Metal Mouth Message Board

I have been doing a lot of research into my lip incompetence on here and Google to try and determine a cure. My lip incompetence is caused by my lower jaw being too long so that my lower lip fails to cover my lower teeth. Here is a picture:



There are lots of references to a sliding genioplasty reducing lip incompetence but always in relation to another pre-existing problem where as my profile is near perfect after a BSSO. Instead what I need is a vertical genioplasty, as shown here:



Here is where the material gets thin on the ground, would the result of shortening the chin be for the lip to move upwards covering my lower teeth and solving my lip incompetence. Here is a picture of the desired effect being demonstrated:



Here is one complicated explanation offered by Dr Barry Eppley that can be found at http://exploreplasticsurgery.com/catego ... reduction/

Any chin reduction procedure must consider the potential effects of the soft tissue envelope. Much like changing a breast implant to a smaller one, what happens to the expanded or stretched out soft tissue afterwards? In my Indianapolis plastic surgery experience, this is a more significant issue with horizontal reduction but it still must be considered with vertical reductions as well. In either case, the mentalis muscle must be shortened and resuspended tightly. Vertical chin reductions do not require skin shortening by excision unlike most horizontal chin reductions. The finesse part of any bony chin procedure is the management of its soft tissue attachments. Failure to do so will likely result in secondary chin problems.

So no real enlightenment on the lip side of things however he does provide a before and after picture of a vertical genioplasty patient. To me it looks like the patient did have lip strain before but not in the after picture.



In another case it was documented that:

The reduction in chin height improved the vertical facial proportionality, but also deepened the labiomental sulcus, which was flatter in the preoperative picture.

There are before pictures showing the patient reveals her lower teeth when smiling, much the same as me and afterwards she does not.



Source: http://www.sarverortho.com/Portals/0/pd ... rcADJO.pdf

My concern is that a vertical chin reduction would only have have this effect:



If anyone could enlighten me that would be a great help! Thanks in advance.

My oral surgeon says a genioplasty alone will do nothing to solve lip incompetence, and in fact it could make things worse.

I'm not sure if others that have had genioplasty only would agree with me...but maybe somebody can chime in with experience?

-Chicago29

I do hope you're wrong Chicago29! Maybe he was referring to a particular genioplasty? I was able to find this on another website: "a vertical sliding genioplasty was performed for reduction of my chin and the lip strain its excess was causing" unfortunately it is from 6 years ago so little chance of contacting the author.

Source: http://www.medkb.com/Uwe/Forum.aspx/den ... pper-lower

-Bowater

Weren't you getting a Lefort 1 done?

Already had it done! It's halved my inter labial gap but would still be nice to address the other half if possible.

Bowater wrote:Already had it done! It's halved my inter labial gap but would still be nice to address the other half if possible.

I see. But in the first picture are your teeth touching? Because it doesn't look like it. I have lip incompetence as well, 11mm inter-labial gap actually and the sliding genio did improve my lip closure as I mentioned in your other thread.

If I were you I'd live with it since you don't have mentalis strain I'm assuming or any other functional/aesthetic issues. I've seen a lot of men with some lip slight incompetence and they looked totally normal.

Strangely enough it was searching for lip incompetence on Google recently that I rediscovered your reply sparking my research into a sliding genioplasty as a solution.

Before I presumed a sliding genioplasty would be for treating the mentalis strain i.e. the lip incompetence gives me a smaller chin so extending the chin outwards would solve it when my lips were pursed. Unfortunately I dismissed it prematurely.

I do still have mentalis strain when my lips are closed but this has decreased alot since the Le Fort I. If I can just solve the whole inter-labial gap issue and mentalis strain it would be an absolute pleasure and close the whole issue!

What was your experience of a sliding genio? How much did it close your inter-labial gap by? Was it a straight forward vertical genioplasty?

Should my teeth be touching in the picture? I know when they took medical pictures before the Le Fort I they had me relax my lower jaw downwards considerably leaving me with an awful looking inter-labial gap in the pictures!

Thanks for your reply... it is very helpful to find someone who has had it and experienced and importantly seen an improvement!

Bowater wrote:What was your experience of a sliding genio? How much did it close your inter-labial gap by? Was it a straight forward vertical genioplasty?

Should my teeth be touching in the picture? I know when they took medical pictures before the Le Fort I they had me relax my lower jaw downwards considerably leaving me with an awful looking inter-labial gap in the pictures!

Thanks for your reply... it is very helpful to find someone who has had it and experienced and importantly seen an improvement!

To be honest the inter-labial gap wasn't reduced significantly, most of the improvement cam from a much stronger profile and less mentalis strain. It was a standard sliding genio with not much vertical reduction.

In retrospect I should have had upper/lower surgery as well since I still have considerable functional/aesthetic issues but I'm optimistic I'll have it corrected in the near future.

The reason I asked about the teeth touching is it just makes your lip incompetence look worse, could you post pics of your lips closed form the profile and front?

ReoSity wrote:To be honest the inter-labial gap wasn't reduced significantly, most of the improvement cam from a much stronger profile and less mentalis strain. It was a standard sliding genio with not much vertical reduction.

In retrospect I should have had upper/lower surgery as well since I still have considerable functional/aesthetic issues but I'm optimistic I'll have it corrected in the near future.

The reason I asked about the teeth touching is it just makes your lip incompetence look worse, could you post pics of your lips closed form the profile and front?

Jaw surgery is definitely worth the effort in my experience. I can't comment on your case but many plastic surgeons advise a geniplasty even though a maxiofacial surgeon could achieve a better result. Presumably because this way they get the custom and not the maxiofacial surgeon. Of the 6 orthodontists I saw none of them mentioned maxiofacial surgery, makes you wonder.

Here are the pictures as requested. I realise it does not look all that bad but after 2 operations to look normal one more to give an aesthetic edge appeals quite strongly. More to the point my mouth is not closed every moment of the day and when it's not it does look pretty dire.

Bowater wrote: Jaw surgery is definitely worth the effort in my experience. I can't comment on your case but many plastic surgeons advise a geniplasty even though a maxiofacial surgeon could achieve a better result. Presumably because this way they get the custom and not the maxiofacial surgeon. Of the 6 orthodontists I saw none of them mentioned maxiofacial surgery, makes you wonder.

Here are the pictures as requested. I realise it does not look all that bad but after 2 operations to look normal one more to give an aesthetic edge appeals quite strongly. More to the point my mouth is not closed every moment of the day and when it's not it does look pretty dire.

From your pics I'm not seeing any mentalis strain (chin dimpling) but I know its your lips not meeting naturally that bugs you. Again, some people have that and they look great, I have a friend who has lip incompetence worse than you but when he closes his lips everything looks fine.

And I might as well show you my pics, as you can see my lip incompetence and mentalis strain is worse than yours. I really do think you should settle with the progress you've made but if you find a surgeon whose confident that he can completely correct it than go for it.

ReoSity wrote:From your pics I'm not seeing any mentalis strain (chin dimpling) but I know its your lips not meeting naturally that bugs you. Again, some people have that and they look great, I have a friend who has lip incompetence worse than you but when he closes his lips everything looks fine.

And I might as well show you my pics, as you can see my lip incompetence and mentalis strain is worse than yours. I really do think you should settle with the progress you've made but if you find a surgeon whose confident that he can completely correct it than go for it.

For me closing my lips does make everything fine with no noticeable mentalis strain (my chin flattens a little) but say when I am a bit sniffly or have a cold, then my lips are relaxed (open) and my facial proportions are shot. Solve the lip incompetence and my facial proportions would look better when my lips are closed.

From your pictures it looks like you have the exact same lip incompetence as me (lower lip) and also your lower lip 'hangs' as does mine - something I can't work out why. Has a surgeon identified an exact cause for your lower lip not being closer to your top lip at rest?

Bowater wrote:For me closing my lips does make everything fine with no noticeable mentalis strain (my chin flattens a little) but say when I am a bit sniffly or have a cold, then my lips are relaxed (open) and my facial proportions are shot. Solve the lip incompetence and my facial proportions would look better when my lips are closed.

From your pictures it looks like you have the exact same lip incompetence as me (lower lip) and also your lower lip 'hangs' as does mine - something I can't work out why. Has a surgeon identified an exact cause for your lower lip not being closer to your top lip at rest?

Interesting that yours hangs as much as mine (without the mentalis strain) yet I have an 11m gap and you've had double jaw surgery.

As far as the cause of mine, I was diagnosed with long face syndrome although now I'm "borderline" because of my sliding genio. Specifically though, other than part of it being the vertical gap between my lips, I believe my chin is too long creating the underdeveloped mental-labial fold. This site talks about it and has numerous examples of people with hanging lower lip.

http://www.massoralsurgeons.com/pro/pro ... Labialfold

ReoSity wrote:Interesting that yours hangs as much as mine (without the mentalis strain) yet I have an 11m gap and you've had double jaw surgery.

As far as the cause of mine, I was diagnosed with long face syndrome although now I'm "borderline" because of my sliding genio. Specifically though, other than part of it being the vertical gap between my lips, I believe my chin is too long creating the underdeveloped mental-labial fold. This site talks about it and has numerous examples of people with hanging lower lip.

http://www.massoralsurgeons.com/pro/pro ... Labialfold

That is an interesting website. The following caught my eye:

'Occasionally, severe Overbites cause a deepening of this mental-labial fold by causing the lower lip to turn outward.'

Like you I had a 11mm inter-labial gap so perhaps the cause of my lower lip turning outwards was the same as yours but post surgery the lip has not recovered from the original cause?

As for examining the cause of your inter-labial gap it might be more helpful to look at pictures before you had the sliding genioplasty. The genioplasty has disguised the originally cause - the intention but makes it harder to identify the underlying cause.

Bowater wrote: Like you I had a 11mm inter-labial gap so perhaps the cause of my lower lip turning outwards was the same as yours but post surgery the lip has not recovered from the original cause?
.

You had 11mm gap before any surgery right? Because in your old thread you wrote it was 7mm.

By the way if you don't mind sharing, how are you paying for all your surgeries? I'm planning on going to the best to have my surgery so including my student loans, I'm gonna be in serious debt.

My estimation was 7mm but subconsciously I was hiding the true size of the gap when measuring it. In reality the surgeon found it to be 11mm. As for expenses:

BSSO - Free on the NHS
Le Fort I - Free on the NHS
Vertical genioplasty - Free on the NHS - possibly, otherwise £2000-£4000
Rhinoplasty - Free on the NHS - possibly (slight medical need), otherwise £4000
Cheek implants - £3000

Worse case scenario the total is looking to be £12,000 however for every year at university I receive a £2,000 bursary based on my parents income. The student loan/grant alone are more than enough to live off so after this year (fourth) that will be £8,000 saved leaving £4,000 to find. Right now I am applying for part time work on the weekend, which would mean 16 hours a week for the 30 weeks until graduation at minimum wage £5.80 that totals £2,784. That leaves £1,216 to find. However having to leave 6 months between operations the earliest I could have the cheek implants is March 2011 and hopefully I will be in full time work by then.

I am presuming you are in America? I realise there is no NHS but a lot of people seem to be having their surgery paid for by insurance as for the cosmetic surgery are the costs significantly different? As for the bursary there are a few benefits to having poor parents after all... at least here.