Genioplasty - yes or no?

[GJ]

Exactly, I am quite worried about the aging effect. Right now I am always told I look a lot younger than my age and obviously as a woman, I do not want to lose that advantage. Do you think the less impaction they do, the smaller the risk? Or is it not that simple?

You summed it up perfectly re: 'allure / mystery'. Doctors keep telling me I will look different after the surgery and I am very intrigued by that - I would like to try it for a few days to see what it's like to live with a different face. However, this is not a video game and I will not be able to go back to this face if I do not like the new one. So yes, it is very much like gambling. Not to mention that so many people have complications like chronic pain or numbness etc. for years after the surgery. So I kind of want to do it but still have my doubts.

Well the surgery isn't going anywhere, so think it over and weigh the risk/reward vs that allure. I could read between the lines and sensed that allure was getting you. I understand that, but it's not a great reason to have surgery; yet I think everyone with a "deformity" has those thoughts. We then convince ourselves of medical problems (e.g. apnea) that might happen down the road to justify the surgery. Get ready for mental torment like that while figuring all that out.

But the bottom line is once the new face is in place it's a bell you can't un-ring so be sure you'll have no regret if it goes awry.

And yes, the less impaction the less aging, in theory at least.

PS. This might help with the mental part: https://humanhow.com/en/list-of-cognitive-biases-with-examples/
Especially understanding things like decision fatigue and optimism bias, but several others as well.

[InvisalignOnly]

This might help with the mental part: https://humanhow.com/en/list-of-cognitive-biases-with-examples/ Especially understanding things like decision fatigue and optimism bias, but several others as well.

You made some excellent points and the link has been really useful as well! 'Decision fatigue' definitely applies to my case. I feel like every time I go to the dentist they keep telling me 'hey did you know you need jaw surgery' and it's really getting to me in the sense that it seems like 'the right thing' to do, like, society sort of expects me to do it so I can look 'normal' like other people. I honestly wish the surgery would have been done to me when I was still a teenager and someone else would have made the decision so I would not have to.

Regarding the optimism bias, I actually had 'pessimism bias' about this for several years. I used to dismiss surgery thinking it was just too risky (especially in terms of pain and other physical problems, nerve damage, speech issues etc.) but I am now more inclined to see the big picture in terms of, if it's done by a 'good' surgeon, chances are the benefits are likely to outweight the risks. Then again, the risks are still there and the older I get, the more risk there will be.

[Dogmatix]

You've got yourself into a very complex field. The thing about surgery and orthodontics is that best result is achieved if it's done before you get a problem, but the motivation is also less if you don't have a problem. The thing is trying to look into the future and try to see if it will cause a problem. I always promote doing it sooner than later. I would try to get more information from those you've consulted and ask what the effects of not having surgery is. Have they measured your airways and do they see tendency to narrow airways? Do you bite up in the palate with your lower incisors and have a deep bite? Will you likely get crowding problems in the upper arch with age?

You also need to be very careful who you listen to and understand what's going on. I was offered braces as a teen. Today I regret not having fixed my problems earlier, as it has evolved into a compensated deep bite, which could've been prevented. But I definitely don't regret denying the extraction treatment they offered me as a teen.

[Post bimax]

If your surgeon is competent I think your plan will be 'relatively' straightforward.

CCW via anterior impaction is more stable than a posterior downgraft, so you've got that going for you.  The surgeon should be able to tell you exactly how much gum-show you'll have post-op so that's another plus.

I would decline any advancement of the maxilla if that's proposed.  The aesthetic risks probably outweigh any benefits there. Personally, I don't think you need a genio.  The impaction will give you a more 'natural' rotation of the jaw and further chin augmentation may be masculinizing.

A well-done bimax alone will fix your issue, insofar as you have one.  The bigger risk, imo, is that you are already comfortable with your face as it is.  Any change is going to cause you some psychological stress if you're attached to your current look, even if it's technically an improvement.  Consider that before you do something.

[InvisalignOnly]

A well-done bimax alone will fix your issue, insofar as you have one.  The bigger risk, imo, is that you are already comfortable with your face as it is.  Any change is going to cause you some psychological stress if you're attached to your current look, even if it's technically an improvement.  Consider that before you do something.

Thanks so much for the detailed info and suggestions, this is really useful and I will refer back to it once I got some plans from surgeons!

Regarding the psychological impact: you are right, this is an important aspect and I have read about people that could not get used to the new face even if they looked better according to pretty much everyone else. I do not think this would happen to me though as I feel mostly 'neutral' about my face, if that makes sense... I do not think it is either ugly or beautiful, it is just the way it is and if it can be improved from an 'objective' viewpoint that's great, but obviously I would be very upset if I ended up looking objectively worse after investing time and money in the surgery.

[april]

I feel like every time I go to the dentist they keep telling me 'hey did you know you need jaw surgery' and it's really getting to me in the sense that it seems like 'the right thing' to do, like, society sort of expects me to do it so I can look 'normal' like other people.

I think you're pretty and have a great smile.  I never even knew a gummy smile was considered a problem (maybe also because I don't have one) until I entered the jaw surgery world and saw everyone getting it corrected by their surgeons.  I know VME causes lip incompetence so there are some valid reasons for correcting it, plus impacting also enables the lower jaw to rotate. The problem is some surgeons go overboard and take too much of the gum/tooth show away (maybe in an effort to get more rotation) I think any female getting impaction needs to be careful and really convey to surgeon/ortho about concerns with aging. You want the right balance. If you like the way you look now, then less of it will be much easier to adjust to.

PS. This might help with the mental part: https://humanhow.com/en/list-of-cognitive-biases-with-examples/
Especially understanding things like decision fatigue and optimism bias, but several others as well.

That's a really helpful link. Thanks for posting. I recognise so many of those in my own attempts at decision-making.

[InvisalignOnly]

I think you're pretty and have a great smile.

Thanks for that, I certainly wasn't fishing for compliments . I must say though, loads of people - men and women - that I meet in real life tell me that I have a great smile, so yes I am quite worried about losing that feature after the surgery.

[InvisalignOnly]

I would try to get more information from those you've consulted and ask what the effects of not having surgery is. Have they measured your airways and do they see tendency to narrow airways? Do you bite up in the palate with your lower incisors and have a deep bite? Will you likely get crowding problems in the upper arch with age?

As far as I am aware, I do not have any crowding problems and right now my lower incisors are inclined so they aren't causing any problems either. If I decide to go for the surgery, they will 'decompensate' them so they will probably end up making my bite worse before, hopefully, making it better.

They haven't actually measured my airways but the 'last straw' that made me strongly consider the surgery was a visit to an ENT specialist for my breathing issues. I have been noticing more and more in recent years that I cannot breath properly through my nose, sleep less well and feel tired in the morning etc. He said he thought it was connected to the position of my jaws and will likely get worse with age.

[GJ]

They haven't actually measured my airways but the 'last straw' that made me strongly consider the surgery was a visit to an ENT specialist for my breathing issues. I have been noticing more and more in recent years that I cannot breath properly through my nose, sleep less well and feel tired in the morning etc. He said he thought it was connected to the position of my jaws and will likely get worse with age.

Hospitals are businesses these days, and surgery is their most expensive product. So keep that in mind. Nobody "needs" this surgery -- people lived with these deformities and had healthy lives for centuries (before 1970, when the surgery was modernized from war injury emergency surgery and essentially invented for the every day patient). So you don't "need" it, but you could "benefit" from it if everything goes right. I wouldn't personally listen to an ENT. Listen to your heart and gut and then weigh it against all those biases and the risk/reward. At the end of the day your decision will likely come down to whether you give in to the great temptress of jaw surgery and the big "what if?" or live with the unknown, because you seem to be content with yourself as-is and realize you don't "need" it. Seems the only thing confusing that belief are doctors who want to sell you their expensive procedure. Ask them to prove you'll get apnea or any of the other scare tactics they're using to make you get surgery.

Again, in short: you can benefit from it if everything goes right, but you don't "need" it. So it's really your own risk/reward tolerance and how much not knowing what it might look like will eat at you. Those would be the reasons you'd do it, from what I'm reading between the lines.

[GJ]

That's a really helpful link. Thanks for posting. I recognise so many of those in my own attempts at decision-making.

You're welcome. Very useful for day to day life as well. There is also a great video lecture on YouTube called "Your deceptive Mind", which is worth watching in it's entirety (very long, but maybe at night before bed put it on for a bit each night).

https://www.youtube.com/watch?v=CGMZL7aAauc
https://www.youtube.com/watch?v=qoquCUn4kVE

[kavan]

A maxfax once told me that there are plenty of people walking around with deviations/ facial imbalances that could be addressed via bi-max surgery. BUT there are enough so that anybody else with with a deviation can easily 'blend in'. It's not as if someone with some deviation from an ideal is going to be stigmatized for having it because it's not a thing where everyone else is totally absent of some kind of jaw imbalance.

That said, you have a common deviation (gummy smile and recession to lower jaw) that they can give a 'YES' to addressing via surgery. So, when they tell you that your deviation would 'NEED' CCW (most likely anterior impaction), that's what is done to address what you have.

There is a big DIFFERENCE between what kind of surgeries or displacements would need to be done to address some kind of jaw imbalance or deviation from balance and YOUR 'need' to have the surgery for it. If you're actually CONSULTING with maxfax docs, it's IMPLICIT to them you are considering surgery for what you have. They're just telling you what the imbalance is and what would BE NEEDED to be done (what they would need to do) to address the imbalance you have. They are just confirming that if you WANT it to address your deviation, they can do surgery for what you have. So, I don't think this is a thing where you're going to a dentist or something like that for a cleaning and their telling you that you 'need' max fax surgery. It's gotta be something where you're actively seeking advice about facial balance.

Given that there are plenty of other people (as in average population) walking around with some form of facial imbalance and are 'surviving aesthetically' with one such that others would still find them attractive in some way despite having some imbalance and/or they are not BOTHERED enough by it to bother with having surgery for it OR to even ask a maxfax what their deviation is, the question you need to ask YOURSELF is what bothers YOU so much that you WANT surgery for it.

[InvisalignOnly]

  There is a big DIFFERENCE between what kind of surgeries or displacements would need to be done to address some kind of jaw imbalance or deviation from balance and YOUR 'need' to have the surgery for it. If you're actually CONSULTING with maxfax docs, it's IMPLICIT to them you are considering surgery for what you have. They're just telling you what the imbalance is and what would BE NEEDED to be done (what they would need to do) to address the imbalance you have. They are just confirming that if you WANT it to address your deviation, they can do surgery for what you have. So, I don't think this is a thing where you're going to a dentist or something like that for a cleaning and their telling you that you 'need' max fax surgery. It's gotta be something where you're actively seeking advice about facial balance.

Given that there are plenty of other people (as in average population) walking around with some form of facial imbalance and are 'surviving aesthetically' with one such that others would still find them attractive in some way despite having some imbalance and/or they are not BOTHERED enough by it to bother with having surgery for it OR to even ask a maxfax what their deviation is, the question you need to ask YOURSELF is what bothers YOU so much that you WANT surgery for it.

You are making good points, however - perhaps surprisingly - it did actually happen to me more than once that general dentists told me I 'should' get this surgery, without me asking, and offered to refer me to a surgeon. This might have something to do with the fact that as GJ mentioned,

Hospitals are businesses these days, and surgery is their most expensive product.

I should add that this happened in non-Western countries and I can actually imagine that the dentist would get a commission for referring patients for surgery. Even when I went to the ENT doctor, it did not cross my mind that the breathing issues had anything to do with my jaws or bite and he started telling me that he thought it was related to that and it would be a good idea for me to get the surgery.

There was even a young male dentist years ago - I went to see him for a filling - that told me really enthusiastically (without me even mentioning the subject) that if I got this surgery I would be stunning and look like a model or something like that. I got quite angry actually and tried to explain to him that it was really unprofessional and also irresponsible to say something like this to a patient but he did not understand what was wrong (again, this happened in a non-Western setting, in other countries I would probably make a formal complaint).

Regarding how I feel: yes, it bothers me that my teeth 'stick out' / are visible even when not smiling, and this is something I wanted to address. That's why I spoke to orthodontists, and without exception they have told me that braces would not really solve this issue. They also told me lots of other scary things like my teeth will 'fall out' if I do not get the surgery, I will have TMJ pain, headaches, digestive problems and so on. The first time they told me all these was over 20 years ago and so far my teeth did not fall out and I do not have any pain anywhere but I do have the breathing issues now... So I am hoping that if the surgery goes well, it could improve my breathing and my appearance too.

[GJ]

Breathing could have something to do with weight, too. I have no idea your weight from the photos, but getting to your ideal weight and muscle tone would help with breathing. Apnea has a lot to do with neck size and tongue size. It can be the jaws, too, but it's important to know the cause before trying to fix it.

[Dogmatix]

Breathing could have something to do with weight, too. I have no idea your weight from the photos, but getting to your ideal weight and muscle tone would help with breathing. Apnea has a lot to do with neck size and tongue size. It can be the jaws, too, but it's important to know the cause before trying to fix it.

I've been trying to figurer out. Does everyone benefit from having the airways opened more, or is it only those with severe obstruction such as OSA? It's clear that someone who have such sever problems that they stop breathing have terrible problems. But let's say you have somewhat narrow airways compared to norm, no apnea etc. Do you still benefit in different ways and feel a relief of having less strained breathing and getting more volume in your lungs?

Maybe a bad comparison, but I'm thinking like testosterone. Some people have sever deficiency and will get medical help. But some athletes take it to another level and go on "treatments" and benefit even though their baseline is good. Can it be same with airways so opening up give benefits or performance in general in some aspect?

[InvisalignOnly]

Breathing could have something to do with weight, too.

You are absolutely right - however, in my case, I am very slim and fit actually. The ENT doctor even mentioned that saying, he typically sees these problems in overweight women, but seeing I am slim, he suggested it must have another cause. He used to work at a large clinic in Taiwan where they performed lots of jaw surgeries and according to him, most people reported that the surgery had a positive effect on their breathing after the mandible was brought forward.