Chin implant or sliding genioplasty?

[Tiny]

Wow.  Your X ray looks SO much better than your pictures.   Your lower teeth are a bit flared and your plane is quite steep, but apart from that your bite doesn't look too bad at all.  At least, the vertical growth of the ramus is excellent

In your case, it's clear made a lot worse by the fact that you carry a lot of far under your chin.  So whatever else you do, you might want to consider lipo for that area

[dantheman]

Plane looks to be upper limit of normal. I had the same first thought, the X-rays don't look half bad. Kind of the same features as my X-ray: strong ramus, steeper plane, and mental deficiency.

[dantheman]

Looking again I wonder if both jaws are somewhat retruded which might explain why we were misled. The relative relationship between jaws looks quite good. Also I notice how straight the C-spine is (cervical kyphosis). This can accentuate any double chin appearance.

[Tiny]

Looking again I wonder if both jaws are somewhat retruded which might explain why we were misled. The relative relationship between jaws looks quite good. Also I notice how straight the C-spine is (cervical kyphosis). This can accentuate any double chin appearance.

Yes, the head posture is very 'backward' and it's making the chin look worse than it is

I think both jaws are a bit retruded, but the bite looks good.  You could get bimax advancement with a bit of rotation, small advancement of the maxilla (~3mm) (+maybe a tiny bit of impaction?) and larger advancement of the mandible (~7mm) but I also think you would get a really decent result from a genio and under-chin lipo.  I also carried a lot of fat under the chin - even as a 90lb 15 year old I had a bad double chin.  I got lipo and the result was amazing so consider it, especially as you bite is decent.  Depends how bad your functional issues are.  You are lucky in that you wouldn't need braces for very long, and in your case the surgical path looks pretty straightforward.

I don't think a BSSO alone is a good move because I can't see how they will create a big enough overjet to move the jaw much without doing extractions.  I have a much bigger skeletal overjet and I was told the most I could get through BSSO alone was a 6mm advancement.  For you it would be about 3mm, 4mm at a max - you might as well do a genio.

As for lifting the cheeks, the options are
1) cheek (midface) lift with endotine
2) cheekbone augmentation with HA or implants
3) cheekbone augmentation with deeply placed, dense filler (e.g. radiesse, perfetha subskin)
4) Korean V-lift (results last about 2 years)
5) reduction of buccal fat and/or microliposuction around the lower face

Early sagging of the cheeks is common when there is less bony support

[chinnychinchin]

Thanks for all the responses! I'm happy to hear that my situation isn't as severe as originally thought, although from my consultation with Schendel/Jacobson they did mention that my case was severe, but not pretty severe. I will be doing a consultation with Gunson and another doctor in the next few weeks to see what they have to say.

I had my overbite opened too for surgery. My last ortho flared my teeth forward to cover up the remainder of my overbite and they just opened that back up to see how big it was. Are you only having lower?

Yep, only lower jaw.

Wow.  Your X ray looks SO much better than your pictures.   Your lower teeth are a bit flared and your plane is quite steep, but apart from that your bite doesn't look too bad at all.  At least, the vertical growth of the ramus is excellent

In your case, it's clear made a lot worse by the fact that you carry a lot of far under your chin.  So whatever else you do, you might want to consider lipo for that area

  Yep, the ortho will actually be used to address the flare. Is steep plane angle bad? What are its implications?

Plane looks to be upper limit of normal. I had the same first thought, the X-rays don't look half bad. Kind of the same features as my X-ray: strong ramus, steeper plane, and mental deficiency. Looking again I wonder if both jaws are somewhat retruded which might explain why we were misled. The relative relationship between jaws looks quite good. Also I notice how straight the C-spine is (cervical kyphosis). This can accentuate any double chin appearance.

Did you already have surgery? Would love to glance at your before/after xrays to compare! Jacobson mentioned that my upper jaw did not need any advancement or it might not look good aesthetically.

Yes, the head posture is very 'backward' and it's making the chin look worse than it is

I think both jaws are a bit retruded, but the bite looks good.  You could get bimax advancement with a bit of rotation, small advancement of the maxilla (~3mm) (+maybe a tiny bit of impaction?) and larger advancement of the mandible (~7mm) but I also think you would get a really decent result from a genio and under-chin lipo.  I also carried a lot of fat under the chin - even as a 90lb 15 year old I had a bad double chin.  I got lipo and the result was amazing so consider it, especially as you bite is decent.  Depends how bad your functional issues are.  You are lucky in that you wouldn't need braces for very long, and in your case the surgical path looks pretty straightforward.

I don't think a BSSO alone is a good move because I can't see how they will create a big enough overjet to move the jaw much without doing extractions.  I have a much bigger skeletal overjet and I was told the most I could get through BSSO alone was a 6mm advancement.  For you it would be about 3mm, 4mm at a max - you might as well do a genio.

As for lifting the cheeks, the options are
1) cheek (midface) lift with endotine
2) cheekbone augmentation with HA or implants
3) cheekbone augmentation with deeply placed, dense filler (e.g. radiesse, perfetha subskin)
4) Korean V-lift (results last about 2 years)
5) reduction of buccal fat and/or microliposuction around the lower face

Early sagging of the cheeks is common when there is less bony support

I think my bite looks decent because I was in a neutral position. When I actually bite however, my lower mandible recedes back so that the molars can get in contact (as seen in first pic). The recommendation for my procedure was a BSSO + genio which will give me a 1 cm advancement. I've been making a serious effort lately to get my bodyfat down so hopefully this will allow me to avoid lipo but that's great to hear that you had success with it. Not sure about the lifting of cheek as I'm not looking to address that.

[Tiny]

The recommendation for my procedure was a BSSO + genio which will give me a 1 cm advancement. I've been making a serious effort lately to get my bodyfat down so hopefully this will allow me to avoid lipo but that's great to hear that you had success with it. Not sure about the lifting of cheek as I'm not looking to address that.

1cm sounds about right for you

IMHO your cheeks look fine, just mentioned options as you said it bothered you!

If you're genetically predisposed to carry fat under the chin then dieting will not shift it. As I said, I had a huge fat chin even when I was super skiny.  The recovery from lipo was not that big of a deal and the result was excellent

[davidnneff]

Since few month i’m planning to get rid of saggy skin which makes me look older than i’m. A friend of mine has advised to consult a cosmetic surgeon ( http://www.plasticsurgeryto.ca/cosmetic-surgery/facial-cosmetic-plastic-surgery/double-chin-removal/ ) of Toronto for double chin
removal surgery in Richmond hill. Does anyone have any experience who has undergone the chin surgery ? Can anyone help me out to guide me on how such surgeries are undertaken. Any suggestions and advises would be appreciated. Thanks in advance

[molestrip]

I consulted Dr Li as well. He's a popular choice on the FB group right now. One had a 20mm bimax advancement even. Other than the pig nose comment from pictures, I haven't heard of any unhappy patients other than a few relapses which will happen with all surgeons. All the people I met who had the arch bars recommended getting braces instead. He does CCW rotations but only in cases that need it. The Stanford orthodontist reportedly gets the best results by far from him. It's hard to tell with pictures because you can't eliminate patient bias. That is, patients with long faces have different possible outcomes than patients who simply lack forward growth. The latter is more likely to produce pig noses.

When it comes to jaw surgery, there's really only three relevant certifications (in that order): oral surgery, plastic surgery, and ENT. Plastic surgery is nice because they have to go through medical school first so can handle more kinds of problems and receive greater training in aesthetics. Oculoplastic would be even better but I have yet to see one. I don't think ENT training adds much in practice. When it comes to jaw surgery, only a small percentage of each of these certifications will actually be relevant of course. We're not getting boob jobs here.

There's plenty of surgeons around who are trained as oral surgeons and plastic surgeons. One such name I've stumbled upon recently is Dr Moloro in Chicago, for anyone in the area. He hasn't done too many surgeries just for sleep apnea but he's done thousands of jaw surgeries and has edited a few textbooks.