in need of help/ difficult case????

[jawstark]

So i am considering jaw surgery

i have a pretty short chin but without the typicial short face that comes usually with it(atleast thats how used to think)
My bite is fine i had orthodontics as a kid.
However i have 2 main concerns

1.) I ALREADY got a rhino in feb this year and my nose appears to be somewhat upturned i dont need much maxilla advancemnet at all but did plan to do ccw so my mandible could be brought more forward so i am concerned my nose will be even more upturned/ turn into a pig nose or become wider which would also be not ideal für me

2.) I have pretty full lips looking at bimax results the lips get usually fuller/wider.

I DONT mind them getting wider but fuller would be a real problem for me since they are almost too full now.




i attached my cephs and would really like to hear ur opinions

https://imgur.com/a/exat5ld

[GJ]

I'd be curious why you think you even need jaw surgery. Your face and jaw proportions looks fine to me in the scan, and you say your bite is good.

I think your concerns about the nose are legit based on the soft tissue position in that scan.

I don't think this is a CCW case. In fact, your face appears short to me. If you think it's already long, I think there's a perception issue here, or you need to share photos of yourself in the flesh so we can see this length. My first instinct wit this case was to consider extracting two lower premolars, and then having the lower jaw advanced. But that would elongate the face a bit, and your perception that you're already long gets in the way there. Maybe you are, but I don't see it in that scan. Feel free to email me photos.

[jawstark]

Thanks for your answer so my chin is very short and i got a pretty deep fold under the lip

A usual genioplasty would only deepen the fold i guess.
So i really dont know where to go. And yes my face is on the longer side while my lower third is on the shorter side


I attached a pic

[kavan]

Pretty simple case. Not difficult case. BECAUSE there is no need for bimax surgery.

Based on your concerns where you pretty much isolated the (short) CHIN as what bothers you, a longer and more outward chin is achieved by a 'down and out' (diagonally downward) genio; something where a bone buttress needs to be 'sandwiched' between the cut for the genio. That type would also address the overly acute angle of the lower lip to chin GROOVE.

[GJ]

'down and out' (diagonally downward) genio; something where a bone buttress needs to be 'sandwiched' between the cut for the genio. That type would also address the overly acute angle of the lower lip to chin GROOVE.

Yeah, after seeing you in the flesh, I think this would work, but it might have to be a pretty large genio, and that might look unnatural. That would be the risk. Probably 6 or 7mm.

The reason I didn't recommend this is because my understanding is he thinks his face is long already. Maybe I misunderstood the original post.

[jawstark]

Pretty simple case. Not difficult case. BECAUSE there is no need for bimax surgery.

Based on your concerns where you pretty much isolated the (short) CHIN as what bothers you, a longer and more outward chin is achieved by a 'down and out' (diagonally downward) genio; something where a bone buttress needs to be 'sandwiched' between the cut for the genio. That type would also address the overly acute angle of the lower lip to chin GROOVE.

.

Yeah, after seeing you in the flesh, I think this would work, but it might have to be a pretty large genio, and that might look unnatural. That would be the risk. Probably 6 or 7mm.

The reason I didn't recommend this is because my understanding is he thinks his face is long already. Maybe I misunderstood the original post.

No it is kinda long. Its not my midface tho its more that my forhead is on the larger side. Probably not that long tbh.

And i really dont want to look unnatural . I also want to avoid doing a genio just to get an increased fold and have to go with a bimax after that.

[kavan]

Its not only the short chin but thats my biggest issue. There is no visible jawline + i seem to be constantly bloated despite being low body fat.

After i saw my cephs/ct i was a little bit suprised . Will a genio even if its a chin shield with forward AND downward movement be enough to fix my submental + give me more  definition(i.e visible jawline). Also is my mandible really not recessed since it seems to short for my maxila.

No it is kinda long. Its not my midface tho its more that my forhead is on the larger side. Probably not that long tbh.

And i really dont want to look unnatural . I also want to avoid doing a genio just to get an increased fold and have to go with a bimax after that.

If you want your mandible and chin brought outward and also want elongation (downward drop) but wish to keep your bite and not change maxilla/nose region, then you can explore a 'chin wing' which would be something where the chin shield could/would be suggested to mitigate the overly acute 'groove' and also something which would most likely require a 'bone buttress' for elongation. If chin wing, then bone buttress is usually a graft from your HIP area. It would tend to help redistribute some soft tissue for more definition. But no prediction (from here) can be made whether it would kick up a 'chiseled' jaw line because it's not as if the procedure 'thins out' thick soft tissue.

[kavan]

Yeah, after seeing you in the flesh, I think this would work, but it might have to be a pretty large genio, and that might look unnatural. That would be the risk. Probably 6 or 7mm.

The reason I didn't recommend this is because my understanding is he thinks his face is long already. Maybe I misunderstood the original post.

I was just going by what he said in his initial post where he targeted his chin as being short. It's not clear to me whether or not he thinks his jaw line is short or long though.

[jawstark]

If you want your mandible and chin brought outward and also want elongation (downward drop) but wish to keep your bite and not change maxilla/nose region, then you can explore a 'chin wing' which would be something where the chin shield could/would be suggested to mitigate the overly acute 'groove' and also something which would most likely require a 'bone buttress' for elongation. If chin wing, then bone buttress is usually a graft from your HIP area. It would tend to help redistribute some soft tissue for more definition. But no prediction (from here) can be made whether it would kick up a 'chiseled' jaw line because it's not as if the procedure 'thins out' thick soft tissue.

Ok so u think a chin wing might be a better option for me than a bimax although it would only bring the lower border of the mandible forward. What would happen to the jaw angles if the cut is made there and they bought forward?

I was just going by what he said in his initial post where he targeted his chin as being short. It's not clear to me whether or not he thinks his jaw line is short or long though.

i do think my whole jawline is short yes since i dont have a flat chin but its kinda set back. Also i am kinda scared of resorption if grafts are used.

[kavan]

Ok so u think a chin wing might be a better option for me than a bimax although it would only bring the lower border of the mandible forward. What would happen to the jaw angles if the cut is made there and they bought forward?

i do think my whole jawline is short yes since i dont have a flat chin but its kinda set back. Also i am kinda scared of resorption if grafts are used.

I don't suggest bimax. In my prior post I told you that a chin wing can 'drop down' the mandible in addition to bringing it forward (chin goes outward and down with it). So chin wing can elongate if you want elongation. The jaw angles go forward because they are being brought forward with the procedure. So, they will be in front of where they used to be after the procedure. Grafts (bone from the HIP area) are used in procedures where the candidate seeks elongation. The more descriptive term for what is called a 'chin wing' is called an isolated osteotomy of the mandibular border. (It does not move the teeth.). Concerns that you have about resorption or particulars of the procedure that are highly specific to you are best discussed during a consult with a 'chin wing' doctor.

[jawstark]

I don't suggest bimax. In my prior post I told you that a chin wing can 'drop down' the mandible in addition to bringing it forward (chin goes outward and down with it). So chin wing can elongate if you want elongation. The jaw angles go forward because they are being brought forward with the procedure. So, they will be in front of where they used to be after the procedure. Grafts (bone from the HIP area) are used in procedures where the candidate seeks elongation. The more descriptive term for what is called a 'chin wing' is called an isolated osteotomy of the mandibular border. (It does not move the teeth.). Concerns that you have about resorption or particulars of the procedure that are highly specific to you are best discussed during a consult with a 'chin wing' doctor.

I DO understand that i just dont want my jaw angles to be messed up afterwards.
Also i would need to know if it can change my submental area and how big this change would be

[kavan]

I'm closing further correspondence, 'back and forth' here with OP 'jawstark'.
Reason: Communication does not appear to be working out despite my providing adequate information.

The OP can:

READ or re-read my prior statement to him:

........ Concerns that you have about resorption or particulars of the procedure that are highly specific to you are best discussed during a consult with a 'chin wing' doctor.

READ or re-read his statement to me after my prior statement to him:

....i just dont want my jaw angles to be messed up afterwards.
Also i would need to know if it can change my submental area and how big this change would be

QUIZ for the OP:

Is your need to know if/how it can/could change your submental area and how big the change is a question HIGHLY SPECIFIC to you? Yes/No. HINT: The answer is 'yes'.

Then who would be the most likely person to address your need to know that?

a: ME

b: a CONSULT with a chin wing doctor