Orthognatic surgery to fix assymetric jaw?

[Sassa]

Hi!

Im a new member and very happy to find this forum! English isn't my first languauge so please have some forgiveness!

I'm very dissappointed with some aspects on my face. I have some overgrowth on my left side and my jaw is deviated which makes my right profile very short vertically while my left profile looks ok. My face and upperlip are assymetrical which makes my front view look weird. I'm also very unhappy with my convex and pointy profile due to my small mandible (?) or perhaps the receeded chin?

Anyway, I've been concerned over these things for a long period of time. 2 years ago I discovered there is something called orthognathic surgery and found out that I might have Class II malocclusion through some own reading.

I went to my dentist and explained everything. The dentist did an examination and then dissmissed my concerns and told me that I was overreacting. She told me that my bite was good and that I wouldn't need any braces or orthognatic surgery.

I haven't done anything since then even though I'm still concerned. I dont think my insurance will cover anything because I dont have any practical problems so I'll propably pay everything out of my own pocket. I've decided to take a few pictures and wonder if I can have some opinions on whether orthognatic surgery could fix these problems or not?

Pictures of face: http://img269.imageshack.us/img269/5231/face2b.png (assymetry and different vertical hights on both profiles)
Pictures of teeth: http://img856.imageshack.us/img856/7808/teeth.png (deep overbite, overjet and dental midline is off?)

Thanks for taking your time!

[Marisama]

Sassa, 

Hi there. Welcome to the forum. My asymmetry is similar to yours. You can see pictures on my blog link below. If your asymmetry bothers you, orthognathic surgery is definitely an option. Where are you from?

[Sassa]

Thanks!

I'm from Sweden. I looked through some of your pictures and I agree that we have similiar assymetry. What kind of surgery are you going to have?

  The problem here in Sweden is that we don't have any private surgeons so I'll propably travel to to Italy or something to get an consultations, just wanted to know if its possible to fix it with orthognathic surgery before bookings appointements etc!

For how long time will you have braces?

[Eroica]

Your mandible is barely receded and your overjet is pretty minor. I think you would be a good candidate for a sliding genioplasty. Your chin is too vertically short and (slightly) underprojected. I can see the assymetry but honestly I'm not sure I'd bother with full orthognathic surgery if my problem was so minor.

Your profile is well within the normal range, by the way, so there is no need to be "very disappointed" with how you look!

[Heavyweight]

Your mandible is barely receded and your overjet is pretty minor. I think you would be a good candidate for a sliding genioplasty. Your chin is too vertically short and (slightly) underprojected. I can see the assymetry but honestly I'm not sure I'd bother with full orthognathic surgery if my problem was so minor.

Your profile is well within the normal range, by the way, so there is no need to be "very disappointed" with how you look!

I actually think his profile is pretty weak and unmasculine. But I do agree that a sliding genioplasty is a better option than orthoganthic surgery, unless he has significant bite or breathing problems.

[Sassa]

Perhaps you're right. I've thought of genioplasty before but would that work? I mean because of the deviated chin, wouldn't it make it worse? Or is it possible to fix the vertical height on one side only? My dental midline is still off by 4 mm and it looks even worse when I open my mouth...

[Eroica]

I actually think his profile is pretty weak and unmasculine. But I do agree that a sliding genioplasty is a better option than orthoganthic surgery, unless he has significant bite or breathing problems.

I think the profile looks slightly weak because of the lack of vertical height in the chin rather than as a result of much mandibular recession. He needs what these folk had done, a genioplasty to add both horizontal and vertical projection.

http://exploreplasticsurgery.com/wp-content/uploads/2011/08/vertical-chin-lengthening-result-side-view-dr-barry-eppley-indianapolis.jpg
http://archfaci.jamanetwork.com/data/journals/faci/11755/m_qst30003f11.png

Perhaps you're right. I've thought of genioplasty before but would that work? I mean because of the deviated chin, wouldn't it make it worse? Or is it possible to fix the vertical height on one side only? My dental midline is still off by 4 mm and it looks even worse when I open my mouth...

The chin assymetry can be improved via genioplasty.

Your midline doesn't look too bad. A slightly off midline is not a "kiss of death" aesthetically.



Still, it's well worth consulting with an orthognathic surgeon and relaying your concerns.

[Sassa]

Ok, thanks for the input! I'll look it up! I thought I needed a bimax surgery where the jaws would need upward rotation because of the gummy smile on one side. It would also bring my chin and mandible forward. Also fix the deep bite to get more vertical length. Perhaps a genioplasty is enough to fix the weak profile and the assymetry.

Thanks!

[neferkitti]

I think you look pretty good. Your jawline is ideal and your chin is masculine. A genioplasty can potentially give a pointy appearance. Not in all cases, but in most. I wouldn't change a thing. As for your left side, there is some minor asymmetry, but it's not at all noticeable. There is a left side cant and a deep bite. Perhaps this could be addressed with orthodontics alone, at least the deep bite can be opened up a bit. But, if your bite is comfortable now, I don't know if I'd risk changing things for a minor cosmetic benefit.

[Eroica]

A genioplasty can potentially give a pointy appearance. Not in all cases, but in most.

That's not entirely true. The "pointy" appearance results when you advance a vertically short chin too far forward without increasing it's vertical height. If you extend the chin in both dimensions it will advance the labiomental groove and the whole chin structure forwards - in effect making the chin less pointy. See the pics below. Compare the aesthetic result of a short chin that has been extended both vertically and horizontally to one that has been extended in the horizontal only.

http://exploreplasticsurgery.com/wp-content/uploads/2011/08/vertical-chin-lengthening-result-side-view-dr-barry-eppley-indianapolis.jpg
http://www.lovethatface.com/_clientfiles/images/chin2.jpg

Though, to really judge I would need to see a picture of Sassa with his head held in a more natural position. In the pictures provided it is titled backwards, which has the effect of masking a recessed profile.

[Sassa]

Thank you for the responses. I'm reconsidering a genioplasty right now. I'll try to consult with a surgeon who is specialized in both orthognathic surgery and genioplasty and ask for his/her advices to get rid of my convex and short face.

Your midline doesn't look too bad. A slightly off midline is not a "kiss of death" aesthetically.

I was actually reffering to my dental midline in my mandible and I guess that's why I also have a deviated chin. Anyway that's why it looks worser when I speak because my mandible doesn't open straight down but instead a little to the right because of the deviation.

Though, to really judge I would need to see a picture of Sassa with his head held in a more natural position. In the pictures provided it is titled backwards, which has the effect of masking a recessed profile.

I didn't realized I was tilting my head. I was sitting on a chair and looked on a spot in front of me. I'm originally an assyrian and our skull/face often have a dinaric type which is characterized with a very convex face (slanted forhead, prominent nose and a receeded chin.)

Like this: http://i781.photobucket.com/albums/yy91/nt_1488/clasificacion/dinaric11.jpg

My nose is slightly tilted upwards and thats why it might look like my face is tiltet?

Anyway I'll attach 2 other images I've taken with my bad camera while im standing up. Hope it helps to get a better picture of my issues?

http://imageshack.us/f/837/mobileface.png/

Thanks again for your input, helps me alot to know how to deal with it!

[neferkitti]

That's not entirely true. The "pointy" appearance results when you advance a vertically short chin too far forward without increasing it's vertical height. If you extend the chin in both dimensions it will advance the labiomental groove and the whole chin structure forwards - in effect making the chin less pointy. See the pics below. Compare the aesthetic result of a short chin that has been extended both vertically and horizontally to one that has been extended in the horizontal only.

Okay, I see what you mean. Perhaps I should have used "bulbous" instead of "pointy". I like Sassa's chin width and smile in front view. Would a vertical advancement change that? The chin width compliments his overall facial structure, IMO. Too bad we cannot see the movement deviation that Sassa doesn't like.

http://www.lovethatface.com/_clientfiles/images/chin2.jpg

Correct me if I'm wrong, but didn't this patient have advancement BSSO only?

Sassa, would you be able to post smiling profile photos?

[Eroica]

Okay, I see what you mean. Perhaps I should have used "bulbous" instead of "pointy". I like Sassa's chin width and smile in front view. Would a vertical advancement change that? The chin width compliments his overall facial structure, IMO. Too bad we cannot see the movement deviation that Sassa doesn't like.

The chin width and smile should not change. However, a vertical lengthening genioplasty can have the effect of lowering the bottom lip somewhat, but this is usually aesthetically beneficial because people with short lower thirds tend to have a "bunched up" lower lip. I have this and Sassa appears to have it slightly.

Correct me if I'm wrong, but didn't this patient have advancement BSSO only?

He had a silicone chin implant. The doctor who placed the implant is clearly clueless because this patient already had a prominent chin button.

http://www.lovethatface.com/cosmetic-facial-surgery-richmond-va/chin-surgery.aspx

A maxfax surgeon would probably want to advance both of his jaws forward while performing a genioplasty to reduce the horizontal projection and increase the vertical height of the chin.

[neferkitti]

The chin width and smile should not change. However, a vertical lengthening genioplasty can have the effect of lowering the bottom lip somewhat

Are you referring to more lower incisor show? I don't see the bunching. Sassa has good lips from my point of view.
 

He had a silicone chin implant. The doctor who placed the implant is clearly clueless because this patient already had a prominent chin button.

http://www.lovethatface.com/cosmetic-facial-surgery-richmond-va/chin-surgery.aspx

Good grief. I wonder if he had that removed, then told all to avoid that plastic surgeon. 

[Sassa]

Sassa, would you be able to post smiling profile photos?

I've added some profile photos when I smile. It doesnt look like my chin is receeded. Also the balances between cheeks, nose and chin looks way better when I smile.

http://imageshack.us/photo/my-images/59/profiletg.png/

And here are some pictures from another angles...
http://imageshack.us/photo/my-images/688/axis1.png/
http://imageshack.us/photo/my-images/20/axist.png/