Almost decided to do a Genioplasty. Need advice

[Cobolt2]

What do you guys think, can I get a result close to the second picture in which I have my teeth edge to edge (some jutting involved)
The third pic is when I jut even more and pull my skin back and the results is that straight jawline which is the dream scenario.

If I do my surgery it will be in Europe. My first choice is in Spain at Dr Birbes clinic. He has a good rating on whatclinic.com and seems trustworthy (maxillofacial surgeon)

I am thinking about 8mm vertical lengthening maximum (8mm is how much my chin is vertically lengthened in pic 2 as I measured my teeth) and I'm not sure about what horizontal advancement should be yet.

What do you guys think, am I realistic?

More pictures of me below

[Cobolt2]

Few more pics, more unflattering than the first three in my first post

[Cobolt2]

Forgot to mention.
I have a tendency to a deep bite
I have a deep labiomental fold because of this
I have a class 1 bite.

The main thing is to increase my vertical length of the chin to reduce the labiomental fold. In my estimation around 8 mm. Forward projection around 5mm maybe? I really dont know.

[Tezcatli]

I'm not sure about the amount of movements but pic 2 is realistic, however you would look much better with full jaw surgery. You would need a couple years of braces to create an overjet before, I'm pretty sure braces could give you a class II bite.

[Post bimax]

I'm not sure about the amount of movements but pic 2 is realistic, however you would look much better with full jaw surgery. You would need a couple years of braces to create an overjet before, I'm pretty sure braces could give you a class II bite.

I think the difference here would be minimal and not worth the time/expense/risk.  Are you suggesting he create a class 2 bite to get a couple mm out of a BSSO?  A vertical lengthening/horizontal projecting genioplasty would soften his labiomental fold and balance out his face a bit more, which are the main concerns I see.

[Tezcatli]

I think the difference here would be minimal and not worth the time/expense/risk.  Are you suggesting he create a class 2 bite to get a couple mm out of a BSSO?  A vertical lengthening/horizontal projecting genioplasty would soften his labiomental fold and balance out his face a bit more, which are the main concerns I see.

He could get a few mms from the braces plus a few mm more from a maxilla advancement, he would end up with a really nice projecting jaw. His nose would also look smaller, his cheeks fuller...
Of course, a lot more money, time and pain would go into that. That's just my view, something I believe he could talk with a surgeon, but a camouflage genioplasty would look good too.
Remember a few mms in the face are like miles.

[Cobolt2]

Full jaw surgery is out of the question, I don't have time nor money to do it. How come my nose looks so much bigger fram a 45 degree angle than from a side view though?

[Post bimax]

He could get a few mms from the braces plus a few mm more from a maxilla advancement, he would end up with a really nice projecting jaw. His nose would also look smaller, his cheeks fuller...
Of course, a lot more money, time and pain would go into that. That's just my view, something I believe he could talk with a surgeon, but a camouflage genioplasty would look good too.
Remember a few mms in the face are like miles.

His maxilla is not recessed and his nose is already slightly large for his face.  Advancing the maxilla at all could have adverse effects on both his nasal width, angle and lip curve.  I advise strongly against that.  I think he looks very well balanced in the picture labeled "picture 3".

Cobolt: I agree that your nose does look slightly larger in the 3/4 view.  My own flaws are also exaggerated at that angle and I'm not sure exactly what causes it.  I think a genioplasty will help balance out your nose and give you a nice lower 3rd.  You could opt for a rhinoplasty at the same time, but that is obviously more expensive and adds another unpredictable variable that would need to be balanced.

[Cobolt2]

His maxilla is not recessed and his nose is already slightly large for his face.  Advancing the maxilla at all could have adverse effects on both his nasal width, angle and lip curve.  I advise strongly against that.  I think he looks very well balanced in the picture labeled "picture 3".

Menapilo: I agree that your nose does look slightly larger in the 3/4 view.  My own flaws are also exaggerated at that angle and I'm not sure exactly what causes it.  I think a genioplasty will help balance out your nose and give you a nice lower 3rd.  You could opt for a rhinoplasty at the same time, but that is obviously more expensive and adds another unpredictable variable that would need to be balanced.

I'm so thankfull for your input. I have thoughts of doing a rhina as well but I hope and think that the smartest way is to do the genio first and if I'm happy with it, the surgeon will have the final result of the genio to proceed from.

Can't help to think why my nose looks so bad from that angle :/

[kavan]

What do you guys think, can I get a result close to the second picture in which I have my teeth edge to edge (some jutting involved)
The third pic is when I jut even more and pull my skin back and the results is that straight jawline which is the dream scenario.

If I do my surgery it will be in Europe. My first choice is in Spain at Dr Birbes clinic. He has a good rating on whatclinic.com and seems trustworthy (maxillofacial surgeon)

I am thinking about 8mm vertical lengthening maximum (8mm is how much my chin is vertically lengthened in pic 2 as I measured my teeth) and I'm not sure about what horizontal advancement should be yet.

What do you guys think, am I realistic?

More pictures of me below

I'll tell you what a typical realistic surgical correction for deep bite is, especially so with some surgeons in Spain (including yours) using high tech VSP (virtual planning software).

Even though you might have reasons NOT to go through with the full surgical correction, knowing what it is should help you understand better that what you are doing in the mirror, does NOT mimick a genio (type to both bring forward the chin and and also make vertically longer) but RATHER what you are doing in mirror mimicks more closely the full surgical correction for deep bite.

Firstly, NOTE what you are doing in order to advance out your chin/jaw.

Q: Are you able to do it when your teeth are in occlusion?

A: Answer for deep biters is usually 'NO'. The upper incisors PREVENT bringing jaw forward when in occlusion. In order for a deep biter to bring the jaw forward, they first have to LOWER it until they get the front teeth edge to edge.

Q: When your front teeth are edge to edge, is there a SPACE between the upper and lower BACK teeth?

A: Answer for deep biters is usually; 'YES'.

That said, even though your chin goes both forward and down when you LOWER your JAW in order to JUT it out, what's making you look good in the mirror is MORE than ONLY the chin going down and forward. What you are doing is creating 'FACE SPACE' that a genio ALONE (even one that advances the chin in addition to elongaging it) just WON'T do. It won't give you the look you are wanting in the mirror.

Here is what they would need to do for you to get CLOSE to the FACE SPACE you are creating when you do what you're doing in the mirror:

1: Extended period of braces (can be close to a year or so) in preparation for the surgery. One of the aims is to 'buck out' the upper front teeth. This is because it's common for people with deep bite to have the upper front teeth either positioned vertically or retro-clined (as opposed to them being angled forward). The vertical or retro inclination of the upper incisors tends to act as a 'clasp' as to prevent the lower jaw comming forward and could obstruct forward movement of lower jaw if not 'bucked out' in preparation for surgery. They act as clasp to keep the lower jaw in a backward position.

2: 3 piece Lefort 1. Usually needed displace the  front part of upper jaw INDEPENDENTLY from BACK part of upper jaw. The back part comes DOWN for more elongation to that area. (so there isn't a space between the upper and lower BACK teeth).  The front part can be rotated up and/or outwards. Both of these together is 'CCW' rotation, usually involving a posterior down graft.

3: #2 above allows for #3 which is bringing the WHOLE lower jaw FORWARD via a BSSO which also brings the chin more forward.

4: Since #3 brings your chin forward with the BSSO, the direction of the genio for deep biters is usually DIAGONALLY DOWNWARD. This is because deep biters usually have what's called 'short chin' which refers to it's vertical deficiency.

Again, you may not want to pursue the full surgical correction for deep bite--for what ever personal reasons-- but genio with advancement plus elongation WILL NOT do for you what you are doing in the mirror.

[kavan]

I'm not sure about the amount of movements but pic 2 is realistic, however you would look much better with full jaw surgery. You would need a couple years of braces to create an overjet before, I'm pretty sure braces could give you a class II bite.

Correct that he would look better with full jaw surgery. But for reasons that what he's doing in the mirror--although not an exact prediction of it-- is giving himself the type of 'face space' the type of full jaw surgery for DEEP BITE would give him. Also correct that he would need a long stretch of braces to prepare for it. They 'buck out' the top teeth as part of the correction of what he has which helps give room to move the lower jaw forward. He most certainly is NOT showing what only a genio (advance + elongation) would do.

[kavan]

I think the difference here would be minimal and not worth the time/expense/risk.  Are you suggesting he create a class 2 bite to get a couple mm out of a BSSO?  A vertical lengthening/horizontal projecting genioplasty would soften his labiomental fold and balance out his face a bit more, which are the main concerns I see.

'Bucking out' the front teeth, in preparation for full surgical correction of deep bite is what they need to do. So, yes, that gives a class 2. But like most brace work that prepares for surgery they need to give the wrong bite--temporarily-- in order to get the right bite with the surgery. What you DON'T see is the same thing that he doesn't see which is the space he's creating inside his mouth by posturing his jaw the way he's doing so that his chin goes forward and down. Full surgical correction will get his bite/occlusion to fill in that space. Stand alone genio will NOT.
 

[kavan]

Full jaw surgery is out of the question, I don't have time nor money to do it. How come my nose looks so much bigger fram a 45 degree angle than from a side view though?

That may be so due to personal preference but what you are doing in the mirror is NOT realistic to expect an isolated genio to do for you. See my prior explanation. Birbe would tell you similar if you showed what you were doing in mirror and asked if a genio would reproduce that.

[Post bimax]

'Bucking out' the front teeth, in preparation for full surgical correction of deep bite is what they need to do. So, yes, that gives a class 2. But like most brace work that prepares for surgery they need to give the wrong bite--temporarily-- in order to get the right bite with the surgery. What you DON'T see is the same thing that he doesn't see which is the space he's creating inside his mouth by posturing his jaw the way he's doing so that his chin goes forward and down. Full surgical correction will get his bite/occlusion to fill in that space. Stand alone genio will NOT.

Okay, I see what you’re saying. Looking at “picture 3” again it’s apparent his teeth are probably not in occlusion. Do you think he could still benefit from just a genio? It may not replicate what he’s doing in the pic but his chin is still vertically short.

[kavan]

I'm so thankfull for your input. I have thoughts of doing a rhina as well but I hope and think that the smartest way is to do the genio first and if I'm happy with it, the surgeon will have the final result of the genio to proceed from.

Can't help to think why my nose looks so bad from that angle :/

Actually, the dumbest thing to do is to get the isolated genio and EXPECT it will do for your face what you are showing in the mirror by lowering your jaw and jutting it forward. (See my prior explanation.)

The reason your nose looks LARGE in your 3/4 view is that you are not opening up 'face space' as you are doing in your profile view when you lower your jaw and jut it out. So, the nose would look relatively less large with MORE 'face space' which is what you are giving yourself in the mirror in the profile views. But it's the full surgical correction which would give you the extra 'face space' that you are kicking up by jaw jutting.

Also, rhino is best considered AFTER maxfax/bimax surgery. Bad idea to get rhino and chin augmentation FIRST before maxfax surgery IF at some point later down the line you want the full surgery. Best done afterwards because the surgery can make the nose look in better balance especially a surgery the opens up face space as in what you are doing in the mirror to COUNTER the look of the DEEP BITE.