Jaw implants vs Chin wing

[DaveE]

OK I went to the maxfax and he told me that I have a class 2 skull = small mandible, I had braces and my bite is fine when I was younger.  I also had a chin implant which I'm happy with but the rest of the mandible is still small.
He recommended me to get costume jaw implants.
I talked to him about chin wing , he has 0 experience with it though. He told me that it's not a good option because when the mandible is small you don't really have enough material to work with so they have to harvest bone, and that bone often get observed by the body over time.
Also from what I saw (before afters) the result for men aren't that impressive, it looks to me that you simply can't get a strong jawline with a chinwing, because all they do is move your own bone, they don't reshape it.

Discuss.

[Bazarov]

Yes, if you need large amounts of augmentation, chin wing isn't likely to give you what you need.

[Alue]

Do you mean absorbed by the body over time?  I was thinking we may have similar issues, but man, looking at your ceph you appear to have a normal class I occlusion, I don't know what he's talking about class II skull. 

[DaveE]

I would need 0.5-0.7mm in order to have a good jaw.
Does it worth the chin wing?

[Optimistic]

It's hard to say. On the one hand yes, if your mandible is very small you won't have much to work with so augmentation is limited (but still substantial). Like all surgeries it depends greatly on your starting point.

That said, a chin wing can be repeated every 10 months. If one were to be particularly implant averse I'm sure it'd be possible to just keep repeating it until you get a result you're happy with.

By the way, the results for implants tend to be average too. You need to consider that you probably have a small skull. Putting a large jaw on that looks ridiculous and out of place 99% of the time. It looks 'off' to have weak and narrow bones for the upper two thirds yet a powerful lower third. In that sense I think a chin wing could provide a good aesthetic balance on the first go.

[DaveE]

It's hard to say. On the one hand yes, if your mandible is very small you won't have much to work with so augmentation is limited (but still substantial). Like all surgeries it depends greatly on your starting point.

That said, a chin wing can be repeated every 10 months. If one were to be particularly implant averse I'm sure it'd be possible to just keep repeating it until you get a result you're happy with.

By the way, the results for implants tend to be average too. You need to consider that you probably have a small skull. Putting a large jaw on that looks ridiculous and out of place 99% of the time. It looks 'off' to have weak and narrow bones for the upper two thirds yet a powerful lower third. In that sense I think a chin wing could provide a good aesthetic balance on the first go.

http://jawsurgeryforums.com/index.php/topic,4093.0.html

My main goal is so add llike 0.6 mm to the ramus.. maybe just 0.2mm width (if any).

My correct concerns are that I already had a chin implant, chin wing is expensive and can safely be done by about 2-3 surgeons that are all out of my country, general longer recovery period then implants and a risk for a nerve damage.

[Optimistic]

http://jawsurgeryforums.com/index.php/topic,4093.0.html

My main goal is so add llike 0.6 mm to the ramus.. maybe just 0.2mm width (if any).
Very realistic, in my opinion.

My correct concerns are that I already had a chin implant, chin wing is expensive and can safely be done by about 2-3 surgeons that are all out of my country, general longer recovery period then implants and a risk for a nerve damage.
Recovery is not that long, and there is no real risk for nerve damage. You'll be made to have a scan to ensure there isn't a nerve running in the way of the planned osteotomy.

The problem is not so much who can perform the chin wing so much as who can provide you with the best labiomental fold / chin area. I've seen a few chin wings and didn't like the appearance of that area - it appeared too unnatural. That is one of the main reasons for my choosing the surgeon I did.

[PloskoPlus]

Implants without exception cause erosion. Talking from experience. CT scan will most of the time show (both medpor + silicone cause erosion). If it doesn't instantly show up in the scan, a surgeon opening up should be able to see. (Implant -> permanent inflammation of tissues -> erosion).

Even if the implant is screwed in? What personal experience do you have? A max fac I talked to said "muscles want to be next to bones".  He only used them when there was no other option - someone's face being really busted up in an accident, and only custom shaped medpor then.  Then there is also the infection risk to consider.

[PloskoPlus]

Yes, even if the implants are screwed in (which was the case: there are several screws visible in the scan, but there is clearly a good amount of erosion visible).

What kind of implant did you have?  Was it easy to take out?

[Vic]

What kind of implant did you have?  Was it easy to take out?

There's the new PEEK implants now

[PloskoPlus]

medpor (not easy to get out).

You mean peek and medpor are one and the same?

[BlueShark7]

What about titanium implants? Surely that wouldn't cause erosion in the same way... otherwise all orthopedic surgery would cause bony erosion

[falcao]

Implants without exception cause erosion. Talking from experience. CT scan will most of the time show (both medpor + silicone cause erosion). If it doesn't instantly show up in the scan, a surgeon opening up should be able to see. (Implant -> permanent inflammation of tissues -> erosion).

The chin wing is interesting and I've seen several terrific results also years post-operative, that looked less fake than implants, but there are so many things not clear to me.
- Is the incision always intra-orally and along the complete border/below the gumline of the lower dental arch?

- I don't get the cut that is made. No matter what drawing I make and how I place the cut, if I'd like to have some more drop down in the jaw angle (that is now roughly 110 degrees, with a nice vertical ramus)/like to have a bit longer ramus, and a bit more forward projection in the chin without too much elongation of the chin (just a little bit), as a result
1) The lower part of the jaw angle/ramus moves forward when the chin wing is moved forward. As a result you get a 'step off' in the ramus.
2) If you want to change the tilt of the jawline a bit, and make it for example a bit less steep, when the chin wing is rotated, the lower part of the ramus would also tilt a bit backwards. You would never end up with a nice vertical ramus that way it seems to me. (The step off in the ramus aside). Unless the chin wing is kept in the same position/not rotated when it is moved forward, and the border of the lower mandible is shaved down in its entirety to make the jawline less steep: but is this even possible/done? That seems rigorous to me.

3) The step off in the ramus could be counteracted, if the chin wing is cut in some places. But then you will end up with step off's along the jawline. (which is what I don't like about a genioplasty).

You never can get a nice elongated vertical ramus without step off in the ramus it seems to me. Unless I'm just not looking into things correctly. Or unless, the hip bone graft is also used to build up a new ramus/jaw angle, but I haven't heard of that.

Yes, I had a chin implant before my jaw surgery and the x-ray showed SIGNIFICANT erosion to the bone. I have an early x-ray from that time if anyone wants to see it.

Implants are still common because the idea is the bone erosion will be (much) less than the actual gain from the implant. Also, the main erosion happens in the first 6 months or so. After that, it's apparently stable. So, it's not like the bone will continue to erode for the rest of your life.

About the chin wing - no, you are not looking into things correctly, as you put it yourself. You neglect the fact that they use a bone graft in the process.

In my case (and I think in 90% of the other cases), they took a HUGE bone graft from the hip. So, if you account for the bone graft into your equations, you'll realize that no, a step off is not typically a result of this surgery, and yes, you can lengthen your ramus considerably in the vertical direction.

[Rico]

Falcao: You said 3 months ago, that someone is gonna to write me about MM and that person has not responded . what happened ?

[falcao]

I only said I would ask him if he would like to talk to you, he chose not to.

You have to understand that for most people a failed or even worse, as in the case with Mommaerts, botched surgery is a devastating experience. We go through a long period of depression. If one manages to get out of that depression that cost you a year of your life or more, they try to move on and the last thing they want to do is talk to absolute strangers about their devastating experience which may provoke relapse into depression.

Most people on this board (99%) have not had a surgery before. Those who will have a surgery will disappear forever immediately after the surgery. It's the way most people think/function, unfortunately. Most people couldn't care less about reaching out and giving back what they have taken from this board (information, knowledge). There are very few (I can count them on the fingers of my hand) who have had a surgery and are still here, trying to help and reaching out to people like you. The person I mentioned in private correspondence to you unfortunately decided he didn't want to talk to you, for personal reasons .