Metal Mouth Message Board

Hi everyone,

I have been a 'fly on the wall' on this site for ages, reading other peoples accounts and questions, and relating them back to my own problems and desire for change. I have now reached the point where I feel it would be really helpful to get some outside advise and opinions regarding how i should proceed with my surgery. I find it really hard to express my feelings about it, but I will try to give you as accurate a picture as possible.

I have what I perceive to be an extremely weak lower jaw. I am reasonably happy with the upper part of my face, but I am very self conscious about the lower half and always posture my jaw forward. My chin is very recessed and goes directly into my neck, with no angle between the two. To make matters worse I have quite dominant, masculine features in the upper part of my face (nose, brow), and it looks as though everything is top heavy and collapses into itself in the lower half of my face. Over the years this has lead to me finding social situations more difficult than I would do otherwise (low confidence/esteem etc), and I really feel ready to make a positive change to my appearance and through it my self conception and my life - if that doesn't sound too lame.

I was told by my surgeon that it would not be possible to move my bottom jaw without also moving the top jaw, as my bite is basically alright. I didn't mind this because when I posture my jaw forward I find that I get the best results by slightly pushing my tongue up behind my top lip to further protrude and accentuate the whole area, although I was aware that this procedure could be more risky. Unfortunately, when I went to see my surgeon he said that he had decided that I was not a suitable candidate for jaw surgery at all. He said that because of my face type he would not be able to move my upper jaw forward by more than a few mm or it would start to change the balance of my face in a negative way (gummy smile, widen nose with an upward tilt, fuller cheeks). What he said he could do for me was a 7-10mm sliding Geno, which he claimed would give me a stronger jaw and straighten out the ligaments in my neck, giving it more of an angle, without risking affecting my bite. However, I was also told that it would be a compromise and that as it would only affect the front part of the jaw it would not fully give me the results I have been looking for, which was in particular a 'squarer' looking jawline which would be heavy enough to fully counterbalance the top part of my face.

I guess I am wondering if the Geno on its own can deliver a sufficient change to my appearance, and significantly enhance/strengthen the appearance of the lower half of my face?

So far I have only been able to see one surgeon, might others have a different opinion on what is possible/advisable regarding the advancement of both jaws? Should I look for a second opinion before going any further? (However, I live in the UK and have waited over a year for this appointment).

Some of the 'negative' consequences of the double jaw surgery actually don't sound too bad to me - I would ideally like to achieve a much stronger jawline, which is more pronounced both upper and lower, and which also enhances the contours of the face leading up to the cheeks. If in the process my smile became a bit gummy I honestly think that I would consider it a worthwhile trade, although I know others on this board have similar concerns to mine specifically about their smile.

Anyway, thank you so much for taking the time to read/respond to my post. I didn't mean to write so much and reading it back now it sounds a bit too vain and specific! I guess that is because I have been thinking about all of this for ages, sorry!

PS If anyone replys I will try to post pictures.

Hey bathspider, welcome!

First off, you are not vain at all and wanting to correct something that bothers you this much is completely understandable!

Your case sounds so similar to my own. Before I knew this surgery existed, I considered getting a chin implant and rhinoplasty to fix my aesthetic flaw, but I am so happy I didn't go through with either one! After years of reading articles and analyzing my face and finally going on a consult with a top orthognathic surgeon here in the US, I now know what my issues were all along and what I need to have done to fix them (it turns out, I didn't even need a genioplasty to achieve an ideal result, just Lefort I and BSSO advancement and rotation). I just went for a consult back in July, check out my post about it entitled "My consult with Dr. Arnett".

I would HIGHLY recommend you NOT settle for a genioplasty, but rather go on more consults with some top orthognathic surgeons. Just as an example, Dr. Arnett and the surgeons he has trained are the only orthognathic surgeons who do a "counterclockwise rotation" of the upper/lower jaw complex (he told me that). This enables him to move the lower face/chin forward without affecting the nose negatively.

Most people I have read about do not end up liking their genioplasty and it is what I would consider to be a "quick fix". It was nice of your surgeon to warn you that the genioplasty would be a compromise (not all surgeons are that honest!)

But seriously, if your surgeon cannot deliver the results you desire, go on some more consults.

Feel free to ask me any questions you like. I am new to all of this as well and am only beginning the whole process.

All the best,

Dan

Hi Dan,

Thank you for your reply, it is really helpful to hear from someone with a such similar set of issues and concerns. I am definitely concerned that the genioplasty will not, if performed in isolation, be sufficient to provide me with the facial balance that I strongly desire. In fact my worst case scenario would be to end up with an overly pronounced, protruding chin 'stuck on' to a weak jawline.

But my surgeon assured me that this would not happen, as the incisions would be made sufficiently wide apart that it would be the front of the jaw and not the 'chin' that would appear to move forward. But I am still sceptical, and like you I have read numerous accounts written by people who have not been happy with the results of a genioplasty and have had to either have it reversed or have gone on to further procedures.

In England it is a bit different to the US, because of the NHS I will not have to pay for my surgery, which is amazing! There is no way I could independently afford anything like some of the figures quoted on this site, so I am really very lucky. However, it does make the whole process really, really slow (waiting years to even get into the system, then several months between each consultation) and it makes getting consultations with other surgeons at other hospitals really difficult, and right now I think that is what I really need.

At the moment I am waiting to see a computer prediction (not sure how helpful this will be?) of the sliding geno. Then I will have to decide whether to go ahead with it or not. Like I said, I would really like the opinion of another surgeon before making this decision. And not being able to makes me feel a bit dissempowered, which isn't how you should feel before entering into possibly life changing surgery!

I guess I am weighing up that if I were to get the surgery I think I want it would possibly include a genioplasty, so it will make a difference, and if it really is all I can have then I definitely want it. But is it really all I can have? And if I was combining it with a jaw advancement it would (I suppose) be administered to quit different effect, so if in the future I wasn't happy the geno would need to be altered again and couldn't just be 'the first stage' of a more complex procedure?

Sorry to go on!

I will read your account under the title you have given me. I hope things are proceeding as planned for you, and that you are on the way to some life enhancing results!

Best,

bathspider

Hi Bathspider

I can also relate to what you have said. My ortho says I could benefit from just a genio, but I have a recessed weak jaw, and a genio is only masking an underlying proportion imbalance. I too have also paid to see 2 top surgeons, one here in london, and one in Belgium. Both say the same thing. I need both jaws done, as well as a genio. I am doing it private as I dont qualify for NHS help (I am 32, and it is not a functional issue)
I am waiting for surgical plan to be discussed in a consult with my ortho and surgeon, then will start braces. I ALSO have a good class1 bite, but in order to give the lower jaw advancement i need, I am going to have 2 pre-molars extracted to create space to move the jaw forward.
Only you can know how you feel. Dont let others influence your decision. It is your face, and you will be the one living with the results. thats the appraoch im taking

Terry

Hi Terry,

Thanks for your reply. It certainly sounds like we are in a similar position with regards to both our problem and the treatment suggested on the NHS. It is really interesting to hear that the private surgeons you have contacted have concurred with your own assessment of the treatment required - I wonder if the same might be true for me.

Do you think you could private message me the name of the private consultant you saw in London? Was it expensive? I think I should perhaps see someone in that capacity before going too much further, just to get another opinion away from the structures, hierarchies and ways of doing things which are probably firmly established at the Hospital I have been involved with so far, even if it ultimately serves to confirm what I have been told already.

What have you decided to do about your case? Do you know the details of the top UK surgeons? I would be very interested to research them...

Good luck with everything! javascript:emoticon(':D')

Best,

Bathspider

I used to go on this site a year back or so and made a thread back when I knew I needed surgery, but was unable to really talk to anyone about it because i was too embarassed. recently, I had some setbacks...chipped a tooth (front right tooth), and had to get a pole & crown put in, which sucks because I was known for having nice teeth. also my orthodontist died a month ago, which was awkward because i had just told him i needed the surgery and he was recommending me doctors to go to and then a week later he died. anyways, this made me kind of want to take control so I told my dentist about it, and told him about my TMJ & jaw problems. he basically said yeah my chin is recessed, but i only have like a 2 mm overbite, so changes wouldn't be noticeable and of course my mom was thrilled because she doesnt want me to have the surgery. but the thing is i think it was the headgear from my braces, and mouth breathing, that messed up my jaw because it pushed my upper jaw back: this site explains (http://www.facefocused.com/whatis1.html)

I am seeing the TMJ specialist tomorrow, and am gonna tell my mom about how i want upper & lower surgery, but i will also bring it up with the TMJ doctor.

basically have the same problems as you, and I know what you are going through, i hope the upper & lower surgery will be ok'd. idk if cost will be an issue, but if it is i will just use money i will have saved up from work or something.

hey kylesoccer

I have no overbite at all. My bite is calss 1, so in order to make space for lower jaw forward movement, 2 teeth will have to be extracted - so the lower teeth are brought back prior to surgery (in effect making the bite worse and look even more recessed). Its a fairly standard approach.

I would be curious to see the computer prediction from the surgeon. In some cases (although not all) a sliding genio can do the trick. In my case my upper jaw was rotated to fix my bite and my chin was brought forward to deal with mentalis strain and a weak chin. I love my results - my bite is perfect and I finally have a chin! Really, if your bite is perfect then why mess with it if you don't need to? If you don't like the results from the prediction, then maybe try getting a second opinion somehow.