Seeing ortho/maxillofacial tomorrow - recessed chin help advice needed

[CuttySark878]

Not sure what to do about my recessed chin/small lower jaw...

I started with a 9mm overjet so I had two upper premolar extractions to camouflage it. I was also offered the option of upper and lower jaw surgery (bring lower jaw forward and rotate both jaws) which I turned down at the time.

I ended up have second thoughts after my extractions so went to see a max-fac orthodontist who told me that I could still have surgery afterwards if I changed my mind. Also if I was to have surgery now I would require bridges to fill in the gaps plus lower extractions compared to after the treatment of camouflaging. Also he warned me that my nose would get wider and its already wide enough.
He felt that the pushing back of my upper teeth would mask my receded chin. But if I still felt unhappy after this treatment then I should return to see him at the hospital afterwards.

Therefore I went ahead with the camouflage route first.

Fast forward 3 years and my overjet is now mostly gone. Due to have my braces removed next week. But I am still unhappy about my chin.

So I have arranged to meet this orthodontist at the hospital one last time tomorrow. I am feeling sooo nervous as its like my last chance to get this sorted.

Here are the details of the proposed surgery option from 2 years ago which he said would most likely not be too dissimilar from the surgery they would plan without camouflage treatment or with. I quote what he said in the letter:
"With his increased lower face height and tendency to an anterior open bite, he is most likely going to require a bi-maxillary procedure, and orthognathic treatment is going to be difficult to give him full chin prominence, due to the proclamation of the lower incisors, and so there would be an element that we would most likely need some occlusal plane alteration during the osteotomy to give him greater chin prominence, as well as having presurgical orthodontic decompensation with retroclination of the lower incisors.
All in all, I am not sure that his chin is so severely retrognathic that it really justifies all the excessive work of an orthognathic treatment."

So my main concerns are:
- widened nose from the above treatment
- lengthy treatment time of the above
- risks involved from the above surgery

He also mentioned a chin implant to me thus I am considering a sliding genioplasty.

Here are 4 photos of me front, side, angle and my smile (you can see that there is no overjet now )
https://ibb.co/m4B18R
https://ibb.co/fns8oR
https://ibb.co/cqAHhm
https://ibb.co/gq8Ra6

Thanks

[Lefortitude]

looks class 2.  likely have a steep occlusional plane.  would benefit from surgical intervention.

[kavan]

You would benefit by max fax surgery; both jaws and sliding genio for chin. It will require time in braces in the opposite direction than what you had.

Not sure what to do about my recessed chin/small lower jaw...

I started with a 9mm overjet so I had two upper premolar extractions to camouflage it. I was also offered the option of upper and lower jaw surgery (bring lower jaw forward and rotate both jaws) which I turned down at the time.

I ended up have second thoughts after my extractions so went to see a max-fac orthodontist who told me that I could still have surgery afterwards if I changed my mind. Also if I was to have surgery now I would require bridges to fill in the gaps plus lower extractions compared to after the treatment of camouflaging. Also he warned me that my nose would get wider and its already wide enough.
He felt that the pushing back of my upper teeth would mask my receded chin. But if I still felt unhappy after this treatment then I should return to see him at the hospital afterwards.

Therefore I went ahead with the camouflage route first.

Fast forward 3 years and my overjet is now mostly gone. Due to have my braces removed next week. But I am still unhappy about my chin.

So I have arranged to meet this orthodontist at the hospital one last time tomorrow. I am feeling sooo nervous as its like my last chance to get this sorted.

Here are the details of the proposed surgery option from 2 years ago which he said would most likely not be too dissimilar from the surgery they would plan without camouflage treatment or with. I quote what he said in the letter:
"With his increased lower face height and tendency to an anterior open bite, he is most likely going to require a bi-maxillary procedure, and orthognathic treatment is going to be difficult to give him full chin prominence, due to the proclamation of the lower incisors, and so there would be an element that we would most likely need some occlusal plane alteration during the osteotomy to give him greater chin prominence, as well as having presurgical orthodontic decompensation with retroclination of the lower incisors.
All in all, I am not sure that his chin is so severely retrognathic that it really justifies all the excessive work of an orthognathic treatment."

So my main concerns are:
- widened nose from the above treatment
- lengthy treatment time of the above
- risks involved from the above surgery

He also mentioned a chin implant to me thus I am considering a sliding genioplasty.

Here are 4 photos of me front, side, angle and my smile (you can see that there is no overjet now )
https://ibb.co/m4B18R
https://ibb.co/fns8oR
https://ibb.co/cqAHhm
https://ibb.co/gq8Ra6

Thanks

[CuttySark878]

Thanks for the replies!

here are my main concerns
-Thing with having upper & lower jaw surgery would be that it could make my nose a lot wider than it already is...
-Having to have braces to move my teeth the opposite way to what I have been doing makes me feel sad/depressed that I have possibly wasted 3 years with camouflaging the overjet...]
-Finally my bite seems good now so really I would be doing this mostly for aesthetic reasons so maybe I should live with it...afterall the orthodontist said he doesn't think my chin is so severe but I have seen people in forums with much more chin prominence than me still go for bi max surgery...
-Not sure why my chin is so slanted back...must be the steep angle that my lower jaw is at? the occlusional plane?

[CuttySark878]

Not sure what to do about my recessed chin/small lower jaw...

I started with a 9mm overjet so I had two upper premolar extractions to camouflage it. I was also offered the option of upper and lower jaw surgery (bring lower jaw forward and rotate both jaws) which I turned down at the time.

I ended up have second thoughts after my extractions so went to see a max-fac orthodontist who told me that I could still have surgery afterwards if I changed my mind. Also if I was to have surgery now I would require bridges to fill in the gaps plus lower extractions compared to after the treatment of camouflaging. Also he warned me that my nose would get wider and its already wide enough.
He felt that the pushing back of my upper teeth would mask my receded chin. But if I still felt unhappy after this treatment then I should return to see him at the hospital afterwards.

Therefore I went ahead with the camouflage route first.

Fast forward 3 years and my overjet is now mostly gone. Due to have my braces removed next week. But I am still unhappy about my chin.

So I have arranged to meet this orthodontist at the hospital one last time tomorrow. I am feeling sooo nervous as its like my last chance to get this sorted.

Here are the details of the proposed surgery option from 2 years ago which he said would most likely not be too dissimilar from the surgery they would plan without camouflage treatment or with. I quote what he said in the letter:
"With his increased lower face height and tendency to an anterior open bite, he is most likely going to require a bi-maxillary procedure, and orthognathic treatment is going to be difficult to give him full chin prominence, due to the proclamation of the lower incisors, and so there would be an element that we would most likely need some occlusal plane alteration during the osteotomy to give him greater chin prominence, as well as having presurgical orthodontic decompensation with retroclination of the lower incisors.
All in all, I am not sure that his chin is so severely retrognathic that it really justifies all the excessive work of an orthognathic treatment."

So my main concerns are:
- widened nose from the above treatment
- lengthy treatment time of the above
- risks involved from the above surgery

He also mentioned a chin implant to me thus I am considering a sliding genioplasty.

Here are 4 photos of me front, side, angle and my smile (you can see that there is no overjet now )
https://ibb.co/m4B18R
https://ibb.co/fns8oR
https://ibb.co/cqAHhm
https://ibb.co/gq8Ra6

Thanks

Seems that the photo links are broken here is a new one
https://imgur.com/a/jxMhX

[CuttySark878]

Just got back from the maxillofacial department...
He gave me 3 options and his opinion on those options...

1) Do nothing and go ahead with the de-bond of my braces next week
This was his preferred option for me

2) Get a Genioplasty but he thinks that my braces are causing my lower lip to flare out and therefore said it would be sensible to wait 6 months to get used to my retainers and see if my lip goes in a bit. He will then refer me to a surgeon for the genioplasty "as it seems your concern is your chin"...I wish is said my entire lower jaw rather chin as there seems to be a significant difference

3) Go for full treatment of bi-max surgery - 3 year time line, risk of nose being wider after etc.

I felt a bit rushed during the consultation and I think I am 70% learning towards option 2 and 30% option 3. But I feel I don't know enough about option 3 to decided on it. For example I asked him what sort of movement would be required to my teeth and he said we don't know yet.

Maybe I should have requested that I get a detailed plan of option 3 before I made my mind up...

[PloskoPlus]

Your midlines appear to be misaligned.  Do you have a cross bite?

[CuttySark878]

Your midlines appear to be misaligned.  Do you have a cross bite?

Hi, I don't have a cross bite...not that I know off. I was just smiling funny in that photo...I notice that I tend to use more of the muscles on the right hand side of my face when I smile. Which is probably what caused that cross bite look.

I am currently researching the difference between have a genioplasty vs double jaw surgery. I notice that my chin is recessed and concerned that only fixing the tip of the chin via genioplasty won't help enough.

[kavan]

From what you say, you turned down the surgery that would have put the jaws in better balance and opted for 'camoflauge' treatment which is something that only makes the 'bite right'. It doesn't camoflauge much other than making the smile look better and a 'Bart Simpson' type of lip imbalance look less.

For example, from the profile view, you see the lower lip is behind the the upper lip which is an indication of recessed jaw. Also, when they bring the lower teeth forward along with pushing the upper teeth backward to get the 'bite right', it doesn't actually 'camoflauge' the chin recession. The push out to the lower teeth angles out the lower lip more such that the chin point is further away from a (red) line dropped from the lower lip. So, assuming your lip imbalance was MUCH more PRIOR, (blue line further out and red line further in), what it camoflauged was a large(ER) lip imbalance but NOT any jaw or chin imbalance.

Are you following me so far? This guy DIDN'T tell you the most camo treatment could do for you was to make less the lip imbalance and make the the smile look nice from the front. Instead, he told you it would 'mask' your chin recession. The red drop down line from the lower lip where the chin should be MUCH closer to it than it is now should be a self evident demonstration. Do you see any 'masking' of the chin recession???

You say you were in camo treatment for 3 years. So this LETTER he wrote 2 years ago where he says your lower teeth were proclined, most likely was from his doing as to procline with braces  1 year into the camo treatment. Basically the letter is saying that at 1 year after your camo treatment, there would have to be a LOT of UN-DOING of this to have the surgery and he kind of justifies what he did by saying he didn't think your chin was that recessed.

Although your concerns of long pre treatment time, surgery risks and possible nose change are valid, IMO, you should concern yourself with consulting directly with a max-fax doctor and NOT this ORTHO guy anymore.

Presently, you are basically captive audience to this guy's advice and for all you know, he might not be working along side a max fax with ADVANCED techniques.  For example, not only do you need both your jaw and chin brought forward but you have a type of 'hyperdigergence' where even CCW to the upper jaw won't be enough to compensate for the high upward inclination of the lower jaw. So, you want to look around for a max fax who not only does CCW to the upper jaw but also does 'inverted L' procedure to lower jaw to make less the hyperdivergence you have.

[CuttySark878]

Hi there,

Thanks for your very detailed reply. It is much appreciated.

The letter was written 6months into my camouflage treatment. Sorry for the confusion. But I have a different orthodontist who is doing the camouflage treatment. This other orthodontist that I have been to see, who wrote that letter, is one that my normal orthodontist referred me to and he's based in the maxillofacial department.

Actually this orthodontist was also the one who treated me back when I was in high school for my overjet (no extractions just twin block appliance and fixed braces so he remembers me from back then).

When you say L movement to the lower jaw do you mean some form of rotation?
He mentioned that the jaw surgery would consist of rotating the lower jaw as well as moving it forward. But also upper jaw rotation. So three main movements in total.

For now I don't know how to get access to a max-fac surgeon. I guess I would have to get my orthodontist to write to the other guy in the hospital again and then ask him to refer me to the max-fac he is working with....OR I could wait and discuss it with the surgeon who would perform my genioplasty who is also a surgeon based at a hospital (NHS one in the UK).

[kavan]

Hi there,

Thanks for your very detailed reply. It is much appreciated.

The letter was written 6months into my camouflage treatment. Sorry for the confusion. But I have a different orthodontist who is doing the camouflage treatment. This other orthodontist that I have been to see, who wrote that letter, is one that my normal orthodontist referred me to and he's based in the maxillofacial department.

Actually this orthodontist was also the one who treated me back when I was in high school for my overjet (no extractions just twin block appliance and fixed braces so he remembers me from back then).

When you say L movement to the lower jaw do you mean some form of rotation?
He mentioned that the jaw surgery would consist of rotating the lower jaw as well as moving it forward. But also upper jaw rotation. So three main movements in total.

For now I don't know how to get access to a max-fac surgeon. I guess I would have to get my orthodontist to write to the other guy in the hospital again and then ask him to refer me to the max-fac he is working with....OR I could wait and discuss it with the surgeon who would perform my genioplasty who is also a surgeon based at a hospital (NHS one in the UK).

Yes. More rotation than CCW alone. 'Inverted L'. Look it up.