12mm genioplasty - should I pursue/have pursued DJS?

[SA1]

Hey all - had a 12mm genioplasty one month ago, and am now wondering whether I should/should’ve attempted to pursue DJS more aggressively.

Background
- Had a bad overbite as a child and camouflage orthodontics treatment + allergies/poor breathing habits
- Have had some sleep/tiredness issues
    - Did a sleep apnea test, but only slept briefly during test. Specialist ruled out severe apnea and said I could/probably have mild/maybe medium but not
      conclusive
- Ortho/TMJ/Sleep apnea specialist all said that I don’t need DJS (in my country seems that there’s a more conservative approach to DJS)
- Uploaded ceph to webceph and got:
    - Moderate Skeletal Class 2
    - Mild maxilla retrusion
    - Moderate mandible retrusion
    - Severe Chin retrusion

12mm Genioplasty
- Decided to get genioplasty to address chin & marginal improvement to breathing, surgeon recommended 12mm
- Had the genioplasty one month ago, people tell me I look different but either not worse or better, but not sure if that's politeness
- I don’t know how I feel about genio results, I can breathe better, and I know I don’t look significantly worse, but I know I’m still “recessed” jaw wise as I didn't do DJS and am hoping to seek answers to:
    - Did the genioplasty improve facial harmony/aesthetics or was it too much advancement? I’m on the fence as I think:
        - Improved side profile
        - Have slight chin asymmetry now
        - The front looks slightly weird to me as the chin looks like it's too large/juts out
        - Hollow cheeks + My cheeks noticeably sink inwards when I speak, attached one image in the after folder with mouth open
        - Not sure if the genio harmonizes well enough with my recessed jaws and if it looks "weird"/too concave
    - Should I still consider pursuing DJS now? (For Mild/Potentially Medium Sleep Apnea + Aesthetics)
        - I’m looking to do another sleep apnea test.

Link to Before/Afters + Ceph: https://drive.google.com/drive/u/1/folders/1mDfQ91nbmEunF_uIByYOV0o17C4OY6cz

[GJ]

People say you look different not better? I find that to be jealousy speaking because you look way better. I'd stick with what you have here and not pursue DJS.

[kavan]

Firstly, I can't see your photos. Very OLD computer and I don't use a Google account. Secondly, I don't need to in order to give you some information about your concerns.

1: When people say you look 'different', it is neither a compliment nor an insult arising from a sense of envy/ jealousy. It conveys there is something 'off' with the changes. So, it is NEITHER a 'you look great what did you do?' NOR an assessment on their part that you look worse. It's a neutral statement where they don't know what to think of the changes in EITHER positive OR negative terms. 'Different' means that something is 'off' that the onlooker CAN'T assess as 'good' or 'bad'.

2: It is NOT uncommon for some doctors to OVER-COMPENSATE with a LARGE genio when a person is a candidate for lower jaw advancement and/or double jaw surgery. On the FLIP SIDE, max-fax doctors who DON'T do that, will bring out the chin POINT with the lower jaw advancement (which often is a part of DOUBLE JAW surgery where the maxilla is either advanced and/or rotated) such that any added genio will be minor.

3: As for an APNEA test for the DJS, it 'depends' whether or not the surgery is SELF PAY or IF insurance is paying for it. The type of doctors I mentioned on statement #2 are often SELF PAY and the surgery is not dependent on whether or not you have apnea. That is to say, IF it's one where counter clockwise rotation would allow them to minimize the maxilla advancement AND maximize the lower jaw advancement (and add a modest genio if that's also needed), that type of surgery would address both aesthetics AND apnea whether you had it or not OR if it looked like you could have it in the future. Like NO apnea test is needed to predict that a lower jaw advancement would OPEN the AIRWAY and help breathing with a self pay doctor who optimizes airway, bite and aesthetics.   

4: In RETROSPECT, if you were actually a candidate for DJS (and again, I can't see your photos, don't need to but it SOUNDS like you WERE a candidate for it), you COULD pursue that. Most likely they would have to REVERSE the prior genio which is not difficult to do because it's a cut right through the prior one to set it backwards given the lower jaw advancement would bring the chin point forwards. The PREPARATION or 'work up' for DJS is a lot of time in BRACES to DE-COMPENSATE the bite (to de-compensate for prior camouflage ortho). So, AGAIN, for all of that, it (most likely) DEPENDS on whether your pursuit is for a SELF PAY max-fax. An insurance one in US or something like NHS like they have in Canada or England, will just do the minimum to help with the breathing. But AESTHETIC optimization is not part of the 'financial equation' when the government or insurance is paying for it.

Conclusion: Based on what you have expressed here and also that you have expressed your situation well, it DOES sound that they over compensated with the chin and did so to MASK the lower jaw recession and that type of masking made your maxilla (mid face area) looked relatively more recessed by relative comparison. So, your pursuit for optimizing aesthetics, bite and airway would be in venue of SELF PAY doctor more than it would be government or insurance pay doctor. Also, I DON'T deny that you could look better (as GJ says you do) given that OVER COMPENSATION with a genio to MASK lower jaw recession is going to be somewhat of an 'improvement'. However,in terms of people who are actually candidates for the DJS where optimizing the balance of bite, airway and aesthetics IS part of what some self pay doctors do, I think what you say here is WITHIN REASON of that type of pursuit. This will require consultations and perhaps outside of what ever country. Hence, if that is within your capacity to pursue, I would say your concerns fit into such a pursuit.

[GJ]

Well he looks objectively way better, so point #1 is definitely not true.

[kavan]

Well he looks objectively way better, so point #1 is definitely not true.

I don't deny he might look better and in fact I said in my post that masking lower jaw recession with a large genio will kick up some improvement. Your subjective assessment (which you call 'objective'), that may be true does not make my point in #1 'definitely untrue'.

[Tomasjohn]

Looks much, much better after 
Where did you do it, Canada?