Sidewing-Technique from DR.B

[Tomasjohn]

Agree, very nice result! Same technique as with the other person (long cw). It’s really baffling how every result looks completely different than the next one. Can you post the link of the vid? I would like to see the X-ray I’d available

When he says "long cw" he means the cut goes all the way back through the angles and "short cw" not through the angles. Some of the "long cw" results had the mandibular border segmented in 2 and then widend.

Video: go through my post history

[kavan]

It is not avoided because of the chin wing but because the cut at the chin goes further up (like a shield) and the space behind is filled with bone graft or alloplastic material.  Other method is something that is called chin visor.

Shield: https://www.instagram.com/p/CRV1mBpJCH_/?utm_source=ig_web_copy_link

In short: Basically just add volume above the chin.
I mean could also be achieved with filler.

Unrelated but this is the best cw result i have ever seen: https://www.instagram.com/p/Ced2dXLoh8C/?utm_source=ig_web_copy_link

... I've posted a video where they show what was done to him if you want to know.

Yes. An 'add on' to the procedure that's referred to as either a chin 'shield' of chin 'visor'.

[GJ]

Yes, I was referring to the strong mento-labial fold mainly. It looks very artificial, non-natural imo.

Kavan, do you know what besides grafting at the time of surgery can mitigate this? Is it possible to graft after, to fill in the LM groove, without detaching the mentalis? He could definitely benefit from that.

And what is the cause of this in the first place - is it an angle issue? The chin goes straight out. I wonder if it was tilted down a little if it would mitigate this type of look?

[kavan]

Kavan, do you know what besides grafting at the time of surgery can mitigate this? Is it possible to graft after, to fill in the LM groove, without detaching the mentalis? He could definitely benefit from that.

And what is the cause of this in the first place - is it an angle issue? The chin goes straight out. I wonder if it was tilted down a little if it would mitigate this type of look?

I said it in reply #`16 in this thread.  An 'add on' to the procedure that's referred to as either a chin 'shield' of chin 'visor'. It's been discussed here before. Might be worth a search. It involves a certain way of cutting that allows for filling in the grooved area. Basically, if a step-off that would show a sharp and deep groove between the lower lip and chin can be predicted to happen from the advancement of the chin a type of cut and back fill behind it can be used that will fill in that groove with part of the chin bone and back fill behind it.

ETA: I originally referred to my post which was #17 in the thread but requests for removal of things changed post # 17 to #16.

[Jan9x1]

You can also fill the labiomental fold/groove area with a lipofilling procedure (fat grafting to the deep chin fold) I have seen it a few times on a Instagram video of a Austrian Surgeon(he does a lot of fat grafting). It looked nice and balanced and according to him it's permanent after everything has settled down.

Filler is also an option, but it's not permanent and i never have seen it before.

[mediumdrinkofwater]

Im actually considering a side Wing After my Chin Wing. My mp is optimal now and I don’t require any further horizontal advancement, yet my gonal angles are somewhat blunted from the front view.

I have picked up, that a side wing would address this, by cutting a part of the posterior mandible border and placing it further back, effectively increasing the mandible border length. The new gap between both segments would be filled with a new hip graft. Is this correct so far?

My main concern would be bone resorption of the new graft. I have read somewhere on this forum, that hip grafts are only meant to work as sandwiches between bones, such as in the prior example provided by dr.B, and not as buttress, filling a gap. Is there any literature on this? Maybe kavan knows something…

Also, What would happen if the new graft gets resorbed? Do the two segments just move back into their old position?

[kavan]

A second chin wing addresses blunted jaw angles and the gap between the segments are filled with a hip graft. (bone buttress). A bone buttress is part of 'sandwiching' the cut bone segments. It's the 'meat' of the sandwich whereas the bone segments are the 'bread' of the sandwich.

Resorption would/could be some but in range of minor minor. The part they take from the hip (illiac spine) is strong type of bone (cortical) and not type that gets porous (spongy bone).

[mediumdrinkofwater]

How exactly does this procedure enhance the jaw angles? Does the jaw angle sitting in a more posterior position than before automatically enhance the gonial angle from the front? Or would it require extra flaring of the segment, which would be a seperate set of movements in the same surgery?

Ideally, I would like to tell my surgeon to do this operation without extra flaring of the jaw angles, since there is a risk of them breaking off, due to elasticity issues. I hope that alone would get the job done, and "undo" the previously blunted jaw angles.

[Tomasjohn]

You said you just had forward movement without any drop down.

So if you move part of the segment back this aspect could look like before surgery but with part of your mand. border more advanced.
Almost as if you had a genio with a cut beginning more posterior in the first place.

In this case it would not enhance the angles but just restore them.

[kavan]

You said you just had forward movement without any drop down.

So if you move part of the segment back this aspect could look like before surgery but with part of your mand. border more advanced.
Almost as if you had a genio with a cut beginning more posterior in the first place.

In this case it would not enhance the angles but just restore them.

Exactly.

[mediumdrinkofwater]

You said you just had forward movement without any drop down.

So if you move part of the segment back this aspect could look like before surgery but with part of your mand. border more advanced.
Almost as if you had a genio with a cut beginning more posterior in the first place.

In this case it would not enhance the angles but just restore them.

It is possible that there may or may not have been some drop down, but it will have been very minor.

The restoration of the previous position of the angles, will provide an improvement over the current gonial angles if I’m not mistaken? The question is do more posterior positioned angles favour the genial angle from the front view and why is this the case?

Would the end result not from a cosmetic perspective be more comparable with a bsso rather than a genio, since more of the mandible has been advanced?

[kavan]

Just a note:

Reply #21 from me on this thread was meant to clarify some questions/confusion you stated in Reply #20 .

There is nothing in your (present) response that followed that demonstrates feedback to your questions furthered much understanding on your part when a return response is a new set of different or more questions.

Likewise with your response to Tomasjohn who also clarified one of your questions. Your response is just a different set and or more questions, none of which demonstrated that you 'digested' the prior info given and none of which were questions about info given.

The salient and very BASIC thing to be understood here (and I'm not sure if it is) is that an additional chin wing (side wing) surgery can put back your posterior jaw angle where it was prior if the initial one ended up blunting by bringing the whole bottom border of the mandible forward.

How exactly does this procedure enhance the jaw angles? Does the jaw angle sitting in a more posterior position than before automatically enhance the gonial angle from the front? Or would it require extra flaring of the segment, which would be a seperate set of movements in the same surgery?

Ideally, I would like to tell my surgeon to do this operation without extra flaring of the jaw angles, since there is a risk of them breaking off, due to elasticity issues. I hope that alone would get the job done, and "undo" the previously blunted jaw angles.

[mediumdrinkofwater]

Just a note:
The salient and very BASIC thing to be understood here (and I'm not sure if it is) is that an additional chin wing (side wing) surgery can put back your posterior jaw angle where it was prior if the initial one ended up blunting by bringing the whole bottom border of the mandible forward.

Yes, I do understand this, but I think I have a hard time visualizing how this will look like. For example, how exactly would a setback of the posterior segment effect the anterior segment cosmetically. What exactly is the cosmetic tradeoff is basically what im trying to figure out?

Im guessing you would also need an xray to give more specific advice. I will provide more information to my case in due time.

[kavan]

Yes, I do understand this, but I think I have a hard time visualizing how this will look like. For example, how exactly would a setback of the posterior segment effect the anterior segment cosmetically. What exactly is the cosmetic tradeoff is basically what im trying to figure out?

Im guessing you would also need an xray to give more specific advice. I will provide more information to my case in due time.

No one here can visualize and describe to you how you would look other than to tell you that if you like everything about the change except the blunting of the back angles, a secondary procedure (side wing) can place them further back without changing the other stuff done prior. We haven't been looking at your face daily in the mirror as you have in order to visualize that for you.

[mediumdrinkofwater]

the following cw-patient "could" be comparable to my case. He had a minor advancement and very little drop off:

https://www.instagram.com/p/BkDw1OoBQvo/?hl=en

Do you guys think he would benefit from the discussed side-wing procedure, where the jaw-angles are set back? Would that alone restore angularity to his face?