I had a chin wing - it blunted and rounded my angles

[mediumdrinkofwater]

Hey guys, im new on this forum.

I had a chin wing about 6-7 months ago with dr. Z, to correct my recessed chin. In addition to that I had/have an underbite of 4mm, so the mandible seems to be a little recessed. To counter this i decided to go with the chin wing, since it seemed like a easy solution to the problem. He ended up moving my chin forward by 4mm.

My chin was also quite asymmetrical before the surgery. So he made some movements to create more symetry. Not quite suire if that worked either. My chin is still a little asymmetrical, however its not that apparent and it does not really bother me that much.

The results are mixed, while it looks much better from the side and diagonal angle, I dont feel good about the front view. I have the feeling it massively blunted my jaw angles, making it seem rounder.

I would like to get some advice on what I can do now. What options I have to fix the gonial angles. I will provide pictures soon.

[GJ]

I'm not positive, but I seem to remember a surgeon telling me they can shave the bone to shape them. I know that's pretty worthless, but maybe start google searching in that realm. Others here will probably know more, too.

[mediumdrinkofwater]

Here are some photos. Please provide feedback on what you think about the result and what I should do. All pictures were done with my iphone 8. Im 26 years old btw.

https://imgur.com/a/cF0Me4a?fbclid=IwAR2CBI2cVnyPscl1cdaWkbyUKdYeNdz2KhZULaIbWDURzheOXPhohhOqQhY

[needadvancement]

I'm not positive, but I seem to remember a surgeon telling me they can shave the bone to shape them. I know that's pretty worthless, but maybe start google searching in that realm. Others here will probably know more, too.

The other day I was reading a surgeon's take on chin bone shaving for aesthetics and he stressed that it should not be done because they have to fully detach the muscles and soft tissue from the bone which would damage them and ruin the outer look. But I don't know if the same counts for the jawline angles though.

[Breakingbad]

I've read about some people here getting a chin wing with Dr. Z twice, where the first time it was done to widen all around and bring the chin forward, and then the second time to shave bone and improve the contours of the jawline. I think that's what StupidJaws had done and the end result looked really good to me. Maybe you could look for his posts and think about doing that.

It's hard to give feedback on the result without before photos. You look good overall but I do see what you're saying about the roundness.

[kavan]

It sounds like you didn't do enough research before getting a chin wing. I say that because blunted jaw angles is a common trade-off in the sense that it's something to EXPECT and pretty much non-avoidable.

Think about it: They cut through the entire mandibular border and right through the posterior jaw angles and move all forward. That means in addition to your CHIN being moved more forward, the lower border of your posterior jaw angles are ALSO going to move forward. That's what you're seeing in frontal view. Again, that's normal for the chin wing you got and are describing.

The 'fix' for this is a SECONDARY chin wing procedure. What they do, is cut through the initial incision cut and GRAFT a piece of bone (harvested from the hip area) onto the posterior jaw angle as to compensate the 'empty space' to it created from the initial chin wing.

[mediumdrinkofwater]

It sounds like you didn't do enough research before getting a chin wing. I say that because blunted jaw angles is a common trade-off in the sense that it's something to EXPECT and pretty much non-avoidable.

Think about it: They cut through the entire mandibular border and right through the posterior jaw angles and move all forward. That means in addition to your CHIN being moved more forward, the lower border of your posterior jaw angles are ALSO going to move forward. That's what you're seeing in frontal view. Again, that's normal for the chin wing you got and are describing.

The 'fix' for this is a SECONDARY chin wing procedure. What they do, is cut through the initial incision cut and GRAFT a piece of bone (harvested from the hip area) onto the posterior jaw angle as to compensate the 'empty space' to it created from the initial chin wing.

Are you confident the second surgery will do the trick? Are there any other cases that did this, apart  from SJ. Did SJ plan to do 2 cws from the start?

Is the second surgery less complicated by nature, since there are no movements made as in the first surgery where the chin was moved 4mm.

Is a procedure where there is no forward movement of the chin referred to as a side wing? What exact movements would be required for me to get similar jaw angles as SJ (after 2 cws and before the filler)

Is the empty space you refer to not already filled with new bone?

[Tomasjohn]

Hey,

first of all: Thank you for posting pictures. I think your chin/jaw  does not look bad at all btw. But can you please also provide before photos. Otherwise it is hard to judge the result.

In general: I don't know how bad your asymmetry was but I think a chin wing for only 4mm (only forward?) movement was not the optimal solution. Ching wing allows for great horizontal movement without step off and other limitations the genioplasty has. But if one only needs 4mm I think the genioplasty has less asthetic risks than the chin wing.
But if a jaw angle is VERY steep then i think a Chin wing could also be better just for small movements. Most very good before/after I have seen online for male patients had a very steep jaw angle and then they had the mandible border dropped at the back as well as moving it forward. They had no visible angle from front view to beginn with, so the outcome was a improvement - even when looking a bit roundish.

As to your case: A second surgery would probably not be less complicated. In my opinion it is best to treat every surgery as a "high" risk. Especially if you already look good.

To assess the outcome better: Please provide before photos and if you have scans from after the surgery.

[mediumdrinkofwater]

I'm sorry I dont want to reveal too much about me. The before pics do not really matter as of right now. The fact is that my gonials are rounded, which they were not before. Yes you are right, i did not do enough research before, which i strongly regret. However, it seems that I have two options now:

1. Go for a second chin wing. This is heavily based on a former user called stupid jaws, who managed to get a very good result after 2 chin wings following a substandard bimax. I require more information on the second chin wing. I'm not really quite sure how this can benefit my jaw angles.

2. The second option is that I simply undo the chin wing. I will ask the surgeon to remove the implanted hip graft and restore my old look and jaw angles. If I do this and fully restore my old look I might opt for a high bsso to fix my 4mm overbite, since my issue is a mildly recessed mandible in the first place. By doing this I should be able to get my chin-wing profile back and avoid jaw angle issues right?

What do you guys think (@kavan)?

[Tomasjohn]

I'm sorry I dont want to reveal too much about me. The before pics do not really matter as of right now. The fact is that my gonials are rounded, which they were not before. Yes you are right, i did not do enough research before, which i strongly regret. However, it seems that I have two options now:

1. Go for a second chin wing. This is heavily based on a former user called stupid jaws, who managed to get a very good result after 2 chin wings following a substandard bimax. I require more information on the second chin wing. I'm not really quite sure how this can benefit my jaw angles.

2. The second option is that I simply undo the chin wing. I will ask the surgeon to remove the implanted hip graft and restore my old look and jaw angles. If I do this and fully restore my old look I might opt for a high bsso to fix my 4mm overbite, since my issue is a mildly recessed mandible in the first place. By doing this I should be able to get my chin-wing profile back and avoid jaw angle issues right?

What do you guys think (@kavan)?

Rather than undo the whole chin wing your doctor maybe could just move a segment of the mandible border back to its original position at the angle and fill the new gap in with bone graft. I think that would be the best solution if it is possible.

I saw a post-op scan once (don't know where, sorry) where the mandible border was cut in two segments (from the gonial angle to the chin). Then the two segments where then laterally moved outwards at the gonial angles. I don't know if this is possible if you already had a chinwing.


Edit: Found the scan. See attachment. Last photo on bottom.

[GJ]

I think the results look pretty good. Doubt I'd notice anything unless you mentioned it. Maybe just give it more time?

[mediumdrinkofwater]

Yes, i will wait a few months more. Are there any known cases on here where someone "undid" a chin wing in the way I described?

The thing is that i have an overbite of 4mm and dr.z forwarded my chin by 4mm as well. So by that logic I should be able to get the same result meaning the same mandibular length if I did a mandibular distraction osteogenesis right, but without the round gonials? Is that correct? On top of that I would avoid another invasive surgery.

Of course a bsso would be the optimal solution, which I should have gotten in the first place.

[kavan]

Are you confident the second surgery will do the trick? Are there any other cases that did this, apart  from SJ. Did SJ plan to do 2 cws from the start?

Is the second surgery less complicated by nature, since there are no movements made as in the first surgery where the chin was moved 4mm.

Is a procedure where there is no forward movement of the chin referred to as a side wing? What exact movements would be required for me to get similar jaw angles as SJ (after 2 cws and before the filler)

Is the empty space you refer to not already filled with new bone?

Denial of further advice.

Reasons: Entitlement issues.

1:'Jumped' my signature (Please. No PMs for private advice. Board issues only.) for such. No 'invitation' on my part to PM me.

2: Used my initial response, where I mentioned NOTHING about 'SJ', as a SPRINGBOARD for me to address questions about 'SJ'. NOTHING in my post could be construed as an 'offer' by me to instruct the OP as to 'exact' movements he should have based on SJ. Hence, entitlement to something I wasn't inviting in the process of giving the OP some initial feedback.

3: The 'fix' (and by that I mean redress) for blunted jaw angles is a SECONDARY chinwing. The OP should not expect that my conveying that info to him is contingent that I PREDICT the outcomes of the surgery as to be 'confident' it will do the 'exact' thing he wants it to do or the exact thing he has in his mind's eye, wishes to see in the mirror or wishes to reproduce whatever SJ had done. All I need to be confident about here is that it's a SECONDARY chin wing procedure that is the redress for the blunted back angles.

In closing, there was nothing in the GENERALLY useful info I offered the OP for him to entitle himself to the type of info/feedback he expected subsequent to it. He wanted to know what options he had to address the blunted jaw angles and was told he had the option of getting a SECONDARY chin wing procedure. He's entitled to explore that option with his chin wing surgeon regarding further articulation/definition to the jaw angles and especially so if SJ's outcome is to be used as reference.

[kavan]

Correct. The venue is secondary chinwing procedure.

Rather than undo the whole chin wing your doctor maybe could just move a segment of the mandible border back to its original position at the angle and fill the new gap in with bone graft. I think that would be the best solution if it is possible.

......

[mediumdrinkofwater]

The former user mentioned sj, thats why I mentioned him... Sorry about the pm, i didnt read your signature.