Your Questions
Your Questions
Q: Dr. Eppley, I am a 25 year old male who currently has braces. Wondering if I should have BSSO mandibular advancement or sliding genioplasty. My jaw is strong but my chin is weak especially when biting.
A: The answer to the choice between a mandibular advancement or a sliding genioplasty to improve your profile is literally ‘between your teeth’. Since you are in braces, the key question is what is your bite relationship and what does your orthodontist to tell you? Is your bite correctable by orthodontics alone or is the discrepancy between your upper and lower teeth significant enough that the lower jaw needs to be brought forward to put your bite together properly and, if so, how much does it need to be moved forward.
There are three possibilities. #1 Your bite is going to be corrected by orthodontics alone and then a sliding genioplasty is needed. #2 Your bite is far enough apart that the lower jaw need to come forward significantly (7 to 10mms) and the profile will be corrected completely by that movement alone. #3 Your bite correction requires a small amount of mandibular advancement and a small sliding genioplasty will be needed as well.
Regardless of the type of mandibular or chin movement needed, I have attached a prediction of the type of change needed for normalizing your facial profile.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Is BSSO mandibular advancement reversible at all and what are the complications of that? Whatever was wrong with my face got accentuated with this procedure, e.g. flatness of my cheeks, flatness on sides of my face, nasolabial distance, short nose, etc. There was a few mm space between my teeth and I just didn’t expect much change to my face nor was told there would be much change nor a bad outcome to my facial structure. My face wasn’t great but with some good cosmetic procedure would have been looking good but now I am not sure what to do about it and how can this be at least partially reversed and if reversals are performed and with what results? I just want this jaw shorter and simply removing the genioplasty probably want give that much of an improvement, I feel I would have a long jaw with flat chin and the effects of my face wouldn’t be reduced, the pulling down part. I don’t gain weight easily on my face nor at all so it’s not like any fat is going to cover this bad outcome and the most I don’t like how the face got all pulled down and how bad it looks, I didn’t really know that would be the outcome of this surgery. If reversal is possible, what would be reversed in the facial structure, would it just be a bit of length of the jaw or would the changes to gonial angle/movement of ramus bone be reversed to any degree? I guess it doesn’t work for every facial type, certainly didn’t work for my face. My orthodontist told me there could be some adjustments over time to my jaw, but I am certain there wouldn’t be any as so far there wasn’t any adjustments and it’s been over 5 months now. The more the swelling went down, the worse my face began to look. I feel now it’s probably the final result except for still swelling on my chin area a bit.
A: At five months after facial skeletal surgery, I would agree that you are essentially looking at the final result. Like the genioplasty, the BSSO mandibular advancement is reversible but the implications of doing so are not as simple as that of the chin. Moving the mandible back is going to change your bite to an unfavorable realtionship. The whole effort at presurgical orthodontics and then the surgery was to change you into a new and good bite relationship. While the BBSO can be undone and moved back, the bite will subsequently be off. Whether that is subsequently in the range of being correctable by orthodontics is a question for your orthodontist since I have no idea what your bite was before surgery or now. There is also the repeat risk of nerve injury (numbness to the lip and chin) with the repeated BSSO procedure.
It would be extremely helpful to see some before and after surgery x-rays (lateral ceph films) which your orthodontist and surgeon undoubtably have. That would provide the critical answers to how far was the mandibular and chin bone segments advanced. (in mms) That would tell me what contribution each made to your now overprojected mandible, where the most likely bone setbacks should be done for the greatest change and the risks involved in doing so. As I had stated previously, undoing the chin is far simpler and has less risk than undoing the BSSO.
Your pictures actually look satisfactory to me and I see no major facial imbalance problems. (I see a slightly strong chin and high gonial angles) But…this is your face and clearly the structural changes are unacceptable to you. While it is common with any form of facial skeletal surgery (what I call facial structural surgery) to have a period of psychological adaptation to their new face, generally that has happened by 6 months or so after surgery.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dear Dr. Eppley, I am a 19 year old male. I am having a 5 mm lower jaw advancement (BSSO). I know that the human jaw and chin and other facial bones continue to grow until around age 25. I also know that after surgery, the doctors screw and bolt your jaw into a new position. Would this mean that since my jaw would be screwed and bolted in its new position that my jaw will not be able to grow anymore? Will I have my 19 year old jaw all my life? The reason I ask this is because I have a small jaw, and I want it to keep growing as much as it can, but I am afraid that this surgery I am having in a few months will stop the growth of my jaw.
A: Jaw (mandible) growth in a male is known to not stop growing until at least age 21 or so. That is the reason any form of jaw surgery, mandibular advancement or mandibular setback, is not usually done until age 17 or 18. At this age, one is unlikely to outgrow their surgical result. This is much more of a potential concern when the jaw is set back than when it is moved forward. I have never seen a jaw advancement done where it becomes ‘too short‘ later in life. But I have seen jaw setbacks where the underbite recurs with ongoing jaw growth. This indicates that surgery of the ramus does not really affect jaw growth and I think this is not a concern that you should have.
Indianapolis Indiana
Q: Can a chin implant be an alternative route to mandibular advancement? I went to the orthodontist today for my overbite and excessively gummy smile and was told that my options are to get the Lefort maxillary surgery (or place 2 screws on my upper jaw and have wires pull my teeth-in sections via braces- upwards to reduce the gummy areas) and mandibular advancement. Read about LeFort and mandibular advancement and don’t think I want to go through all the pain and side affects so I looked into chin implant and I am entertaining the idea of a chin implant and the 2 screw method to pull my teeth upwards….. any suggestions?
A: Both chin augmentation and mandiibular advancement will have similar effects on the chin…bringing it further forward. How much each approach will bring it forward is more adjustable with a chin implant as different sizes can be chosen. In mandbular advancement, the chin will only be brought forward as far as the jaw comes forward and the teeth still fit together properly.
Chin augmentation is certainly a far easier and more efficient choice if the primary motivation for the surgery is the aesthetics of the chin. But it will not obviously change one’s bite so there may be some functional chewing and temporomandibular joint tradeoffs if the lower jaw is significantly short.
Mandibular advancement is a commitment both in orthodontic preparatory time and in surgical recovery. Therefore the amount of jaw shortness and how well one is able to chew and bite comes into play as to whether this effort is worth the risks.
Indianapolis, Indiana