Genioplasty date confirmed but unsure about expected outcome.

[girl]

Well, the NHS's job is to tightly screen patients for suitability (free surgery). They don't routinely offer IVF to women in their early 40s. So maybe there's a certain cut-off point for jaw surgeries too.

Have you looked into a custom wraparound implant? This guy is very receded and the after is dramatic (too long, mind you) - but it does give a sense of what can be achieved with that method. If you could get something similar without so much excessive drop, I think it would be good. But I don't know what's really possible with these implants myself. Just posting this here for your reference:

[tdawg]

Unfortunately, that mandible angle is too steep for genio to be much use. It might improve your situation, but it might also result in a deep, unnatural labiomental fold. What you truly need is a pretty significant CCW rotation. At least that's what I see. Did you see an orthognatic surgeon for opinion?

So I talked to Dr. Francq about my situation via email and he said he thinks a vertical shortening, horizontal advancement genioplasty with "bony filling of the labiomental fold" is all I need. This may be an option for OP as I imagine the bony filling he refers to is to counter the deep labiomental fold you warn of.

[kavan]

So I talked to Dr. Francq about my situation via email and he said he thinks a vertical shortening, horizontal advancement genioplasty with "bony filling of the labiomental fold" is all I need. This may be an option for OP as I imagine the bony filling he refers to is to counter the deep labiomental fold you warn of.

It might be all YOU need. But info for you might not apply to the OP who has extensive chin retrusion.

[GJ]

So I talked to Dr. Francq about my situation via email and he said he thinks a vertical shortening, horizontal advancement genioplasty with "bony filling of the labiomental fold" is all I need. This may be an option for OP as I imagine the bony filling he refers to is to counter the deep labiomental fold you warn of.

In your emails to him, did you or he mention filling the fold first? If him, cool, but if you mentioned you know that it needs to be filled to prevent a large groove, then you basically biased his answer.

[tdawg]

In your emails to him, did you or he mention filling the fold first? If him, cool, but if you mentioned you know that it needs to be filled to prevent a large groove, then you basically biased his answer.

He mentioned it, I had no idea that was even something that was done.

[tdawg]

It might be all YOU need. But info for you might not apply to the OP who has extensive chin retrusion.

Agreed but OP is short on alternatives since jaw surgery isnt an option. Its something worth looking into.

[kavan]

Agreed but OP is short on alternatives since jaw surgery isnt an option. Its something worth looking into.

Sliding genio doesn't look like it will do much for him either given the extent of retrusion. He would probably need a bone block buttress between separation of chin cuts.

It sounds like in your case, you want to address what you feel is some residual 'longness' to the face?  If so, the sliding genio advancing forward and up on a diagonal cut to give some projection and to shorten but where the bone paste fill in would be modest.

Did you not get that with your initial VME max fax surgery?

[tdawg]

Sliding genio doesn't look like it will do much for him either given the extent of retrusion. He would probably need a bone block buttress between separation of chin cuts.

It sounds like in your case, you want to address what you feel is some residual 'longness' to the face?  If so, the sliding genio advancing forward and up on a diagonal cut to give some projection and to shorten but where the bone paste fill in would be modest.

Did you not get that with your initial VME max fax surgery?

No the chin wasnt touched at all. Let me ask you since you seem to know about this. I feel like I still have some lip incompetence, mostly from the lower not coming up far enough to cover my lower teeth(I still show some upper teeth at rest but according to my orthodontist that is normal and a good thing given that the upper lip droops with age) . Do you think that genioplasty plan would help with that? To be honest, I am hesitant and want to wait until I see Gunson in June before I do anything that would complicate things further but it does seem like most long face syndrome patients have a genioplasty performed. In my case the surgeon never mentioned it.

[kavan]

No the chin wasnt touched at all. Let me ask you since you seem to know about this. I feel like I still have some lip incompetence, mostly from the lower not coming up far enough to cover my lower teeth(I still show some upper teeth at rest but according to my orthodontist that is normal and a good thing given that the upper lip droops with age) . Do you think that genioplasty plan would help with that? To be honest, I am hesitant and want to wait until I see Gunson in June before I do anything that would complicate things further but it does seem like most long face syndrome patients have a genioplasty performed. In my case the surgeon never mentioned it.

Well, in general, lip incompetence is from chin muscle (mentalis strain). The strain is made less when the movement of the muscle is more on a VERTICAL plane and not on a diagonal. If the chin is too backwards, then the orientation is backwards diagonal. Think of a right angle where the distance of the hypotenuse is longer than the distance of the vertical leg. So, one drops a vertical line from the lower lip and advances the chin 'somewhat to slightly' posterior to the line so the mentalis orientation is more vertically aligned which makes less the strain associated with lip incompetence.

This is from a mechanical geometric perspective. I'm not a doctor. However, the mechanics or geometry of it pretty much explains why chin advancement is done to ease that type of strain. However, IF someone has a very recessive chin, there's also a mechanical 'limit' as to how far it can be advanced without stretching the mentalis muscle which is yet another strain on it.