genioplasty or jaw surgery, with simulation.

[Aleina8586]

Definitely achievable with genioplasty only. Your face is perfectly balanced and you don't have problems with your bite, getting jaw surgery is a bit extreme in your case.
I think you look great as it is but if the slight recession bothers you, a genioplasty can do the trick. Good luck!

[SJay]

@ForeverDet: Yeah, I'm hoping to go for something around the 8mm mark, but I've not heard Dr G do more than 6mm, and I've not got my paper consult back from them yet. SGSeeker recently got 6mm advancement with Dr Gunson, plus HA paste and I think her result is absolute amazing... this is one of my main motivations for going with Dr Gunson. I know many people are against the HA paste, but it seems A/G know what they are doing with the stuff and can create smoother, more naturally looking results as a consequence. Regarding other surgeons, I've consulted with three and one of them was in NYC – Dr Majid Jamli, is he the guy you are referring to? He has some good results and has provided me with a quote, but he doesn't provide morphs and I would like to see what we are shooting for before letting someone take a knife to my chin... another reason for my preference for Dr Gunson.

[SJay]

@asphyxia: Double jaw surgery, my bite is good so both jaws would need to be advanced, plus some rotation. They are in high demand and are therefore very busy, but everyone at the office has been very polite and friendly, Dr Gunson seems to have a warmth and understanding to him, which I really like... I don't know, perhaps I just got lucky!

Oh right, well I really hope that it went well and you're healing nicely! How far were you advanced? Do you mind sharing photos?

[SJay]

@Aleina8586: Thanks for your comments... you're far too kind! I really do hope that you're right. I don't even know how I'd even find the money for the jaw surgery, but I'm determined to fix the issue, one way or another, as it does bother me a lot. Hopefully the genioplasty will indeed do the trick!

[ForeverDet]

@ForeverDet: Yeah, I'm hoping to go for something around the 8mm mark, but I've not heard Dr G do more than 6mm, and I've not got my paper consult back from them yet. SGSeeker recently got 6mm advancement with Dr Gunson, plus HA paste and I think her result is absolute amazing... this is one of my main motivations for going with Dr Gunson. I know many people are against the HA paste, but it seems A/G know what they are doing with the stuff and can create smoother, more naturally looking results as a consequence. Regarding other surgeons, I've consulted with three and one of them was in NYC – Dr Majid Jamli, is he the guy you are referring to? He has some good results and has provided me with a quote, but he doesn't provide morphs and I would like to see what we are shooting for before letting someone take a knife to my chin... another reason for my preference for Dr Gunson.

No not Jamli.. I forget his name and I just searched a bit but can't find him. He was known as the chin doctor or something due to his expertise/experience. r.

Did gunson mention any vertical lengthening? I would push for 8mm. I had a bad reaction to HA (swelled/brused up way more than most people and still have a little bit of swelling on my cheek 2+ years later) so I would be cautious with that altho Idk if he would operate without it.

[SJay]

Sorry to hear about your bad reaction to the HA paste... I hope everything has settled down now though? I think I'd rather use it, if it's safe, as it seems it can certainly improve the cosmetic result! No, he actually mentioned a little shortening... sliding forwards and upwards, but I don't have exact measurements yet. I'm still waiting for my ortho to send them the models of my teeth.

[mike888miller]

also keep in mind that if he moves the bone 8mm you will only see about 75P.C. of that flowing through.

you are good looking from the front nicely proportioned between lower middle and upper but could use some lateral projection - have you discussed this also? i think it could boost your looks quite a bit.

[SJay]

Thanks! You mean lateral projection of the jaw/chin, when viewed from the front... widening? No, it's not something I've discussed with Dr Gunson. I hear it is possible with a sliding genioplasty, but it's not something I've seriously looked into.

[ForeverDet]

also keep in mind that if he moves the bone 8mm you will only see about 75P.C. of that flowing through.

you are good looking from the front nicely proportioned between lower middle and upper but could use some lateral projection - have you discussed this also? i think it could boost your looks quite a bit.

75p.c.?

[SJay]

75 percent? I've not heard this before... is it common knowledge?

[ForeverDet]

If he means percent, that's false. Genio has 1:1 ratio (bone/soft tissue) up to 8mm.

Which is consistent when I had mine and it was moved 8-9mm.

References: http://archfaci.jamanetwork.com/article.aspx?articleid=479824

[needadvancement]

I take it you guys are strictly talking about forward movement with SG right? I will soon get a SG with vertical movement as well. If I were to get 8mm for both movements won't there need to be bone grafting done as well? Same with a standard 8mm forward SG like TS I'm assuming.

[SJay]

@ForeverDet: I also heard that it was 1:1, thanks for the link.

@needadvancement: Yes, we're talking about forward movements, but I'd imagine you could have a vertical advancement of 8mm without grafting. I guess the question is, how far can osteoblasts jump? I mean, how far can you be advanced with a BSSO without the insertion of a graft? I'm no expert, so maybe someone with more knowledge can tell us...

[SJay]

Regarding BSSO, is it even still possible now that I've had 4 pre-molars (2 top, 2 bottom) removed? I only had them removed 18 months ago, so where does the space actually go, is it (or some of it) still there, perhaps in the back of the gums? If so, then couldn't I have my lower teeth pulled back to create an overbite, then have my lower jaw brought forward, perhaps with a small genio too? I think this would achieve a much better cosmetic result, it would avoid a large genio thus avoiding the problems with the metoloabial fold and it should also give me a stronger face when view from the front. It seems a BSSO can sometimes give the allusion of a wider jaw, and more define jaw structure in general. As always, your input is much appreciated!

[ForeverDet]

Regarding BSSO, is it even still possible now that I've had 4 pre-molars (2 top, 2 bottom) removed? I only had them removed 18 months ago, so where does the space actually go, is it (or some of it) still there, perhaps in the back of the gums? If so, then couldn't I have my lower teeth pulled back to create an overbite, then have my lower jaw brought forward, perhaps with a small genio too? I think this would achieve a much better cosmetic result, it would avoid a large genio thus avoiding the problems with the metoloabial fold and it should also give me a stronger face when view from the front. It seems a BSSO can sometimes give the allusion of a wider jaw, and more define jaw structure in general. As always, your input is much appreciated!

What do you mean by "where does the space actually go" in regards to your molars? Regardless, removing molars doesn't not exclude you from BSSO. I had them removed as a teenager as have many people.

As far as retracting your bottom teeth... I don't know if that is viable although I'm not 100% sure what you mean there either. Do you mean use orthodontics to cause your bottom to shift/tilt backwards to exaggerate the overjet (horizontal distance between lower teeth and upper teeth)?

Generally during decompensation pre-surgery for class II cases like yours, there will always be an exaggeration of your bite to maximize movement during surgery. So the ortho will flare out your upper incisors primarily while straightening any crowding then during surgery, the lower jaw can be moved further forward because the upper teeth were flared, correcting the recession and leaving you in a class I bite position. And using counter-clockwise rotation, you can advance the lower jaw even more forward if needed (in the cases of significant recession, vertical maxillary excess,etc.) which would otherwise not be possible with standard double jaw advancement.

Unfrotunately, occlusal rotation is still not taught or used by many (most?) surgeons so they'll compensate the insufficient lower jaw advancement by adding a large genioplasty which often does not give a optimal aesthetic result.