Genioplasty concerns (photos and X rays included)

[Luka2020]

Hello everyone!

I am very happy to join this forum. I will try to keep the post not too long.

I have always known that something was off about my chin/jaw. It bothers me a lot, and for the last 3 years I have often been thinking of getting it fixed.
My problems are recessed chin, asymmetrical (crooked) chin, gummy smile (moderate) and lip incompetence.
However, the gummy smile doesn't concern me really and would rather not touch it.

I have spoken to 2 maxillofacial surgeons that are ranked the best in my country.
The younger one said he would shave down the longer part of the chin and then advance the chin a bit forward.

The older one who is a prof. will contact me soon with his plan after I send him the X rays and CBCT which I didn't do yet and probably won't do it for some time until this pandemic is over. He said he would cut out
an asymmetrical piece out of the chin instead of shaving it. He would also advance the chin forward. But he said there might be a need for a jaw surgery instead of
just genioplasty. Basically he wants the X rays, CBCT, photos and everything. After he had studied them carefully we will meet again to discuss the options.


I have some concers and would like to hear your opinions. I am scared that after advancing the chin forward I will end up with a deep labiomental fold since I have somewhat protrusive and thick lips.
Vertical lengthening is not an option since it is already a bit too long vertically.
I also don't want a full jaw surgery since I don't have any functional issues besides lip incompetence. I think the jaws look fine if you exclude the chin. The procedures just seem too invasive for cosmetic reasons only.
Do you think bone shaving would be good? It seems simpler. Also, when advancing the chin, does the vertical shortening has to happen or can the height stay the same during advancement. I really don't want to end up with a chin that's too short.


The LL ceph is from before orthodontic treatment but that shouldn't be a problem I think. It is from two years ago.


I would be very happy to hear your opinions and advice.

Link to the pictures: ?

Thank you and best regards!

Luka

[GJ]

Just glancing at the photos, it seems 1-2mm or so of impaction and the slight rotation that comes from that + chin moving forward would give a great result. But is it worth it for such minor movements? I think the risk is extreme to get there. Easiest improvement might just be to move the chin. I'd probably lean toward that. Get some more consults and maybe it will form a consensus. Make sure not to tell Doc A what Doc B said because it could bias their diagnosis.

[Post bimax]

Agree with GJ.  TBH I wouldn't worry too much about the fold.  A deep fold is more of an issue for women since it can be perceived as a masculine trait.  JS for a tiny bit of impaction is not worth it.  You may actually be glad for your slightly gummy smile because your upper lip will lengthen as you age.

[Luka2020]

Thank you for the replies guys! I am glad that you confirmed my thinking. As I said, I don't think going through jaw surgery would be worth it.
What do you think about cutting vs shaving the asymmetrical part of the chin? The dr told me that with cutting there is always room for mistake 1-2 milimeters. Sanding/ shaving seems maybe better in my situation.
Also, is it true that the chin cannot be advanced forward only, but has to go either upwards or downwards also when sliding?

I Appreciate your answers,

Luka.

[kavan]

Although I don't have a lot of time to explain, my assessment is for a sliding genio where they slide diagonally upward. It will give you horizontal advancement which will help with lip support and will also vertically shorten your chin. Hence, you will be able to 'get away' WITHOUT the Lefort 1 and the BSSO.

[Luka2020]

Although I don't have a lot of time to explain, my assessment is for a sliding genio where they slide diagonally upward. It will give you horizontal advancement which will help with lip support and will also vertically shorten your chin. Hence, you will be able to 'get away' WITHOUT the Lefort 1 and the BSSO.

Thank you for the answer Kavan. Do you think that the vertically shorter (left) part of the chin needs shortening as well? I agree that the right part is too long but that is due to asymmetry and crookedness. I am afraid that I would end up with a chin that is too short which is not a desirable trait I think. It is a hard decision and I don't want to let it completely to the  surgeons.

[kavan]

Thank you for the answer Kavan. Do you think that the vertically shorter (left) part of the chin needs shortening as well? I agree that the right part is too long but that is due to asymmetry and crookedness. I am afraid that I would end up with a chin that is too short which is not a desirable trait I think. It is a hard decision and I don't want to let it completely to the  surgeons.

The shorter side could still be shortened and not be too short.

[Luka2020]

The shorter side could still be shortened and not be too short.

Sorry for having so many questions and annoying you, but I will ask this also. Is there/ what is the drawback of the option 1: shaving down the longer part of the chin to match the shorter one and then advancing the chin straightly forward and not upward?

I will now explain my reason for asking this. There seems to be the least room for error in that scenario. To explain it further,
2 years ago I had a septorhinoplasty for an extremely crooked nose and very bad breathing. I did 6 months of research and chose what was supposed to be the best surgeon in the region. Well the end result is that my nose is now straight, I can breathe, but my profile changed for the worse a lot. And the worst part is: the profile wasn't supposed to change AT ALL - I was happy with it. The surgeon said afterwards that because of the severity of deformation he had to use grafts to fixate the nose and that was the reason it changed. I wouldn't have done the surgery if I knew how the result would look.
This is why I want the simplest possible approach. Shortening the chin might end up looking great, but also might end up looking not so great.

Thank you again!

[kavan]

A sliding genio is slide over a DIAGONAL cut. There are 2 directional displacement vectors; horizontal for outward projection and vertical for upward decrease in height. Both those displacement vectors would work for you. If you're really that concerned about the whole chin being too short after the longer side is reduced towards equalizing the sides, then ask the surgeon to do a predictive morph for you or something to show you what he anticipates via his plans. As I said in my first post, I don't have a lot of time to explain a lot.

Sorry for having so many questions and annoying you, but I will ask this also. Is there/ what is the drawback of the option 1: shaving down the longer part of the chin to match the shorter one and then advancing the chin straightly forward and not upward?

I will now explain my reason for asking this. There seems to be the least room for error in that scenario. To explain it further,
2 years ago I had a septorhinoplasty for an extremely crooked nose and very bad breathing. I did 6 months of research and chose what was supposed to be the best surgeon in the region. Well the end result is that my nose is now straight, I can breathe, but my profile changed for the worse a lot. And the worst part is: the profile wasn't supposed to change AT ALL - I was happy with it. The surgeon said afterwards that because of the severity of deformation he had to use grafts to fixate the nose and that was the reason it changed. I wouldn't have done the surgery if I knew how the result would look.
This is why I want the simplest possible approach. Shortening the chin might end up looking great, but also might end up looking not so great.

Thank you again!

[Luka2020]

Now I am even a bit more confused. If Kavan doesn't have time to explain, maybe somebody else would be willing to do it. I see a lot of you here have extensive knowledge about jaw surgery and I am trying to get a grasp of it.

Since the cut in a genioplasty is a diagonal one, that would mean that achieving only horizontal advancement is not possible and that vertical dimension has to be changed also. It would mean that the more horizontal advancement I would get, the more vertical reduction it would create. However, in reality (on the internet), I have seen genioplasties that were horizontal only, without a change to the vertical dimension. Could someone explain me, what does the cut look like in such situations and how does the surgeon move the bone so it doesn't cause vertical reduction?

I appreciate your answers!

[kavan]

I've looked at your photos and told you that you could get away with genioplasty only which would be a SLIDING genio (diagonal cut) which would BOTH horizontally advance and vertically shorten. I also told you (from looking at your photos), the shorter side could be shortened and not be too short. That's because you have a very SHORT distance between the base of your nose and the upper lip and a disproportionately long distance between the upper lip and the base of your chin even on the SHORTER side. Hence, the shorter side could be shortened and not be too short.

Advancing 'forward' over a DIAGONAL plane is just elementary geometry. There is a horizontal movement and and vertical one. Think advancing forward by climbing up a hill. There is both a horizontal movement and vertically upward movement and it depends on the INCLINE of the hill, the angle of inclination it has with the horizontal. Hence, a low ANGLE cut would maximize horizontal advancement and minimize vertical

Too many people on here lack elementary geometry concepts via illustrations which relate to a lot of these procedures. So, what I don't have time for is to give remedial tutorials in the concepts behind these things along with distance ratios that relate to areas of the face.

Again, my answer for CONSERVATIVE surgery and not full maxfax is a sliding genio along with making both sides of chin equal height (shortening the longer side).