgery/comments/18xg6uc/le_fort_3_midface_shortening_surgery/)

I also have my CT scans to share. Thanks a lot in advance!
97
Surgeon Reviews and Leads / Re: Rhino Doctors
« Last post by GJ on December 11, 2024, 04:10:38 PM »
Quote from: beautyislife on December 05, 2024, 09:09:06 AM
Was the second hand info from male patients?
Currently restarting my venture into looking for a rhino doc. I've been highly debating going to Raffaini

Actually, I forget at this point since it was many months ago, but I think so.
98
Aesthetics / Re: Genio/chin wing vs rhinoplasty for facial harmony
« Last post by kavan on December 06, 2024, 12:30:10 PM »
Quote from: beautyislife on December 06, 2024, 09:56:37 AM
Thanks for this detail, Kavan. The approach you mention surgeons using to try and strike a balance between nose and chin makes total sense. Also noted on finding a surgeon that is skilled in both that could achieve harmony between both the nose and chin, that is most certainly the best strategy.

My goal for the almond eye surgery is to restore a youthful appearance to my face. My eyes have always been a weak point and have always 'aged' me. Canthoplasty seems to give a more 'awake' and youthful look to ones eyes (at least in my opinion). Would getting this upward tilt not achieve that outcome?

My undereye area is also very hollow, very noticeably so and is becoming too much of an annoyance with how much I notice it. A few years ago, it was suggested to me by Taban to get oribital rim implants to correct this hollowing. Though, I have seen some successful results from PRF fillers, I just don't know how that filler would impact the desire of receiving a canthoplasty. Perhaps it's best to ask him directly.


As always, your input is much appreciated Kavan

The cantho procedure gives an uptilt to the lateral canthal area so, ya, it could look more youthful if you have a drooped down lateral canthal area at present. I'm not that familiar with how Taban puts them in to fill hollows. I'm more familiar with how Yarmemchuk (now retired) would use the orbital rim implants. He would need to do a subperiosteal midface lift as part of the process aimed at mitigating the hollow groove below the eyeball. If you don't have the 'prominent' or bulging eye, then fillers can be used to fill in the groove OR if the groove is mostly SHADOW because there is a fat pad sticking out from the orbit, above it, then there is a type of surgery that slips the orbital fat into the groove. So, you could enquirer with him about that.
99
Aesthetics / Re: Genio/chin wing vs rhinoplasty for facial harmony
« Last post by beautyislife on December 06, 2024, 09:56:37 AM »
Quote from: kavan on December 05, 2024, 10:15:47 AM
What I can tell you as to some GENERAL background info is that it is common for plastic surgeons to BALANCE the nose with the chin. It is considered an inter-related aesthetic complex. This is because the nose could look too projected RELATIVE to some recession at the chin. Also, a rhino to reduce any hump on nose whereas humps there are usually a combination of bone and cartilage is not limited to only 'shaving' the hump. If only that is done, the dorsal area of the nose will look too wide in frontal perspective. Hence, the dorsal hump of the nose usually includes breaking the nose bones and squeezing them in medially so the dorsal area doesn't look too wide from frontal perspective.

Although I don't give references for doctors, I can tell you it is best to find a good rhino guy with an outlook for aesthetically balancing the nose to chin relationship in ONE surgery. So, don't try to 'job out' the rhino to one doctor and the chin to another.


Thanks for this detail, Kavan. The approach you mention surgeons using to try and strike a balance between nose and chin makes total sense. Also noted on finding a surgeon that is skilled in both that could achieve harmony between both the nose and chin, that is most certainly the best strategy.

Quote from: kavan on December 05, 2024, 10:15:47 AM
With regard to 'almond eye' surgery, it tilts the lateral canthus higher than the medial canthus is. However it does not horizontally lengthen the palebral fissure (tissue surrounding the eyeball). So, the WIDTH of your eye won't increase. I mention that because some people pursue that type of surgery because they associate the almond eyes with something models have. So, if you are getting it with THAT goal, be reprized that models also have horizontally 'long' eyes in addition to an upward tilt. Also orbital rim implants work well for people who have over projected EYEBALLS. If over projected eyeballs are not your complaint and/or you are getting that kind of surgery with any expectation for horizontally longer eyes, you need to rethink about it.

In closing the general information I've given above is to help you avoid making a mistake. It isn't aimed at pin-pointing exactly what to do and with this or that doctor.



My goal for the almond eye surgery is to restore a youthful appearance to my face. My eyes have always been a weak point and have always 'aged' me. Canthoplasty seems to give a more 'awake' and youthful look to ones eyes (at least in my opinion). Would getting this upward tilt not achieve that outcome?

My undereye area is also very hollow, very noticeably so and is becoming too much of an annoyance with how much I notice it. A few years ago, it was suggested to me by Taban to get oribital rim implants to correct this hollowing. Though, I have seen some successful results from PRF fillers, I just don't know how that filler would impact the desire of receiving a canthoplasty. Perhaps it's best to ask him directly.


As always, your input is much appreciated Kavan
100
Aesthetics / Re: Genio/chin wing vs rhinoplasty for facial harmony
« Last post by kavan on December 05, 2024, 10:15:47 AM »
What I can tell you as to some GENERAL background info is that it is common for plastic surgeons to BALANCE the nose with the chin. It is considered an inter-related aesthetic complex. This is because the nose could look too projected RELATIVE to some recession at the chin. Also, a rhino to reduce any hump on nose whereas humps there are usually a combination of bone and cartilage is not limited to only 'shaving' the hump. If only that is done, the dorsal area of the nose will look too wide in frontal perspective. Hence, the dorsal hump of the nose usually includes breaking the nose bones and squeezing them in medially so the dorsal area doesn't look too wide from frontal perspective.

Although I don't give references for doctors, I can tell you it is best to find a good rhino guy with an outlook for aesthetically balancing the nose to chin relationship in ONE surgery. So, don't try to 'job out' the rhino to one doctor and the chin to another.

With regard to 'almond eye' surgery, it tilts the lateral canthus higher than the medial canthus is. However it does not horizontally lengthen the palebral fissure (tissue surrounding the eyeball). So, the WIDTH of your eye won't increase. I mention that because some people pursue that type of surgery because they associate the almond eyes with something models have. So, if you are getting it with THAT goal, be reprized that models also have horizontally 'long' eyes in addition to an upward tilt. Also orbital rim implants work well for people who have over projected EYEBALLS. If over projected eyeballs are not your complaint and/or you are getting that kind of surgery with any expectation for horizontally longer eyes, you need to rethink about it.

In closing the general information I've given above is to help you avoid making a mistake. It isn't aimed at pin-pointing exactly what to do and with this or that doctor.


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