Q: Dr. Eppley, I am interested in jaw surgery. I’ve had braces throughout high school. My orthodontist used spurs on the back of my top 4 teeth in order to stop my tongue thrusting. That was unsuccessful and he removed the braces. A year later I went to a different oral surgeon then the one who worked with my orthodontist to have my wisdom teeth out and he mention jaw surgery for my receding chin but wasn’t a priority then. Now my concern is cosmetic as well as functional. I don’t wish to get braces again but want to do things “the right way” to fix both. I do have an uneven and open bite as well as jaw pain. When I currently take pictures I thrust my lower jaw forward and I like the way that looks but I want something more permanent.
A: Thank you for sending all of your detailed information and pictures. I believe you may be confusing a lower jaw advancement (sagittal split ramus osteotomy, SSRO) with a sliding genioplasty. An SSRO moves your whole jaw forward and is primarily done to get the teeth to fit together. It often has a coincidental chin augmentation effect whose magnitude depends on how much the jaw moves forward. An SSRO procedure can not be done without pre- and post surgical orthodontics in the vast majority of cases. Conversely, a sliding genioplasty moves the chin bone forward but leaves the part of the jaw behind it that contains the teeth. Thus it does not improve one’s bite relationship and is only done for its cosmetic chin augmentation benefits.
To come remotely close to the ideal female jawline that you have provided you would really need an SSRO procedure combined with a sliding genioplasty to get that much chin change. Jaw angle implants would then need to be placed six months later. They key to this approach, as previously mentioned, is the need for orthodontics.
The non-orthodontic option, which leaves the existing bite as it is, is a combined sliding genioplasty with concurrent placement of jaw angle implants. Such a result will probably create an outcome that is about halfway between where you are now and the ideal jawline you have shown.
Dr. Barry Eppley