x-rays/pics- advice on SG/chin augmentation

[needadvancement]

^I am not sure, I'm just going by what the page of the website is saying. I think his mouth looks the same on the side shot, but the picture below where you see the front I think he may be jutting his jaw down a little bit to make his chin look even longer. Don't some surgeons use this sort of minor optical illusion to enhance the results a tad bit more?

[needadvancement]

Also I forgot to ask, I have a cleft chin and ideally I'd want it gone, would these chin augmentations get rid of it? It's not that big of a deal but it'd cool if I could kill two birds with one stone.

[dantheman]

I wouldn't get anything done. Maybe you don't have an ideal profile, few people do. I think if anything you have some maxillary prognathism and thick subnasal tissue (if that makes sense). Your profile reminds me of my own in some ways (we also both have prominent brow ridge, though we have very different issues (I have steep plane and class II jaw relationship).

If you get something done, do a chin visor / wing. You don't have the profile of someone with sleep apnea, with a fairly acute cervicomental angle (this is helped by your predominantly forward growth pattern)

[needadvancement]

I wouldn't get anything done. Maybe you don't have an ideal profile, few people do. I think if anything you have some maxillary prognathism and thick subnasal tissue (if that makes sense). Your profile reminds me of my own in some ways (we also both have prominent brow ridge, though we have very different issues (I have steep plane and class II jaw relationship).

If you get something done, do a chin visor / wing. You don't have the profile of someone with sleep apnea, with a fairly acute cervicomental angle (this is helped by your predominantly forward growth pattern)

Do you mean in terms of surgery don't get anything done? Because my orthodontist assured me that the forward growth of the subnasal tissue is caused by my front teeth tipping forward and that it can be improved with braces pulling them in. If I look at my brother who looks a lot like me with mostly the same genetics, he does not have this protrusive looking tissue and I can see from his teeth that his are in a straight line. All of this is what convinced me to get the braces.

You may be right, maybe I won't get any surgeries at all if I'm happy with the results from the braces for my profile(honest, surgery is a scary idea still, so I'm carefully considering it). For years I have felt subconcious about my mouth, I do weird things with it sometimes when I'm out in public like bite on my lips etc. I will update later on how I'm feeling about it.

[dantheman]

I'm no expert by any stretch, but google "cephalogram" and get a feel for what other people's x-rays look like. I would say your upper incisors appear well within normal limits. If anything, I think people look worse with their upper teeth pulled back... You can end up with a nose hump and increase in your nasolabial angle. In fact I think you might even end up with a MORE prominent nose. Allow the others to weigh in on this.

If I were you I would NOT get braces for the purpose of pulling your upper incisors back. They play a role in upper lip support. Perhaps you have an element of maxillary prognathism, but I firmly believe that pulling the teeth back at this stage is to your detriment. We all have different growth patterns and a band-aid fix of one component only is unlikely to lead to satisfactory results.

Again, the above is only my non-expert opinion.

[notrain]

I wouldn't get anything done. Maybe you don't have an ideal profile, few people do. I think if anything you have some maxillary prognathism and thick subnasal tissue (if that makes sense).

I have to disagree with you on this one. He doesn't have maxillary prognathism, he has an Anteinclination of the Maxilla. This means his Maxilla has basically grown in a CCW Vector where the back is lower than the front which causes upturn of the nose and this illusion of thick subnasal tissue. Right now his dentition compensates for that as his maxillary and mandibular incisors have overerupted to meet regardless.

I know this because I have the exact same thing going on (I will have a slight anterior open bite once fully decompensated). This is a jaw deformity in its own right but it is visually way less offensive than having a hyperdivergent (loooooooong) face.

In addition to that he has mandibular anterior-posterior deficiency for which he needs a BSSO of the mandible.

And lastly his chin bone hasn't grown downwards because the mandible adapted to the ccw growth vector of his maxilla, so he needs genioplasty as well (moving it back and down).

So, while OP doesn't have the obviously retarded long face mouth breather double chin look, he is just as deformed - medically speaking. A chin wing wouldn't fix even 10% of his issues because his entire lower face is way too short because of his growth pattern - his lower mandibular border is parallel to the floor for god's sake.

[needadvancement]

@dantheman. I see, I will make sure to present these questions to my orthodontist the next visit. Braces can surely have an impact on the look of the face, I certainly don't need a trade off where my other features would worsen, but how could it possible create a nose hump at this age? lol.

@notrain. Ok after a lot of googling I think I'm finally starting to understand my facial development and deficiencies. But I'm not sure if it's accurate to desribe it all as complete deformities as I don't have any health problems due to this at all except for some minor crowding in the lower mandibular incisors. In fact my oral posture is near perfect, and indeed my face is quite broad and normal looking from the front, it's just the comically short chin that ruins my face. I would like to hear your opinion on the orthodontic treatments I will persue next year if you can, do you think I can improve the issue of the subnasial tissue with braces? And without risking other issues like dantheman theorised?

Thanks to both.

[dantheman]

Notrain, SNA > 90 degrees. This is prognathism by definition. Yes, ultimately there is a hypodivergent growth pattern but that can just be genetic and by no means is it definitively pathological. I also don't see how one concludes that the incisors are over erupted, as if this were the case his mandibular plane would be steeper and there would be a greater disparity between his mandibular and occlusal planes.

I also was under the impression that upturning of the nose is caused by vertical maxillary excess, or just do to genetics...

Ultimately, I agree that clockwise rotation seems plausible, but unless there are functional issues, why would one pursue this? I'm sure there are many brachycephalic celebrities out there.

[notrain]

Notrain, SNA > 90 degrees. This is prognathism by definition. Yes, ultimately there is a hypodivergent growth pattern but that can just be genetic and by no means is it definitively pathological. I also don't see how one concludes that the incisors are over erupted, as if this were the case his mandibular plane would be steeper and there would be a greater disparity between his mandibular and occlusal planes.

he does have excessive curve of spee (two plane occlusion) in his lower jaw and the tip of the maxillary incisors is lower than the chewing surface of his molars. I don't want to draw on OPs ceph and post it here without permission. EDIT: you have seen my ceph. I am brachycephalic with a flat mandibular and occlusal plane as well and my mandibular incisors are severely overerupted - as are the upper incisors.

I also was under the impression that upturning of the nose is caused by vertical maxillary excess, or just do to genetics...

If the anterior part of the maxilla is turned upwards, then the nose turns upwards too. It's visible on his ceph (in my opinion)

Ultimately, I agree that clockwise rotation seems plausible, but unless there are functional issues, why would one pursue this? I'm sure there are many brachycephalic celebrities out there.

He came here because he wants to look better. If he wants to accomplish lengthening his lower face, he needs CW rotation. I agree that it is not necessary but who am I to tell people what they should be doing with their money and body ?


@needadvancement

don't get ortho treatment without surgery. it will only worsen your appearance. if you don't want to get jaw surgery, a chin wing is indeed your best bet. but it will not yield close to the same result as bimax cw advancement. i would consult with surgeons and make a decision sometime next year.

[needadvancement]

@notrain feel free to do so, you have my permission. Also could you elaborate on how ortho would worsen my appearance? Keep in mind they will not extract any teeth. They're gonna fix the crowding and straighten the rest, I think it's only my incisors where a noticable change could be made. Also I forgot to mention, when I come in in a couple of weeks they have a digital method where they can see the future results on the computer, I think could be very helpful if it's a realistic preview of what the results could be. It's called Insignia.

[notrain]

nonextraction ortho would be fine. I thought they were going to extract the 4 first premolars in each jaw and pull the rest back. but you should be aware that the aesthetic improvement of moving teeth around is quite small - you will not look much different. especially the chin will not change at all from doing this.

[needadvancement]

Well I am counting and hoping on the braces lessening the subnasial protrusion, which in turn would actually make my chin look more prominent. I have actually photoshopped this on pictures of myself several times, and I can safely say this would improve my profile.

Indeed the chin itself won't change, that is why I may consider a SG lengthening in the future. I am really hoping that the plan that I have come up with(ortho+genio) could mask my deficiences and improve my lower half of the face. It would be a great success because again, I do not have any breathing/chewing problems etc. Avoiding an evasive jaw surgery+specific ortho would be my goal.

[dantheman]

I don't want to dissuade you, but I highly doubt you will notice much if any change to your profile with non-extraction orthodontics.  Have you gotten a second opinion from another ortho?

[needadvancement]

No I haven't, even a consultation is quite pricy at the moment. Well I am not banking on a big change, I realise other people may not notice it but I definitely would notice any change on myself. They say every milimeter on facial features matters, and if I could just get my upperlip pulled back maybe even 2 milimeters it would already be a good change for my lips placement(I would accept that over extractions that do give a major change). I guess this is something I'm doing for myself. I'm definitely going to press this issue at my next visit, I would expect a competent orthodontist to be truthful with me, so he should not get my hopes up either.