Implant vs Sliding Genioplasty vs Jaw Surgery?

[eastcoastian1]

Hi everyone,

Actually posted my situation over at jawsurgery forums, but since I'm in a pretty high state of confusion, I thought I might as well seek feedback from people on here as well.

I'm essentially trying to balance my lower face. I have a pretty recessive chin which I'm quite self conscious about, and really looking for the best option just to get everything harmonized. I've done a lotttttt of consulting, but still not sure the route I should take.

First off, I should mention I have about a 40% overbite and a bit of a recessed jaw. I've got no functional issues such as sleep apnea, snoring, chewing problems, other than TMJ on the right which has some very loud annoying clicking everytime I open my jaw. No pain though. I've already gone to two oral/ max fac surgeons and two orthodontists to inquire if I would be a good candidate for jaw surgery. They actually told me since my overbite is pretty moderate (class 1 on left and class 2 on right) and my jaw is only slightly recessed, it would be very extreme of me to consider jaw surgery as aesthetically, they told me I would see only a minor difference. They also said often TMJ issues aren't even solved with jaw surgery. They all told me to just consider chin augmentation. That said, two other oral surgeons who I only consulted with over Skype, said I should consider jaw surgery. As mentioned though, these two were not in person and were basing their opinions off first glance.

To add more confusion to the mix, both initial max fac surgeons suggested a sliding genioplasty for the chin, about 4mm, while two plastic surgeons I've consulted with (one being Yaremchuk who's famous in the world of implants) told me that a sliding genioplasty would make my face very very narrow, cause "step-off" issues and suggested chin+jaw implants for balance.

I'm really at a loss on the route I should take, as I've been getting different opinions from just about everyone I see. Since a lot of people on here have experience dealing with the same issue as me, could you guys give me your feedback on the route you would take if you were me? Just trying to gather as many opinions as possible.

Thanks!

http://imgur.com/a/fQ2Qf

[javisst]

Which images are "before" and which ones are projected "afters?" I know what it's like to hear this when you're considering surgery because I was once there myself, but I'd say you have ideal facial proportions and my honest suggestion would be to leave things as they are. If you were considering anything I'd say go for more chin projection but don't attempt to widen the chin.

From my own experience having a sliding genioplasty almost two years ago, I'll say this: it's not something to take lightly. I had a retrusive chin (it looks like your chin isn't technically retrusive) and although I look better, I've been left with tightness in my chin that hasn't resolved, even after Botox injections, and my front bottom four teeth are almost entirely numb. That said, my experience with the tightness and discomfort seems to be unusual for people who've had SG, but it's still a very real risk. If I could go back in time I might consider having a custom implant made since it's a less invasive procedure that carries fewer risks.

Best of luck!

[eastcoastian1]

Hey everyone.

Just got back from the oral surgeon. Based on my case, he said we can do jaw surgery but it would be more cosmetic than functional as it wouldn't guarantee fixing my TMJ (though I think it would since my TMJ is primarily on the dude where my midline drifts to).

If we did move forward, it would be about a 3mm lower mandible adjustment forward plus rotation.

Do you guys think it's worth it for 3mm? Would I see a pretty big difference?

[Clairey Fairey]

Hi,

I am in the same predicament as you, I was offered all kind of solutions from different surgeons. The two I consulted with online using only photos advised either jaw surgery or sliding genioplasty but when I met with two diff max fac surgeons face to face they both said I had a good bite (due to previous orthadontics) which my photos don't show, so jaw surgery wasn't necessary although I could move the teeth back and start from scratch if I really wanted too - no thanks!

I was also offered a sliding genioplasty on the NHS (UK) for free as they don't do the implant on the NHS but yet the other max fac surgeon advised against the sliding genio as it would - like you - cause narrow face and 'step off' issues, it is also a much bigger surgery with a long recovery and potential nerve damage.

I have now decided to go private and pay for the chin implant as it is a simpler surgery, less complications, quicker recovery time and is reversible. The other two options are too extreme for me and the surgeon is confident I can achieve a good result without the risks of a genioplasty. I won't be having it until Feb so I will post then exactly how it goes. I can't wait

Looking at your photos I think you look fine as you are (my chin is far more recessed than yours). Just keep researching, it took me a year to decide and five different consultations so fingers crossed I have made the right decision.

Good luck with what ever you decide.

[sandiego88]

Any updates on your situation? My jaw is in a similar position. I also have class 1 on the left and class 2 on the right with an overbite.

[AlfAteCats]

I got a chin implant 10 years ago when what I really needed was jaw surgery. Now the implant is eating away the bone underneath (seriously - implants will eventually recede into the bone) and I have to get the jaw surgery I needed PLUS remove the implant and hope my chin is okay underneath to perform a genioplasty on. It might be deformed and we might have to use a custom implant to cover up the damage.

If you're borderline needing jaw surgery for functional reasons, milk your insurance and get it done right the first time.