Hi guys,
I am considering a sliding genioplasty procedure mostly for cosmetic reasons because my chin too small for my jaw. Its not super recessed but lacks vertical height. I am considering a couple of surgeons in both the OMFS and Plastic Surgery fields. I am not too limited by budget. I want to go to a surgeon who is highly skilled in performing genioplasties and understands its short comings (permanent nerve damage and lower lip roll) and will be honest with me about them and how much improvement can be expected. Of course obvious answers would be someone like Gunson but they told me they won't take a cosmetic case even if I do have sleep apnea (though I am 99% sure it has more to do with my deviated septum than the position of the tongue) so I guess fair enough.
I just want to know what is your guys opinion on the following surgeons. Are there any others I can add to my list who have low levels of complications and a decent eye for aesthetics
OMFS:
Wittenberg (Has great results but he has an ongoing lawsuit which has to do with a melanoma so idk how relevant that should be)
Relle (If they will accept my cosmetic case)
Posnick (Again might not accept my case but didn't turn me down and wanted pics and X-rays)
Cosmetic Craniofacial Surgeons:
Fialkov
Steven Cohen
Lamperti (Seems to favor implants which is a non-starter for me)
Your help is greatly appreciated. I would post my pics here but as a new member I don't have those privileges.
-Jay
Sliding Genioplasty
Moderator: bbsadmin
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PierreDeFermat
- Posts: 114
- Joined: Sat Jan 06, 2018 2:02 pm
Re: Sliding Genioplasty
In regard to your sleep apnea:
A deviated nasal septum does not cause Obstructive Sleep Apnea (OSA) but may make it worse. I recommend you have your general practitioner prescribe you a home sleep study (polysomnography) to see if you have any trouble breathing at night. OSA is a serious, possibly life-threatening condition that should be investigated thoroughly if you suspect you're at risk. (Even persons who appear to have healthy craniomandibular development can have some level of oropharyngeal obstruction). Sleep studies and treatment of OSA is usually covered by insurance.
As far as cosmetics go, all those surgeons seem to be pretty skilled so it's really just a matter of if they fit your style. Most will recommend implants as they're much less invasive, easy to revise, less expensive, and pose far fewer complications. I personally don't think they look that good but it's certainly something to consider, especially if you think that your chin is minimally retruded. Basically unless your is mandible fairly well developed, a chin implant will often make a small chin just poke out a little farther, not necessarily "even it out" with your upper jaw. For aesthetic reasons, genioplasty is usually the better option.
I should mention that most surgeons in the US do not perform osseous genioplasty (i.e. sliding genioplasty) for cosmetic purposes, as there is a much greater risk of complications (though major, life-lasting complications are rare). However, sliding genioplasty is a common (though investigational) treatment of OSA as it advances the genioglossus muscle and can reduce obstruction in the throat.
Bottom line: get tested for sleep apnea first.
A deviated nasal septum does not cause Obstructive Sleep Apnea (OSA) but may make it worse. I recommend you have your general practitioner prescribe you a home sleep study (polysomnography) to see if you have any trouble breathing at night. OSA is a serious, possibly life-threatening condition that should be investigated thoroughly if you suspect you're at risk. (Even persons who appear to have healthy craniomandibular development can have some level of oropharyngeal obstruction). Sleep studies and treatment of OSA is usually covered by insurance.
As far as cosmetics go, all those surgeons seem to be pretty skilled so it's really just a matter of if they fit your style. Most will recommend implants as they're much less invasive, easy to revise, less expensive, and pose far fewer complications. I personally don't think they look that good but it's certainly something to consider, especially if you think that your chin is minimally retruded. Basically unless your is mandible fairly well developed, a chin implant will often make a small chin just poke out a little farther, not necessarily "even it out" with your upper jaw. For aesthetic reasons, genioplasty is usually the better option.
I should mention that most surgeons in the US do not perform osseous genioplasty (i.e. sliding genioplasty) for cosmetic purposes, as there is a much greater risk of complications (though major, life-lasting complications are rare). However, sliding genioplasty is a common (though investigational) treatment of OSA as it advances the genioglossus muscle and can reduce obstruction in the throat.
Bottom line: get tested for sleep apnea first.
Re: Sliding Genioplasty
[quote="PierreDeFermat"]In regard to your sleep apnea:
A deviated nasal septum does not cause Obstructive Sleep Apnea (OSA) but may make it worse. I recommend you have your general practitioner prescribe you a home sleep study (polysomnography) to see if you have any trouble breathing at night. OSA is a serious, possibly life-threatening condition that should be investigated thoroughly if you suspect you're at risk. (Even persons who appear to have healthy craniomandibular development can have some level of oropharyngeal obstruction). Sleep studies and treatment of OSA is usually covered by insurance.
As far as cosmetics go, all those surgeons seem to be pretty skilled so it's really just a matter of if they fit your style. Most will recommend implants as they're much less invasive, easy to revise, less expensive, and pose far fewer complications. I personally don't think they look that good but it's certainly something to consider, especially if you think that your chin is minimally retruded. Basically unless your is mandible fairly well developed, a chin implant will often make a small chin just poke out a little farther, not necessarily "even it out" with your upper jaw. For aesthetic reasons, genioplasty is usually the better option.
I should mention that [b]most surgeons in the US do not perform osseous genioplasty (i.e. sliding genioplasty) for cosmetic purposes,[/b] as there is a much greater risk of complications (though major, life-lasting complications are rare). However, sliding genioplasty is a common (though investigational) treatment of OSA as it advances the genioglossus muscle and can reduce obstruction in the throat.
Bottom line: get tested for sleep apnea first.[/quote]
Hello,
Thank you for your response. I really appreciate it. I wasn't aware of the link between OSA and deviated nasal septum. I should definitely look into it more seriously now. I have already completed a sleep study and am awaiting results. I am from Canada so sometimes for non-urgent things it can a little longer. I haven't checked either because I have been busy with exams.
I would take a far worse chin than mine before I would consider an implant. I had read that the complication rates were roughly the same but patient satisfaction for sliding genioplasties was 90%+ and implants about 80%. Regardless I didn't do anything about my chin for all these years of being senstitive about it is because I thought implants were the only option available and that will always be an easy pass for me even if it could serve the aesthetic purpose I am after which they can't. Off the shelf implants mostly give horizontal projection like you mentioned which I need far far less than vertical height. If it were possible I would only get that and would have a satisfactory side profile. As far my jaw is concerned I don't think it is underdeveloped. If anything its my wide and length of my jaw that makes my chin look small. I have no bites issues as far as I know from all my dentist visits. Though I will be seeing an orthodontist soon for the purposes of obtaining X-rays and occlusion pictures which were requested by one of the surgeons mentioned above. So if there are any mechanical issues I will find out about them then.
I know a lot of the prominent oral surgeons don't perform cosmetic genioplasties which I figured were because a) they don't want to be bothered boring cosmetic procedures like SGs and would rather do something that is upto their skills (one office of a well known oral surgeon told me he doesn't do cosmetic work simply because most patients looking for that type of procedure will have unrealistic expectations and start demanding model like aesthetics b) Its probably not as profitable for them to do genio as the more complex procedures? But from some of the maxillofacial literature I have read on sliding genioplasties it seems like they are the preferred method over implants for the purposes of cosmetics. So I wonder if sliding genioplasties have just been slow to be accepted as a cosmetic procedure and now it seems like more and more docs even from other specialties like ENT or plastics are paying attention to it. ALso same studies seem to demonstrate low permanent complication rates but none address the lower lip roll issue which is a complete mystery to me so far. But then again I haven't consulted any of the docs mentioned above. That process is starting tomorrow.
A deviated nasal septum does not cause Obstructive Sleep Apnea (OSA) but may make it worse. I recommend you have your general practitioner prescribe you a home sleep study (polysomnography) to see if you have any trouble breathing at night. OSA is a serious, possibly life-threatening condition that should be investigated thoroughly if you suspect you're at risk. (Even persons who appear to have healthy craniomandibular development can have some level of oropharyngeal obstruction). Sleep studies and treatment of OSA is usually covered by insurance.
As far as cosmetics go, all those surgeons seem to be pretty skilled so it's really just a matter of if they fit your style. Most will recommend implants as they're much less invasive, easy to revise, less expensive, and pose far fewer complications. I personally don't think they look that good but it's certainly something to consider, especially if you think that your chin is minimally retruded. Basically unless your is mandible fairly well developed, a chin implant will often make a small chin just poke out a little farther, not necessarily "even it out" with your upper jaw. For aesthetic reasons, genioplasty is usually the better option.
I should mention that [b]most surgeons in the US do not perform osseous genioplasty (i.e. sliding genioplasty) for cosmetic purposes,[/b] as there is a much greater risk of complications (though major, life-lasting complications are rare). However, sliding genioplasty is a common (though investigational) treatment of OSA as it advances the genioglossus muscle and can reduce obstruction in the throat.
Bottom line: get tested for sleep apnea first.[/quote]
Hello,
Thank you for your response. I really appreciate it. I wasn't aware of the link between OSA and deviated nasal septum. I should definitely look into it more seriously now. I have already completed a sleep study and am awaiting results. I am from Canada so sometimes for non-urgent things it can a little longer. I haven't checked either because I have been busy with exams.
I would take a far worse chin than mine before I would consider an implant. I had read that the complication rates were roughly the same but patient satisfaction for sliding genioplasties was 90%+ and implants about 80%. Regardless I didn't do anything about my chin for all these years of being senstitive about it is because I thought implants were the only option available and that will always be an easy pass for me even if it could serve the aesthetic purpose I am after which they can't. Off the shelf implants mostly give horizontal projection like you mentioned which I need far far less than vertical height. If it were possible I would only get that and would have a satisfactory side profile. As far my jaw is concerned I don't think it is underdeveloped. If anything its my wide and length of my jaw that makes my chin look small. I have no bites issues as far as I know from all my dentist visits. Though I will be seeing an orthodontist soon for the purposes of obtaining X-rays and occlusion pictures which were requested by one of the surgeons mentioned above. So if there are any mechanical issues I will find out about them then.
I know a lot of the prominent oral surgeons don't perform cosmetic genioplasties which I figured were because a) they don't want to be bothered boring cosmetic procedures like SGs and would rather do something that is upto their skills (one office of a well known oral surgeon told me he doesn't do cosmetic work simply because most patients looking for that type of procedure will have unrealistic expectations and start demanding model like aesthetics b) Its probably not as profitable for them to do genio as the more complex procedures? But from some of the maxillofacial literature I have read on sliding genioplasties it seems like they are the preferred method over implants for the purposes of cosmetics. So I wonder if sliding genioplasties have just been slow to be accepted as a cosmetic procedure and now it seems like more and more docs even from other specialties like ENT or plastics are paying attention to it. ALso same studies seem to demonstrate low permanent complication rates but none address the lower lip roll issue which is a complete mystery to me so far. But then again I haven't consulted any of the docs mentioned above. That process is starting tomorrow.
Re: Sliding Genioplasty
Hello @miwe13 -any update or progress with your search? (I'm in a similar situation)