surgery in 2 days: sliding genio, chin wing or orthognatic? pics + xray

[landscape]

hello, guys

my small, retruded chin and undefined jaw have bothered for a long time, but only recently i began learning why.

it all started with me feeling tired in the morning. i then suspected it could have to do with my sleep. voila: a polysomnography revealed a light/moderate OSA (mostly hypopnea), which has various causes, of course, one of them being inadequate facial development.

i visited a couple great surgeons, and both agreed orthognathic surgery would give the best aesthetic results. they could not be certain my apnea would be resolved with the procedure but said it would def help.

however, after reading a lot, i felt like orthognathic would perhaps be a bit too radical for me – besides the many risks people here are tired of hearing about, it would demand an amount of time and commitment i'm not sure i have: a year and a half in total, including pre-op orthodontic work. i have slight retrognatism, but my occlusion/overbite was compensated by orthodontic work in the past.

i then began searching for less aggressive alternatives. my current doctor suggested sliding genio as a milder alternative, and after researching some more i came across chin wing osteotomy. both seem somewhat effective for light OSA cases (according to my doc as well as pubmed). dealing with my apnea is important, but optimal aesthetics is probably more important for me at the moment.

based on my pictures, which of the three procedures would you experts recommend? would sliding genio be fine or is chin wing required? more than that, is my case such that orthognathic surgery is the only adequate option?

my insurance is gonna cover all the costs. i chose to have surgery (sliding genio) in two days but can cancel if i decide to go for orthognathic in the end.
i'll have the last meeting with the doc tomorrow and want to suggest chin wing osteotemy and bring some final insights to him, hence my post.

any input would greatly appreciated!
thanks in advance!

[attachment deleted by admin]

[jawguy123]

I'm all for camouflage procedures (genio/chin wing) when possible but in your case I think orthognathic surgery would be by far the best option.

I don't see how a genioplasty/cw could yield satisfactory results. You already have a very deep mentolabial fold; a genioplasty/cw would only worsen that.

Your lower jaw looks more than "slightly" retrognathic. I know the time/commitment of jaw surgery can be dissuading, but I really think it's the only worthwhile option for you.

[kavan]

Here's my opinion:

If you wish to 'crowd source' for opinions on message boards,in the act of making a decision for yourself, it's best done before you book a surgery.

Said 'crowd' also includes my opinion, in the event you seek it specifically from the crowd (which I note re; your most recent PM) in any exigency* you have created for yourself this way where your decision appears to be contingent on gathering more opinions.

exigency*: surgery already booked SOON where now contingent you have more opinions to decide to go through with it or not.

[landscape]

i agree with you, but it was not my intention to make it seem like i’m in a rush to get more answers.
i was pretty much settled on genio until i started digging further and had the feeling i might be disappointed with the choice.

[landscape]

kavan, i reposted the question in the appropriate section and more politely. you may close/delete this thread.

jawguy, thanks a lot for your comment! note taken.

[kavan]

Your post is FINE here, where it is. No need to start another.

I've had like 3 emergencies crop up (house hold accidents, repair services to call, computer problems whatever). Just ask that people don't rely on my 'timing' and/or availability to focus on their issues within a time frame where I might not be available to do so.

ETA: duplicate post on other thread deleted because you already got responses to this one and I hesitate to delete threads where others took time to respond.

[haven]

Hard to tell but it looks like both your upper and lower teeth are flared out. Did you have any extractions? I wouldn't do a genio at all in your case first. You should look into jaw surgery first. Your lower lip sits noticeably behind your upper lip. Jaw surgery is supposed to help alleviate sleep apnea and prevent it. Perhaps there's a correlation with effectiveness and the amount of space the bone is moved.

[PloskoPlus]

Jaw surgery

[landscape]

haven, they are indeed somewhat flared out, but my bite has been compensated and is fine.
therefore, i am eligible for orthognathic surgery, but it isn’t strictly necessary.

i never had teeth removed, no. and yes, my lower lip sits behind my upper lip and that bothers me. my doc said genio could help with that slightly, but my expectations are low in that regard.

regarding sleep apnea, you are right orthognathic is more appropriate in this case, but genio and chin wing are said to help as well (various articles on pubmed show the benefits). i would preferably like to avoid the more extreme, orthognathic route, but i discard the possibility if the genio/chin wing result ends up being below my standard.

jawguy: my doc said the genio could help with the mentolabial fold actually; i brought him my concerns but he’s experienced and seems pretty sure.

do you guys think a genio could look weird on my face, considering my features? he said chin wing is too risky a procedure and still advocates my going through with the genio, still leaving the door open for an orthognathic in the future.

[jawguy123]

do you guys think a genio could look weird on my face, considering my features? he said chin wing is too risky a procedure and still advocates my going through with the genio, still leaving the door open for an orthognathic in the future.

Did your surgeon by any chance use software to "simulate" how the genioplasty without jaw would look?

As your doctor points out, a genioplasty now shouldn't preclude you from a jaw surgery later. However, you might end up needing a revision genio if that's the case.

[landscape]

yea, he used dolphin imaging. it looked a bit weird, but he said it’s not accurate since it doesn’t take into account how soft tissue will change after surgery, which is a very difficult thing to simulate (muscles will stretch, leading to a subtly more defined jaw and overall contour). the software acts more like smarter, data-fed liquify tool (similar to photoshop’s but surgically precise). he showed me how it works and it is unimpressive. you help it map facial features of a profile xray picture and, after that’s done, you feed it with an actual profile photo, which the application willl stretch based on certain parameters you can set – it has a list of different procedures; you add, say, 4mm to genioplasty and it’ll liquify, accordingly, that point of the map. looks a bit fake... it also doesn’t give you an idea of what the front view could be.

yea, i would need a revision genio if i decide to do an orthognathic surgery later. he said a revision is easier than doing it the first time, tho.

my main concern at this point is whether the genio will make my chin look like it doesn’t belong to my face, since the work will be done on it more or less exclusively, leaving the root causes unchanged… a developed feature in a somewhat undeveloped face, so to say.

[jawguy123]

To be honest, I don't really have good advice for you. I'm really struggling to see how a genioplasty could adequately address your aesthetic concerns, but I'm not a doctor. Obviously the decision is yours.

Also, why would the genio revision be easier than the first time? Wouldn't there be more scar tissue?

[haven]

I don't think a person's lower lip is advanced forward with a genioplasty. I'm not an expert, but someone else can correct me on that. I would think the lower lip would move forward when the mandible is advanced.  I know it can alleviate lip incompetence (when the lips don't meet at rest) if the patient has it and wishes to address it.

Perhaps they could do a genioplasty where they add vertical height as well and perhaps use some filler. But I can't imagine them doing anything outside of a conservative movement. What I think the surgeon(s) should tell you is that there are limitations on what it can do based on your anatomy and ultimately what works for YOUR FACE. So you should set realistic expectations for yourself and not expect to come out looking like Brad Pitt 

Are you non-white? I ask because I see that type of fold in lots of more ethnic populations (Hispanic, Indian & Black). I see it at the office I work at and even the media (i.e Kendrick Lamar). In person a lot of these people look fine to me, so I can't really compare you to them since we've never met, and I'm not trying to criticize your appearance since I don't have the whole picture to go off of.

[ditterbo]

Your whole lower third seems pretty well (aesthetically) cocked to the right, if that frontal shot is any indication.  That's a bimax and rhino thing.

[kavan]

In general, we drop 2 vertical lines. One from the upper lip and one from the lower lip.

Drop from upper lip: When the lower lip is behind the drop down line from the upper lip, that's usualy an indicator that the lower jaw is recessive relative to the upper jaw.

Drop from lower lip: When the chin is noticably behind drop down line from lower lip, which is the case with the OP, that's an indicator that the chin, is recessive. The chin need not touch the vertical drop line and is fine if it is 'somewhat' to 'modestly' behind it. That's because in reality the line is a bit angled toward the chin and i'm just trying to give a GENERAL guideline here using simple lines.

In men, it's OK for the chin to get close to the drop down line. In women, it should be somewhat posterior to it.

In general, it's usually 'not OK' to bring the chin PAST the vertical drop from the lower lip in any attempt to COMPENSATE for a recessed mandible. This is particularly so if one LATER decides to have the full 'maxfax' surgery, especially if the surgery is aimed at addressing sleep apnea. That is because, the surgeon, most likely would elect to MAXIMIZE the BSSO advancement. Hence prior over compensation with the chin advancement can interfere (aesthetically) with the surgeons goals to maximize the BSSO.

So, IF genio ONLY, with option LATER down the line to have maxfax surgery, you are better off erring on the side of 'not close enough' to the lower lip vertical drop down line than 'kissing' the line and most certainly NOT advancement past the line.

Also, EVEN IF it looks like ONLY the lower jaw is recessed. Never 'bank' on a single jaw surgery as the upper jaw might have to be displaced to accommodate displacement of the lower jaw  whether or not the upper jaw is already in a 'good' to 'ok' aesthetic position.