Revision double jaw surgery - advice

[kavan]

Tnx.
This is original mail

Dear Mr. Xxx,
 
to peform a correction of your pofile, it is necessary to redo the complete surgery (more clockwise rotation).
(LFI, BSSO, chin).
Kind regards

I am really confused and sad - just want to look normal. I am scheduled for consultation with more surgeons. Does it seem that I am candidate for Lefort 3?
Reversing genio (moving up) will help improve my lip incompetence and closing lips? My original surgeon suggested slight backward movement.. please share your comments, thoughts.. thanks

Hi, I've given you my take which was to think about reversing the genio and making the chin shorter which is just a revision genio. Also explained why 'no' to chin wing. That's my 'take' on the matter.  Won't opine on lefort 3 or anything else. But maybe others will chime in. END of giving my take on the matter.

[Brachy]

Thanks,
You have helped me a lot. I will inform on results of other surgeons opinions in upcoming months. I would appreciate if You could reply is it better to perform revision genio (upward movement) as early as possible for the function of the lower lip? Thanks, once again

[kavan]

Thanks,
You have helped me a lot. I will inform on results of other surgeons opinions in upcoming months. I would appreciate if You could reply is it better to perform revision genio (upward movement) as early as possible for the function of the lower lip? Thanks, once again

First consult about having a revision genio.

[Brachy]

Hi, yesterday I was at my original surgeon. My main concern is protrusive profile, lip incompetence and midface defficiency.
He has offered possibility to reduce the size of the chin verticaly, but also I would like to go back with my both jaws for e.g. 2mm because of the chimp look. My jaws are extremely wide and since my midface is underdeveloped it creates additionally effect of unbalanced face.
So, I would appreciate Your comments - slight backward jaw movement and reducing chin to achieve lip competence and smaller lower third.
I have scheduled consultation with dr. in Austria, Germany and Switzerland where I would seek opinion on zygomatic osteotomy since it is not done in Croatia (I have realistic expectations and my surgeon was very humble taking my concerns into consideration. He daid that I will have to rrmove the screws from the chin and if I decide to.we can make small backward movement).
As for consultations abroad, maybe widening zygomas could help since my jaws are very wide.
I will post cephalometric analysis after returning from work. Please, I would appreciate your comments. Thanks in advance.

[Lazlo]

For what its worth I think you look great.

If you have no funcitonal problems then seriously don't do another surgery. For all these tiny movements its not worth it and I doubt will make much difference as you think

Maybe what you need is the zygomatic osteotomy later but I can't tell causse you have no frontal picture. But you look greaat. And if you have no numbness don't risk another surgery.

[Brachy]

Thanks on your comment, Lazlo.
To begin with, I had vertical maxiliary defficiency, class 2 and plan was 6mm maxiliary downgraft, clockwise rotation and mandibular advancement (7mm). Also, chin was vertically elongated and moved back (3 mm back, 4mm down)
Now, 5 months after I am pleased and thankful my team on tooth show.
However, I am really self consious regaring mandibular projection which has "taken over" my face and I was even bullied due to one. What is your opinion - would some camouflage treatment help - I am consulting dr. Brusco an

Additionally, I am posting frontal pictures and would appreciate your comments.

I have wide palates in contrast to midface (my midface is really unattractive - recessed, I believe both zygomas and orbital rims). I would not be interested and probably would not be able to find a surgeon to perform LF 3 in Europe, so I was wondering whether it is possbile to achieve more facial harmony via:
- zygomatic osteotomy to increase midface width and small anterior movement
- chin wing camouflage to decrease mandibular projection and achieve lip competence (I have seen on web some results were chin wing is actually used in clas 3 to decrease manidbular projection)
For both of these options I am consulting Mr. Zarrinbal and Mr. Brusco. If I will revise something with my original surgeon and I was thinking on genioplasty and small backward movement of both jaws)

Once agan, many thanks - appreciate your comments. If you would like to see CBCT or anything else, please do not hesitate to ask.

[kavan]

IF the surgery you got made your BITE RIGHT as in made 'right' where the teeth should meet and be oriented relative to the lips, which sounds to be somewhat the case, it's not for me to opine on moving the jaws again in revision surgery simply because it's not for me to second guess whether or not moving the jaws with the objective of getting a more ideal jaw balance will maintain the SAME bite balance. Since bite balance usually is PRIORITIZED in jaw surgeries, it's not uncommon to have some aesthetic trade offs.

I'm not going to opine either on Lefort 3 or modified L3 or bone cuts to bring forward the midface areas. Nor am I going to opine on whether or not the 'chin wing' doctors will do what you want.

What I will opine on would be a 'camouflage' procedure that does NOT involve moving both jaws and hence does not involve altering the bite. I think shortening the chin in addition to bringing it backwards would make less your protrusion and also make less the struggle with lip incompetence. I would suggest you ask the doctors if an isolated genio where the chin was shortened and brought back somewhat would accommodate the objective of camouflaging the protrusion to the lower jaw and making it easier for you to close your lips (lip incompetence is a 'struggle' when getting the lips to meet.)

Here is a morph of ONLY a possible camo procedure isolated to the chin.



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[Brachy]

Kavan, I am honestly grateful on your reply. Mandibular projection is making me self conscious and I was even having hard time due to bullying.. I have asked my surgeon even before this week's consultations and he has said that moving both jaws back is an option.. I hope that 2mm setback will decrease the protrusion and give me the cute "soft" profile as before.. also, I would wish to reduce the size of the chin.. next consultation with original surgeon are in 3 months time, meanwhile I am seeing other surgeons..tnx

[Lazlo]

Thanks on your comment, Lazlo.
To begin with, I had vertical maxiliary defficiency, class 2 and plan was 6mm maxiliary downgraft, clockwise rotation and mandibular advancement (7mm). Also, chin was vertically elongated and moved back (3 mm back, 4mm down)
Now, 5 months after I am pleased and thankful my team on tooth show.
However, I am really self consious regaring mandibular projection which has "taken over" my face and I was even bullied due to one. What is your opinion - would some camouflage treatment help - I am consulting dr. Brusco an

Additionally, I am posting frontal pictures and would appreciate your comments.

I have wide palates in contrast to midface (my midface is really unattractive - recessed, I believe both zygomas and orbital rims). I would not be interested and probably would not be able to find a surgeon to perform LF 3 in Europe, so I was wondering whether it is possbile to achieve more facial harmony via:
- zygomatic osteotomy to increase midface width and small anterior movement
- chin wing camouflage to decrease mandibular projection and achieve lip competence (I have seen on web some results were chin wing is actually used in clas 3 to decrease manidbular projection)
For both of these options I am consulting Mr. Zarrinbal and Mr. Brusco. If I will revise something with my original surgeon and I was thinking on genioplasty and small backward movement of both jaws)

Once agan, many thanks - appreciate your comments. If you would like to see CBCT or anything else, please do not hesitate to ask.

YOU DO NOT NEED ANY BACKWARD MOVEMENT. ANYONE TEASING YOU IS f**kING JEALOUS OF YOUR STRONG JAWLINE. MOVING THINGS BACK A BIT IS NOT WORTH IT FROM ANY STANDPOINT. I THINK A GOOD ZSO would help balance the face out a bit but do nothing the jaws.

[kavan]

YOU DO NOT NEED ANY BACKWARD MOVEMENT. ANYONE TEASING YOU IS f**kING JEALOUS OF YOUR STRONG JAWLINE. MOVING THINGS BACK A BIT IS NOT WORTH IT FROM ANY STANDPOINT. I THINK A GOOD ZSO would help balance the face out a bit but do nothing the jaws.

Wow. Suggesting a ZSO is quite a difference from unsuggesting it on another post. How'ed you change your mind so fast?

Yeah life is totally s**t now.

Honestly, I don't think the ZSO does s**t for cheekbones. Maybe just augments the width a little but I don't know, haven't seen enough results. Every person I know who has looked at Zarrinibal's before and afters says they're s**t. Can't see any difference.

[Lazlo]

Wow. Suggesting a ZSO is quite a difference from unsuggesting it on another post. How'ed you change your mind so fast?

Yes, yes I know. ZSO is not optimal. But for this guy who has great structure everywhere else the framing aspect of it will help. It will help balance his face out. Will it give him perfect cheekbones? Not on your life.

[PloskoPlus]

The maxilla looks over advanced.

[Brachy]

YOU DO NOT NEED ANY BACKWARD MOVEMENT. ANYONE TEASING YOU IS f**kING JEALOUS OF YOUR STRONG JAWLINE. MOVING THINGS BACK A BIT IS NOT WORTH IT FROM ANY STANDPOINT. I THINK A GOOD ZSO would help balance the face out a bit but do nothing the jaws.

I have to move my jaws back, I have severe lip incompetence and was bullied due to protruding mouth.. my biggest problem is speech which is so incomprehensible and I have troubles at work. I do not know why but people are smiling when I talk (assume due to protruding mouth and everted lips which make sullen appearance)..apparently, my midface is underdeveloped..  I just want to look normal, I hope that 2mm backward movement could make me less bullied and improve speech.. I assume there is no surgeon who would adress my midface problems, so I just want to have smaller, rounder lower third.. please your comments are helpful

[GJ]

Agree with Kavan. Sometimes the plates in the chin themselves bind to the muscles and can cause strain or pulling down of the lip, too, so see if that's what is causing it and possibly just remove the chin plates.

[Brachy]

Thank you very much. I will be removing the plates but surgeon told me it would be better, if I decide on reoperation, to have everything done during one operation. I have scheduled meeting with him in August, until then I am consulting other surgeons and hope to decide when having more treatment plans. All of you guys have been great support and your advices are very helpful.
Swiss doctor has replied if chin wing is possible after first operation, it could improve my incompetence. I hope he can help me. Also, do you know is there any time limit for revision surgery, i.e. whether is better to perform redo surgery in first 12 months or revision can be undertaken at any point in life (as long as you are healthy). Once again, many thanks.