BSSO first before sliding genioplasty?

[wolfhero]

My orthognathic surgeon said that we should do a BSSO first before I decide whether I want a sliding genioplasty 6 months later. The thing is, whenever I jut my lower jaw forward to simulate a mandibular advancement, I believe that my chin still looks moderately recessed.
Is this common practice when doing mandibular advancement surgeries? And wouldn't it be easier to perform both in one sitting?

I read in a book on maxillofacial surgery that surgeons should resist the temptation of waiting to perform a sliding genioplasty on a class II patient because a small lower jaw is usually accompanied by a recessed chin.

Should I push for a sliding genioplasty in combination with the BSSO or should I trust in my surgeon's decision?

[snapdresser]

I think it's more common to either do both at the same time or else not do a SG ever. It's easier and cheaper to do both in one sitting. Waiting 6 mos sounds weird unless he really thinks you'll look better without it, and that could depend on a lot of factors. I can tell you that the aesthetic ideal for men is that there should be a vertical line directly down from the glabella to the pogonion. For women the pogonion should be a couple mm behind the vertical line down from the glabella. If I were you, I'd ask my surgeon if I could see his surgical plan and see where my pogonion will end up without the SG and go from there. That's just me though; it's your face!

TL;DR: This is your face. I wouldn't recommend going by what your research says is the norm, I'd see what exactly your face needs to look its best and then demand that.

[wolfhero]

Thanks for the answer snapdresser.

Here is a picture of my side profile, with one being my normal bite Vs. pushing my lower jaw forward. https://imgur.com/a/tJTui

Well it seems that maybe the reason why he wants me to wait 6 months is because maybe he doesn't do the surgery that often(just my assumption, but he told me that he does 3-5 surgeries a year), even though he's a maxillofacial surgeon. He said the risk of nerve damage would be great if it would be done at the same time, and that there are many ways to alter the chin, and that the ideal standard of beauty for me could be different for him.

He also said that I could also possibly need a bone graft from my hip for the sliding genioplasty.

He's currently the best we have in our country because the procedure isn't common in our country (The Philippines).

Unfortunately, due to costs, I wouldn't be able to have it performed in another country like Canada or the United States. I even tried to book a consultation with a surgeon in Canada when I went there but I wasn't able to book one because an appointment was not available due to so many patients(I only wanted to go for a second opinion, but did not plan on getting surgery there).

I really believe that I also need a sliding genioplasty to complement my lower jaw advancement, but I think that he really wants me to wait another 6 months even though I need it. I'm not sure if it's due to inexperience(because other surgeons; such as in Canada, can do both in one sitting because they have performed thousands of it) or if it's because he wants me to wait and see the result of BSSO only.

I'm thinking the reason is the former, because of how uncommon the procedure in our country is.
My surgeon is an ENT-Maxillofacial Surgeon for what it's worth and he had his Oral & Maxillofacial Surgery Residency in Germany. He's also a board certified Oral and Maxillofacial Surgeon.

[braces101]

I would not suggest demanding or pushing him to do anything he isn't comfortable with. I too would be a little nervous about getting surgery from someone who only does 3-5 of these a year, especially considering that every case is different. I don't think what you're doing with sliding your jaw forward is going to give you an accurate idea of the positioning. Basically, my surgeon used facial measurements along with modeling the surgery in his lab beforehand. He said a lot of the appearance aspect (ie what looks good on different types of faces) just comes down to experience. Regardless of whether you need it or not, it definitely sounds to me like there is a degree of inexperience on his part if he is worried about causing nerve damage with just BSSO and the sliding genioplasty. Though it does seem like he is trying to take a more conservative approach which is probably a good thing if he just really does not think you need the sliding genioplasty.

Perhaps ask your surgeon if he has any references or previous cases he can show. Maybe he can show you one similar to yours. I personally would not have done the surgery with someone I was not comfortable​ with or if I had any doubt about their general ability to achieve a good result. In your case if things were to turn out for the worst, you may very well have to travel elsewhere to get a proper revision -- something to consider and another reason his conservative approach is probably better.

[Jeff1337]

Hi Wolf,

It sounds like he's hesitating because he doesn't have much experience with genioplasties.

I looked at your pics and can see what you're saying and why you're wanting the genio.

Can you find a different surgeon?

[Jeff1337]

Hey Wolf,

Just want to add to my post above: When I said "I can see why you want genio," I didn't mean that you look bad or anything like that. I meant that I understand where you're coming from. Wanted to clear that up in case it sounded that way. You'll look fine either way, man. Good luck with whatever you choose.

[kcjawjourney]

I had a BSSO to rotate my lower jaw and I was VERY concerned about my chin being off-center after the procedure. The original plan was to do a BSSO and a sliding genioplasty (in my case, the movement was horizontal, not vertical like what you may need).

However, two days before my actual surgery, my surgeon said he wasn't going to do the genioplasty because the computer imaging models showed him that it probably wouldn't be necessary. I shared with him my concerns, and he said if I was unhappy with the results, he'd do a genioplasty 6 months after my BSSO.

I'm just shy of 4 months post-op, and I'm so glad he took a more conservative approach to my surgical planning. Even though you'll already be "under," jaw surgery is a long, complicated procedure with a long, difficult recovery. Even though it sounds simple to us patients, the sliding genio comes with its own recovery and potential complications, not to mention adding additional time under anesthesia. I highly doubt that he is hesitating because he's not familiar with the procedure, or because he wants more money--I would almost guarantee he doesn't want to do an additional procedure if it's not absolutely necessary.

I know several people from the jaw surgery Instagram community who underwent a genioplasty after recovering from their BSSO, on their surgeons advice. This is NOT an uncommon recommendation.

If this is the surgeon that you have selected for your procedure, you need to trust his judgement as a medical professional. If you don't trust him, then I would suggest finding another surgeon. At the very least, seek out a second opinion.