3D CT Scan, removing implant, which procedures do I need?

[Lancer54]

I need some high IQ answers in regards to which procedures I should get based on the scan. I prefer not using implants, in fact I'm having mine removed. I'd appreciate any helpful comments from anyone. I was looking at chin wing, side wing, Bimax and BSSO. I'm hesitant on the chin wing because it messes with the ramus from what I understand. I'm also unsure of the BSSO, if it would be redundant assuming I was having a Bimax done.

@Acromegaly_Chad​

 

[Adonis]

Why do you want them removed?
I thought wraparound implants mog?

 

[ChristianChad]

Why do you want them removed?
I thought wraparound implants mog?

I'm interested in this aswell.

 

[Silver]

Wtf is the transverse width of that chin? 40mm? Obviously I have no idea what you look like but that design looks very bulky. Poor design at the angles as your gonions are already outwards, they shoudl've been accentuated not made "bulky". I bet you look bloated.

 

[Lancer54]

Asymmetry became more apparent, the surgeon told me it was due to soft tissues but I think it was implant placement based on the scan. The dimensions of the chin need changed and there’s an implant reveal in the corners. I’m told they need to be rounded, I believe this is due to my masseters insertion point being higher up.

The gonial angle on the right side in the post op placement shows the angle isn't going in a straight line like the left side is. It was placed slightly above the bone and is noticeable to me from both the front and side profile views.The right side of the chin also had a slight tilt to it as well, making the vertical height seem shorter than the left side.

 

[Silver]

Asymmetry became more apparent, the surgeon told me it was due to soft tissues but I think it was implant placement based on the scan. The dimensions of the chin need changed and there’s an implant reveal in the corners. I’m told they need to be rounded, I believe this is due to my masseters insertion point being higher up.

The gonial angle on the right side in the post op placement shows the angle isn't going in a straight line like the left side is. It was placed slightly above the bone and is noticeable to me from both the front and side profile views.The right side of the chin also had a slight tilt to it as well, making the vertical height seem shorter than the left side.

Your masseter muscle follows the shape of your ramus/mandibular angle. If your implant doesn't follow this shape and is too sharp at the edges then you are bound to have implant reveal. Faulty design because of lack of knowledge from both surgeon and patient.

 

[Lancer54]

Wtf is the transverse width of that chin? 40mm? Obviously I have no idea what you look like but that design looks very bulky. Poor design at the angles as your gonions are already outwards, they shoudl've been accentuated not made "bulky". I bet you look bloated.

45mm in width and 10mm horizontal projection. You’re right I look bloated, everything is too bulky. I’m curious about your opinion on the gonions being accentuated, what this should have looked like on the implant. Do you have any examples you’d be able to provide?

 

[Silver]

45mm in width and 10mm horizontal projection. You’re right I look bloated, everything is too bulky. I’m curious about your opinion on the gonions being accentuated, what this should have looked like on the implant. Do you have any examples you’d be able to provide?

Instead of having a linear design at the ramus border down to the gonions it should be more concave with majority of width added at the gonions. I don't want to spoonfeed you more information as you clearly lack knowledge. I choose to refrain from doing so as I think you can benefit from it. Start learning by reading up. You've already committed the mistake once, you are about to do it again by asking losers like me to feed it to you.

45mm width, not even the biggest chads have that wide of a chin. Think Chris Carmack is 40mm and that is already wide af. 10mm horizontal projection, your mentolabial fold is crying for revision.

 

[Adonis]

Asymmetry became more apparent, the surgeon told me it was due to soft tissues but I think it was implant placement based on the scan. The dimensions of the chin need changed and there’s an implant reveal in the corners. I’m told they need to be rounded, I believe this is due to my masseters insertion point being higher up.

The gonial angle on the right side in the post op placement shows the angle isn't going in a straight line like the left side is. It was placed slightly above the bone and is noticeable to me from both the front and side profile views.The right side of the chin also had a slight tilt to it as well, making the vertical height seem shorter than the left side.

Did you go to a good blackpilled surgeon?

 

[Adonis]

you are about to do it again by asking losers like me to feed it to you.

I love the irony and self reflexion yakhiii

 

[Lancer54]

Did you go to a good blackpilled surgeon?

Eppley

 

[dakchuh]

Eppley

another eppley victim

 

[Adonis]

Eppley

F
He is shilled here a lot.
Yaremchuk mogs

 

[Adonis]

another eppley victim

lets start trending #metoo for eppley victims

 

[Lancer54]

Instead of having a linear design at the ramus border down to the gonions it should be more concave with majority of width added at the gonions. I don't want to spoonfeed you more information as you clearly lack knowledge. I choose to refrain from doing so as I think you can benefit from it. Start learning by reading up. You've already committed the mistake once, you are about to do it again by asking losers like me to feed it to you.

45mm width, not even the biggest chads have that wide of a chin. Think Chris Carmack is 40mm and that is already wide af. 10mm horizontal projection, your mentolabial fold is crying for revision.

Something like this as far as the gonions? Commited the mistake twice sad to say which is why I'm over implants. This is the current implant I have in (2nd time around), no CT scan to show how it looks currently on the bone though. It has all the same issues as the previous (asymmetry, implant reveal, too much chin width and horizontal projection, bulky looking). 35mm width, 10mm horizontal projection.

 

[Silver]

Something like this as far as the gonions? Commited the mistake twice sad to say which is why I'm over implants. This is the current implant I have in (2nd time around), no CT scan to show how it looks currently on the bone though. It has all the same issues as the previous (asymmetry, implant reveal, too much chin width and horizontal projection, bulky looking). 35mm width, 10mm horizontal projection.

Wait.. Are you that guy from Eppley's blog who got 25mm at the jaw angles? Is that you? How much width you get at each side of the jaw angle?

Literally everything you mention in your comment is shit Eppley has gone through on his blog and how it can be avoided. Your surgeon, Eppley, is blogging about this, "raising awareness", meanwhile he literally does the opposite of the words he is preaching. Butcher and scammer. This guy also has a background in OMFS. Yet he dishes out chin implants that add up to 25mm horizontal projection, YES actually 25mm. He does the most disgusting mentolabial wrecking shit I've ever seen. Doesn't even recomend his patients to first get MMA.

But yes to answer your question, that type of concavity, much less pronounced and exaggerated. Also more refined, is along the lines of what I am thinking.

 

[OnlyWs]

Eppley

If you go to Eppley you need extensive knowledge yourself or you’ll get botched which you clearly lack

Guessing your 15%+ bodyfat as well

 

[OnlyWs]

Wait.. Are you that guy from Eppley's blog who got 25mm at the jaw angles? Is that you? How much width you get at each side of the jaw angle?

Literally everything you mention in your comment is shit Eppley has gone through on his blog and how it can be avoided. Your surgeon, Eppley, is blogging about this, "raising awareness", meanwhile he literally does the opposite of the words he is preaching. Butcher and scammer. This guy also has a background in OMFS. Yet he dishes out chin implants that add up to 25mm horizontal projection, YES actually 25mm. He does the most disgusting mentolabial wrecking shit I've ever seen. Doesn't even recomend his patients to first get MMA.

But yes to answer your question, that type of concavity, much less pronounced and exaggerated. Also more refined, is along the lines of what I am thinking.

When you say horizontal projection do you mean anterior/forward?

Cause 25mm isn’t huge for chin horizontally

 

[Silver]

When you say horizontal projection do you mean anterior/forward?

Cause 25mm isn’t huge for chin horizontally

Horizontal

 

[Lancer54]

Wait.. Are you that guy from Eppley's blog who got 25mm at the jaw angles? Is that you? How much width you get at each side of the jaw angle?

Literally everything you mention in your comment is shit Eppley has gone through on his blog and how it can be avoided. Your surgeon, Eppley, is blogging about this, "raising awareness", meanwhile he literally does the opposite of the words he is preaching. Butcher and scammer. This guy also has a background in OMFS. Yet he dishes out chin implants that add up to 25mm horizontal projection, YES actually 25mm. He does the most disgusting mentolabial wrecking shit I've ever seen. Doesn't even recomend his patients to first get MMA.

But yes to answer your question, that type of concavity, much less pronounced and exaggerated. Also more refined, is along the lines of what I am thinking.

I don’t think that’s me, 15mm width per side. 10mm width per side on the first implant. I had the first implant put in several years ago. I’ve had this one a couple years. I’ve seen some of the articles he’s written, he’s even used some of my scans. Pretty sure he used me (and others) as Guinea pigs.

 

[OnlyWs]

Something like this as far as the gonions? Commited the mistake twice sad to say which is why I'm over implants. This is the current implant I have in (2nd time around), no CT scan to show how it looks currently on the bone though. It has all the same issues as the previous (asymmetry, implant reveal, too much chin width and horizontal projection, bulky looking). 35mm width, 10mm horizontal projection.

Holy fucking shit that jaw width projection is unbelievable

Even Brad Pitt doesn’t have that type of projection relative to his bizygomatic width and he only gets away it because of his harmony

And that was the second design

Going to Eppley for my cheekbones because I have the required knowledge but Jesus Christ he’s even more than a money grabbing (((whore))) than I thought

 

[Silver]

I don’t think that’s me, 15mm width per side. 10mm width per side on the first implant. I had the first implant put in several years ago. I’ve had this one a couple years. I’ve seen some of the articles he’s written, he’s even used some of my scans. Pretty sure he used me (and others) as Guinea pigs.

Ye, this guy is experimenting on his patient and literally has no limit as to how far he is willing to go. I would never trust my face under the hands of someone who looks like this, his haircut is literally oozing signs of him being a maniac

 

[Acromegaly_Chad]

Ok so from my understanding you want to have a similar look to right now but it should be a) symmetric b) without implants and c) more natural/no implant show

Chin wing/side wing basically any osteotomy along the corpus mandibulae is extremely prone to asymmetry, I've experienced it myself and even surgeons who perform it themselves (like brusco) admitted it. So these procedures are OUT imo.

So you are left with a wraparound or a combination of implants/osteotomies.

The latter could theoretically be achieved by a 2 piece genioplasty combined with jaw angle implants. Depending on your mid mandibular width this would create a nice concave shape but DON'T OVER DO THE JAW ANGLES.
You've already done this mistake, how do you expect it to look natural when it looks comically even on x rays?

So this is also valid for the wrapround variant: the jaw angles must not stick out so far and pointy. I'd say 20mm is more than enough width for you there. And the implant ideally goes a little further up, especially towards posterior. The clue is to not augment the mid mandibular region or do so only slightly. Your mid mandible isn't super narrow so even 0-5mm would be enough there.

 

[OnlyWs]

Ok so from my understanding you want to have a similar look to right now but it should be a) symmetric b) without implants and c) more natural/no implant show

Chin wing/side wing basically any osteotomy along the corpus mandibulae is extremely prone to asymmetry, I've experienced it myself and even surgeons who perform it themselves (like brusco) admitted it. So these procedures are OUT imo.

So you are left with a wraparound or a combination of implants/osteotomies.

The latter could theoretically be achieved by a 2 piece genioplasty combined with jaw angle implants. Depending on your mid mandibular width this would create a nice concave shape but DON'T OVER DO THE JAW ANGLES.
You've already done this mistake, how do you expect it to look natural when it looks comically even on x rays?

So this is also valid for the wrapround variant: the jaw angles must not stick out so far and pointy. I'd say 20mm is more than enough width for you there. And the implant ideally goes a little further up, especially towards posterior. The clue is to not augment the mid mandibular region or do so only slightly. Your mid mandible isn't super narrow so even 0-5mm would be enough there.

20mm would be insane

 

[Acromegaly_Chad]

20mm would be insane

I thought his first was 20mm per side nvm so I say 10-15 ik total is more than enough

 

[OnlyWs]

That's roughly the shape you should looking for, similar idea interms of design but not comical in terms of jaw and chin width. The edge of the jaw should roughly line up with the middle of the outer wall of the eye socket on both sides in most cases.

And chin width should line up with canines.

Don't go back to Eppley because the pair of you together is literally room temp IQ, go to Yaremchuk or Pagoni/Ramierri if in Europe imo

 

[Acromegaly_Chad]

View attachment 1849995
That's roughly the shape you should looking for, similar idea interms of design but not comical in terms of jaw and chin width. The edge of the jaw should roughly line up with the middle of the outer wall of the eye socket on both sides in most cases.

And chin width should line up with canines.

Don't go back to Eppley imo because the pair of you together is leterally room temp IQ, go to Yaremchuk or Pagoni/Ramierri if in Europe imo

Agreed.

OP did you apply for a Hollywood movie or why did you get that crazy first implant in in the first place?

 

[Lancer54]

Ok so from my understanding you want to have a similar look to right now but it should be a) symmetric b) without implants and c) more natural/no implant show

Chin wing/side wing basically any osteotomy along the corpus mandibulae is extremely prone to asymmetry, I've experienced it myself and even surgeons who perform it themselves (like brusco) admitted it. So these procedures are OUT imo.

So you are left with a wraparound or a combination of implants/osteotomies.

The latter could theoretically be achieved by a 2 piece genioplasty combined with jaw angle implants. Depending on your mid mandibular width this would create a nice concave shape but DON'T OVER DO THE JAW ANGLES.
You've already done this mistake, how do you expect it to look natural when it looks comically even on x rays?

So this is also valid for the wrapround variant: the jaw angles must not stick out so far and pointy. I'd say 20mm is more than enough width for you there. And the implant ideally goes a little further up, especially towards posterior. The clue is to not augment the mid mandibular region or do so only slightly. Your mid mandible isn't super narrow so even 0-5mm would be enough there.

Thank you for the detailed reply, you understand correctly. My experience with implants hasn't been the best but if I was to go that route again I would avoid a wraparound this time. I'm going to have to look into how a 2 piece genioplasty differs from a regular genioplasty.

I wanted to clarify the reason we increased the total width from 10mm per side on the first implant to 15mm per side on the second implant is because at 10mm per side my front profile did not appear square or angular (it was rounded). This made me assume my gonials were inward or flat. @Silver said they are outwards so looks like I need to take his advice and read some more to understand why I didn't achieve that angularity I was looking for. Both implants have made me look bulky and bloated but the second did so while giving a slightly more square look (still looks bad, head looks massive in pictures).

During 2 separate revision surgeries he added a 3.5mm soft tissue implant directly on top of the 15mm implant (both sides), a 2mm alloderm implant under the skin (both sides, incisions behind the jaw) and a 2mm (alloderm or soft tissue, I forget) implant under the chin on the right side. These revisions were done in order to try and hide the implant reveal at the gonials, fill in the soft tissue deficiency above the gonials and fix the asymmetry in the chin.

It's interesting you mentioned the implant should go a little further up, I've seen some designs that appeared to do this. What does this achieve? I'm not certain what my mandibular width is but is there a way to reduce it, would it be beneficial to do so?

I thought his first was 20mm per side nvm so I say 10-15 ik total is more than enough

Just to clarify this would mean roughly 5-7mm per side? What about something like an IMDO for just ramus widening? I believe I read somewhere on this site a bimax can also widen the ramus if done a certain way. Are these prone to asymmetry like the chin/side wing?

 

[Lancer54]

Agreed.

OP did you apply for a Hollywood movie or why did you get that crazy first implant in in the first place?

Nah lol. I got it based on his recommendation, he took the scan and said that was what I needed. I trusted that he knew what I was looking for.

 

[Lancer54]

Your masseter muscle follows the shape of your ramus/mandibular angle. If your implant doesn't follow this shape and is too sharp at the edges then you are bound to have implant reveal. Faulty design because of lack of knowledge from both surgeon and patient.

In regards to insertion points I’ve seen a handful of threads like this one quoted below. When I clench my jaw the masseter isn’t thickest at the base. It’s unfortunately thickest at the top. As far as you know is there a solution to this?

Different masseter insertions.
View attachment 355535
The superficial layer should be the thickest layer.

Also it depends of what type of muscle fibers you have:

https://forum.****************/threads/chewing-for-a-more-defined-and-broad-jaw-only-works-if.2327/

 

[Silver]

When I clench my jaw the masseter isn’t thickest at the base. It’s unfortunately thickest at the top. As far as you know is there a solution to this?

Absolutely no clue, since you had vertical height and lateral width added to your ramus you could have disrupted your pterygomasseteric sling. It makes the masseter muscle retract superiorly.

Could be why your masseter isn't "thickest" at the base. Could be different reason, should hit Dr. Eppley up.

 

[Deleted member 16220]

Terrible design you are probably bloated looking. Chin is too large and forward. It's assymetrical as well on your skull based on the CT scan. Contouring on the mandible is shit. Bad design

 

[Wallenberg]

Post a picture of your lower third.

 

[Lancer54]

Absolutely no clue, since you had vertical height and lateral width added to your ramus you could have disrupted your pterygomasseteric sling. It makes the masseter muscle retract superiorly.
View attachment 1850831

Could be why your masseter isn't "thickest" at the base. Could be different reason, should hit Dr. Eppley up.

I’ve seen the diagram you posted and thought the same thing. I reached out to Eppley and I also reached out to Yaremchuk last September to get their opinions. Both said that they don’t think it’s a tear. @Acromegaly_Chad posted this thread about a year ago. He talked about the size and positions of the masseters, I believe it has something to do with my medial pterygoid muscle being larger than normal. As of yesterday I started looking into myotomy procedures to possibly remove some of that medial muscle. I’ve seen other people with this issue and it may be where the misconception of a higher muscle insertion point comes in. Like you said the insertion points don’t change.

It's time to add another chapter of brutal blackpill to the jaw surgery database. This is all about jaw angles and jaw width.

The preferred jaw angle has these characteristics: 130° in face profile view, intergonial width similar to facial width, vertical position in frontal view at the oral commissure or at least not below the lower lip, jawline slope in the face frontal view nearly parallel to (with a maximum 15° downward deviation from) a line extending from the lateral canthus to the alare, ascending ramus slope 65°–75° to the Frankfort horizontal, and curvature in the oblique view visible from earlobe to chin and not pointy.

View attachment 1367626

Redirecting

But what if your jaw looks like the example on the left side and you aim for a look like on the right side ?

View attachment 1367631

This guy had fillers, but generally, after only after a few weeks, they start to migrate, dissolve and lose contour. Additionally, they are very prone to look unnatural:

View attachment 1367632

Just look at this after

It turns out that it's necessary to take a look at the underlying scelettal situation. What makes a jaw wide, angular and aesthetic from the front are mainly:
- Width and shape of the jaw angle i.e. shape and thickness of the posterior corpus mandibulae that connects to the ramus
- Position and size of the masseter muscle and the medial pterygoid muscle

View attachment 1367640

A narrow, unaesthetic jaw, with blunted, rounded jaw angles, which reeks of micrognathia and other illnesses is often the result of posterior mandibular hypoplasia that is expressed by a severe lack of posterior lateral growth of the corpus mandibulae, malplacement of the ramus or TMJ issues.
When we look at this example, we find relatively normal TMJ to dentoalveolar arch vectors which indicates that this patient has a narrow jaw due to posterior hypoplasia and not because of TMJ problems. This is the most common cause of a rounded jaw:

View attachment 1367649

Red line: The vector
Blue circle: Lack of bony mass

So lets talk about solutions. In my opinion, implants are unfavorable for young patients, silicone because of the infection and erosion risk, medpor because of tissue ingrowth, unsatisfactory ossification, titanium because it doesn't interact with the body AT ALL and can cool down dangerously in cold wheater and HA paste well because it usually looks like shit and has other issues. It's literally bone or death.

The patient above already got a chin wing which mainly increased mid mandibular width, but also some posterior width as shown below:
View attachment 1367656

However, unfortunately, the jaw angles tend to get lost during this procedure as shown below:

View attachment 1367657


Reconstruction and replacement of the jaw angles and masseter muscles is therefore needed as shown in this surgical simulation:

View attachment 1367661

This is the so called side wing. It should add anything between 8 - 14mm bigonial width, reshape and accentuate the jaw angles and reposition the masseter muscles.
However, in some cases this will not be enough, and in some cases an aggressive side wing might produce unfavorable outcomes. In that case, a BSSO can help (narrow jaws are almost always recessed so you'll need this anyways probably)

View attachment 1367663

The red circles show the consequence of ramus widening with a BSSO, around 4 - 6mm per side. Combined with a side wing it could add almost 25mm wigonial width.

There's a guy from jawsurgeryforums who had a chin wing and side wing, plus very little fillers done. This is his before and afters:

View attachment 1367665

If it hadn't been enough, he still could have gotten the BSSO.

To sum this up:

- A narrow jaw with inward tilted jaw angles is best fixed with a chin wing, side wing, BSSO and some fillers on top.
- Young people should stay away from implants.
- And additional information: IMDO doedn't accentuate the jaw angles, it just makes the whole jaw wider which is not desired.

Therefore the promoted approach is the ONLY approach that is LEGIT, and LONG TERM SAVE.

 

[Silver]

I’ve seen the diagram you posted and thought the same thing. I reached out to Eppley and I also reached out to Yaremchuk last September to get their opinions. Both said that they don’t think it’s a tear. @Acromegaly_Chad posted this thread about a year ago. He talked about the size and positions of the masseters, I believe it has something to do with my medial pterygoid muscle being larger than normal. As of yesterday I started looking into myotomy procedures to possibly remove some of that medial muscle. I’ve seen other people with this issue and it may be where the misconception of a higher muscle insertion point comes in. Like you said the insertion points don’t change.

What does your medial pterygoid muscle have to do with anything related to the implant? It's on the inside of the mandible and should not be affected by implant placement. Have you asked Eppley and Yaremchuk what they think might be causing the "bulge" or extra thickness of your masseter?

 

[Wallenberg]

OP, did you design the implant yourself or was it the surgeon?

 

[Lancer54]

What does your medial pterygoid muscle have to do with anything related to the implant? It's on the inside of the mandible and should not be affected by implant placement. Have you asked Eppley and Yaremchuk what they think might be causing the "bulge" or extra thickness of your masseter?

I believe they are two separate issues. I don’t recall asking them what the cause was, now I wish I had. I believe it’s just the type of muscle fibers (type 1, type 2) and caused from chewing. I’m sure you’ve seen posts where people say chewing has helped them look better and others where chewing made them look worse (bloated, potatoe face etc). I think because I’m getting the thickness higher up instead of the lowest point it may be what’s actually causing the bloated rounder look.

 

[Lancer54]

OP, did you design the implant yourself or was it the surgeon?

The first design was the surgeon and the second design I added my .02 telling him I wanted both the chin and mandible width reduced.

 

[Silver]

I believe they are two separate issues. I don’t recall asking them what the cause was, now I wish I had. I believe it’s just the type of muscle fibers (type 1, type 2) and caused from chewing. I’m sure you’ve seen posts where people say chewing has helped them look better and others where chewing made them look worse (bloated, potatoe face etc). I think because I’m getting the thickness higher up instead of the lowest point it may be what’s actually causing the bloated rounder look.

It's impossible to judge. Since there's a faulty implant design present my money is on that this is where the problem stems from. Your 2nd implant design is still poor. It starts way too high up on the ramus and is still too bulky as it goes down towards the gonions. This amount of bulkiness reflects on the exterior. It pushes the masseter outwards which is why you are seeing more masseter "mass" higher up.

 

[Lancer54]

It's impossible to judge. Since there's a faulty implant design present my money is on that this is where the problem stems from. Your 2nd implant design is still poor. It starts way too high up on the ramus and is still too bulky as it goes down towards the gonions. This amount of bulkiness reflects on the exterior. It pushes the masseter outwards which is why you are seeing more masseter "mass" higher up.

I asked this to Acromegaly_Chad but your opinion would also be valued. If my gonials are outwards already as you said and the general consensus seems to be that I only need a minimal amount of gonial widening, would something like an IMDO or Bimax be beneficial compared to implants? I believe I read somewhere on this site a bimax can widen if done a certain way.

 

[Silver]

I asked this to Acromegaly_Chad but your opinion would also be valued. If my gonials are outwards already as you said and the general consensus seems to be that I only need a minimal amount of gonial widening, would something like an IMDO or Bimax be beneficial for just widening? I believe I read somewhere on this site a bimax can widen if done a certain way.

My knowledge is 0 regarding IMDO, never researched it as it's not applicable to me myself.

1. Bimax widening is kinda grey area. You widen it by torquing the condyles, an Italian surgeon does it and so does a Brazilian surgeon. My personal concern is that it could relapse because of condylar sag.

2. There are some studies that report widening of the posterior (proximal segment) mandible following advancement of anterior (distal segment) mandible. From my personal observations this is something that becomes a thing and more prominent with larger advancements. There are only two studies out there as of now and one of them is talking about a specific cut that should automatically yield in bigonial width increase but IDK.

 

[Lancer54]

My knowledge is 0 regarding IMDO, never researched it as it's not applicable to me myself.

1. Bimax widening is kinda grey area. You widen it by torquing the condyles, an Italian surgeon does it and so does a Brazilian surgeon. My personal concern is that it could relapse because of condylar sag.

2. There are some studies that report widening of the posterior (distal segment) mandible following advancement of anterior (proximal segment) mandible. From my personal observations this is something that becomes a thing and more prominent with larger advancements. There are only two studies out there as of now and one of them is talking about a specific cut that should automatically yield in bigonial width increase but IDK.

Thank you for the detailed reply brother. I re-read the Acromegaly_Chad thread and at the end he mentions IMDO widens the entire jaw and doesn't accentuate the jaw angles. I've read a couple other comments on this site that say similar things. I'm sure like anything it's going to be a case by case basis, maybe that is what I need. I'll need to read more. I am curious, do you have links to those two case studies? I'm curious who did them, when they were done and if they've given a name to the procedures.

More reading on my end is necessary but I would need to confirm if these types of comments are accurate. If my mid mandible is already not narrow, widening it is probably not going to be a good thing aesthetically. Maybe it depends on how the IMDO is performed.

You’re getting confused with jaw width and bigonial. IMDO increases the mid mandible width I believe which often produces a satisfactory jaw widening but it doesn’t widen the gonials. I wonder if that means with IMDO you’d be less likely
To have hollow cheeks

IMDO doesn’t widen the bigonial why are you spreading this fake news


bigonial width actually decreases with IMDO but jaw appears wider.

I think MSDO slightly increases bigonial but mostly chin width

 

[Silver]

Thank you for the detailed reply brother. I re-read the Acromegaly_Chad thread and at the end he mentions IMDO widens the entire jaw and doesn't accentuate the jaw angles. I've read a couple other comments on this site that say similar things. I'm sure like anything it's going to be a case by case basis, maybe that is what I need. I'll need to read more. I am curious, do you have links to those two case studies? I'm curious who did them, when they were done and if they've given a name to the procedures.

More reading on my end is necessary but I would need to confirm if these types of comments are accurate. If my mid mandible is already not narrow, widening it is probably not going to be a good thing aesthetically. Maybe it depends on how the IMDO is performed.

Posterior mandibular widening secondary to advancement sagittal split osteotomy: A retrospective study - PubMed

Our results suggest that ABSSO is responsible for posterior mandibular enlargement which must be taken into account during the aesthetic preoperative assessment. Further studies are mandatory to identify the risk factors for this phenomenon.

pubmed.ncbi.nlm.nih.gov

Mandibular Advancement Means Lower Facial Enlargement: A 2-Dimensional and 3-Dimensional Analysis - PubMed

This 2D and 3D analysis of transversal modifications shows that advancement with the BSSO is responsible for marked lower third facial enlargement. This parameter must be taken into account during the preoperative esthetic assessment to ensure the provision of pertinent information to the...

pubmed.ncbi.nlm.nih.gov

Just realised both are from the same author, the latter one is just a follow-up to the initial study with new data from new patients.

 

[Cheat_Win]

To begin with, I'm sorry for all the money you've squandered and the difficulties you're experiencing. I'm sure you have a dire need for answers and options. Fillers have not yet been mentioned. This might be because many believe they migrate and cause facial bloating, which is not totally true.

Let me tell you something: for the past two years, I've been utilizing fillers on my jaw angles and chin. I have access to a highly qualified and board-certified plastic surgeon who specializes in head and neck procedures.

In these areas, he does not use hydrophilic filler since you need filler that does not draw water. Fillers operate essentially like implants, with clear limitations:

• They break down slowly, especially around the gonials and high movement areas
• They can migrate and deform if you get trauma in the area
• the overall result highly depends on your surgeon skill and how well you take care of your investment
• To achieve the results you want, it may take up to 10 sessions with 4-6 months apart of injections, never do everything in one.
• If you underlying bone structure is way to recessed, fillers might not be the first solution, but definitely something to consider.

In my experience, though, the benefits exceed the disadvantages. I am a man who is both cautious and socially engaged. Since I had fillers, I was never required to take time off from work. Since the changes were subtle, no one ever guessed that I had work done; instead, they believed I was experiencing a second puberty. To achieve optimal results, I just need to inject 0.5 ml into each gonial every four to six months and 1 ml into my chin annually. Let's concentrate on the jaw and chin at this time.

How do fillers function? My fillers (Voluma) create a pocket in your soft tissues that maintains them in place; they adhere like glue. They will only move or change form if you are injured in that region, thus I must avoid bar fights and pray I am never struck in the face. Additionally, I had to remind my girlfriend to quit pinching my jaw and chin, haha. However, I was quite clever in my delivery.

But I digress.

I've been using Juvaderm Voluma ever since beginning. It is a filler similar to Radiesse, but it is safer, lasts longer, and does not cause puffiness. In your situation. If I were in your position. I would remove the implants or significantly reduce their size. Then let my masseter to heal. Then, begin injecting with the best surgeon in your area, and begin molding your perfect jaw gradually. Never inject more than 2-3 ml on either side of a gonial in a single session. Always be patient and wait at least three months between injections. Ensure that the filler is put beneath the skin and NEVER over the bone, with the exception of the chin, but if you doctor is expereinced he would know this.

I have a lot more tips but I think I will just make a post talking about this.

If you're curious of how I look, and before and after pics please DM me.

 

[dakchuh]

Posterior mandibular widening secondary to advancement sagittal split osteotomy: A retrospective study - PubMed

Our results suggest that ABSSO is responsible for posterior mandibular enlargement which must be taken into account during the aesthetic preoperative assessment. Further studies are mandatory to identify the risk factors for this phenomenon.

pubmed.ncbi.nlm.nih.gov

Mandibular Advancement Means Lower Facial Enlargement: A 2-Dimensional and 3-Dimensional Analysis - PubMed

This 2D and 3D analysis of transversal modifications shows that advancement with the BSSO is responsible for marked lower third facial enlargement. This parameter must be taken into account during the preoperative esthetic assessment to ensure the provision of pertinent information to the...

pubmed.ncbi.nlm.nih.gov

Just realised both are from the same author, the latter one is just a follow-up to the initial study with new data from new patients.

makes sense, considering jaw is narrower near the front and wider near the back. if you move it forward the back portion will have to widen. its basic geometry.

 

[Silver]

makes sense, considering jaw is narrower near the front and wider near the back. if you move it forward the back portion will have to widen. its basic geometry.

Yes it makes sense but it's not present in every case of advancement. There is obviously some variable that is the determining factor. For larger advancements I sometimes see this type of widening at the proximal segments so I think it has to do something with how narrow the jaw is from a inferior view to begin with.

 

[Acromegaly_Chad]

I asked this to Acromegaly_Chad but your opinion would also be valued. If my gonials are outwards already as you said and the general consensus seems to be that I only need a minimal amount of gonial widening, would something like an IMDO or Bimax be beneficial compared to implants? I believe I read somewhere on this site a bimax can widen if done a certain way.

IMDO even pushes the gonials slightly inwards according to two surgeons who perform it. Apparently, it's got something to do with the direction of force.

Note that IMDO means in this case a cut between the two last molars or behind the last one to lengthen the jaw. There is another IMDO where a median split in the front of the jaw is performed. This IMDO widens the jaw but pushes the gonials in (simple geometry at work here, condyles are the turning point, up to 7 degrees rotation are safe per side).

BSSO combined with advancement always pushes the ramus out but not significantly (max. 2-3mm per side). Widening the jaw angles during a BSSO is very dangerous for the jaw joints according to some surgeons (I didn't find any conclusive studies on that subject matter). Dr. Augustopary or Alfaro do it. In turn Dr. Triaca has said that A LOT of former Alfaro patients need theur jaw joints replaced just a few years after surgery because the are worn down quickly after the repositioning.

Back when I looked into this I thought my last resort was an osteotomy going very high up the ramus and pushing the gonials out (like a vertically extended side wing). I had discussions with Dr. Andreishchev about it and he said it is possible in theory but not done for 3 reasons:
1) In many cases the inferior alveolar nerve is in the way 2) risk of a bad split is very high 3) it's hard to acces intraorally.

Again, the conclusion is that for anything above 5mm per side implants are the only promising solution.

 

[Lancer54]

IMDO even pushes the gonials slightly inwards according to two surgeons who perform it. Apparently, it's got something to do with the direction of force.

Note that IMDO means in this case a cut between the two last molars or behind the last one to lengthen the jaw. There is another IMDO where a median split in the front of the jaw is performed. This IMDO widens the jaw but pushes the gonials in (simple geometry at work here, condyles are the turning point, up to 7 degrees rotation are safe per side).

BSSO combined with advancement always pushes the ramus out but not significantly (max. 2-3mm per side). Widening the jaw angles during a BSSO is very dangerous for the jaw joints according to some surgeons (I didn't find any conclusive studies on that subject matter). Dr. Augustopary or Alfaro do it. In turn Dr. Triaca has said that A LOT of former Alfaro patients need theur jaw joints replaced just a few years after surgery because the are worn down quickly after the repositioning.

Back when I looked into this I thought my last resort was an osteotomy going very high up the ramus and pushing the gonials out (like a vertically extended side wing). I had discussions with Dr. Andreishchev about it and he said it is possible in theory but not done for 3 reasons:
1) In many cases the inferior alveolar nerve is in the way 2) risk of a bad split is very high 3) it's hard to acces intraorally.

Again, the conclusion is that for anything above 5mm per side implants are the only promising solution.

Thank you for the detailed reply man. I’m simultaneously disappointed and relieved in the sense that it seems like bone isn’t an option for me but that an implant was my best bet to begin with.

I really wish there were some bone procedures that could do the the trick. I’m on the fence about the side wing you posted about the other as there’s already asymmetry going on. Also curious if a bimax for forward growth could do much for me.

So I wasted money with too big of implants but it could have been worse in that I’d created more problems with bone cutting procedures and attempted an implant after the fact.

 

[HerpDerpson]

Eppley

Good goy.

 

[Male-Mottle]

before/after pics?