Am I A Good Candidate For A Combined Horizontal and Vertical Bony Genioplasty?
Q: Dr. Eppley,I am interested in osseous genioplasty or jaw surgery to advance my lower jaw.I have a type 1 occlusion however I also have very heavily proclined lower teeth, as you will see in the cephalogram image (attached).
In the past, I have also had an 8mm chin implant when I was 25 y/o however had it removed in about 3 months because I did not like how it rounded out my chin so much, and greatly deepened my labiomental fold. The small dimensions of my lower jaw made the imprint of the standard, round implant stand out considerably, although the projection was good. (see attached image)
Since then, my chin has returned essentially to normal (with very slight lingering augmentation which is fine), however, at this stage I am interested in doing a forward and vertical lengthening genioplasty (possibly with grafting) to advance my jaw/chin point whilst minimising depth increase of the labiomental fold too much.
I have also previously considered jaw surgery to bring back my lower teeth via pre-molar extractions, then lower jaw surgery to bring the jaw forward. For me right now however, I would prefer not to do jaw surgery as I am hoping that genioplasty can achieve a similar result, whilst being less invasive.
I have seen some very decent results from surgeons (including yourself in the B&As) achieving height, length and width (as the chin comes forward) increase, whilst also giving the impression of shallowing out the fold.
I have also seen cases where deep (nearer to the back of the mandible), flat cuts are made with forward and down advancement which have worked well for protruded lower teeth and low vertical height.
In my country, I have found that surgeons are quite conservative, in particular when it comes to vertical lengthening and significant forward advancement. There are really only two maxfax surgeons in a 100km radius of where I live, one who will only do a kind of one dimension, chin-button forward type advancement (5mm max) with a high bony contact and no grafting – they said it will likely deepen the labiomental fold more than the chin implant I had before. Otherwise, there are a significant amount of surgeons who offer off-the-shelf chin implants but no osseous genioplasty procedures.
Finally, I am interested in how I may go overseas to do this surgery, how health insurance coverage might differ and so forth.
In summary I am interested in:
1) genioplasty to lengthen and advance lower jaw/chin point
2) comparing this to lower jaw surgery and pre-molar extraction
3) limiting labiomental fold increase
4) digital imaging to compare skull dimensions to standard/aesthetic dimensions. From my own assessment viewing B&As, journals and similar, advancement of approx 8-10mm and 5-7mm down seems broadly suitable
5) how insurance might work and the general travel/stay over process (how many days recommended etc.)
A: In answer to your questions:
1) Combined vertical and horizontal chin bone lengthening can be done. (see attached imaging)
2) If you can tolerate the experience lower jaw surgery treats the source of the problem and, at the least, lowers the chin augmentation dimensional movements if needed secondarily.
3) Limiting the deepening of the labiomental fold would be the proper understanding.
4) Determining the chin dimensional changes is done by imaging of the facial pictures looking at variable amounts of change not some theoretical aesthetic standards.
5) This is an aesthetic procedure so the concept of insurance does not apply.
6) Most international patients return home in a few days after the surgery.
Dr. Barry Eppley
World-Renowned Plastic Surgeon