Ramieri, genio and technique

[EverythingMattersCel]

Case #1:
16mm genio-only projection with jawline implants. Clearly a trimax case, but for some bizarre reason, Ramieri chose to only do a genio instead. Note the deep mentolabial fold and the bunching around the submental from the transition between the chin and the rest of the mandible.

The post was uploaded to Instagram, but now seems to be deleted. The fact that this was considered a good result worthy of posting is kind of concerning ngl. That being said, 16mm is a massive movement when the whole mandible is clearly fcked in this case... so aesthetic complications are not surprising.

Case #2
Chin reduction and rotation to address asymmetry.

Look at the transition between the chin and the mandible; clearly a step-off. Is this because of chin shaving/reduction having the opposite of a tightening effect, or just simply poor technique on Ramieri's part?

Now I DM'd a user who claims he has spoken to 5 people who got genio with Ramieri, and all of them had a combo or at least an issue with asymmetry and step-off, even with conservative movements.

Genio is supposed to be a relatively simple surgery, and hard to mess up. Is it really just poorly planned cuts or something else about the technique? Or is the step-off exaggerated in these after photos because of soft tissue swelling? Is the problem case-specific, or is Ramieri generally bad at genioplasties? I don't think it's fair to judge based on 2 cases and a few supposed forum anecdotes, but it doesn't set a good precedent for sure.

Also, if anyone had only a custom genio with Ramieri please post your results/experiences here.

 

[Nahorscend]

Yes I would like to know about this because I only ever see these two cases cited as evidence, and both are highly irregular cases. Are there known Ram cases where there was a step-off despite being a normal advancement genio?

@lurking truecel How about you, did you get a step-off?

 

[lurking truecel]

You can get a higher cut genio(balcony genio plasty), which has more risks because you will need to detach the muscle which also higher the chronic lower lip numbness risk.

As we all know ram is risk adverse, and does often standard genio cut, like this one:

Something like this where you make it vertically shorter and low cut, this has the potential to give the step off in the cuts esp if not bonegrafted which unfortunately ram doesnt do that much(its not needed really but for aesthetics it helps with bone growing and filling the gaps)

Then most people can correct the bone for symmetry, but since most people have fat there and the correction of bone symmetry can shift the fat so it seems to be assymetric when its more the fat and soft tissue

 

[lurking truecel]

Yes I would like to know about this because I only ever see these two cases cited as evidence, and both are highly irregular cases. Are there known Ram cases where there was a step-off despite being a normal advancement genio?

@lurking truecel How about you, did you get a step-off?

No i didn't get a step off, because it was so small advancement. But it could have been better still

 

[Nectar]

Why does the first one look like a faggot?

 

[Nahorscend]

No i didn't get a step off, because it was so small advancement. But it could have been better still

How many mm
And in what way could it have been better still

 

[lurking truecel]

How many mm
And in what way could it have been better still

Slightly less forward and more downgrafted, 3 mm

 

[tweaqo]

You can get a higher cut genio(balcony genio plasty), which has more risks because you will need to detach the muscle which also higher the chronic lower lip numbness risk.

View attachment 4715305

As we all know ram is risk adverse, and does often standard genio cut, like this one:

View attachment 4715290

Something like this where you make it vertically shorter and low cut, this has the potential to give the step off in the cuts esp if not bonegrafted which unfortunately ram doesnt do that much(its not needed really but for aesthetics it helps with bone growing and filling the gaps)

Then most people can correct the bone for symmetry, but since most people have fat there and the correction of bone symmetry can shift the fat so it seems to be assymetric when its more the fat and soft tissue

I mean what I don’t understand is that Ram can do complex genios, like he’s published papers about the Tetris Genioplasty which he developed.

But he’s still just shit at them? I think he’s just got a bad philosophy about gemioplasties, rather than actual surgical technique

 

[EverythingMattersCel]

Slightly less forward and more downgrafted, 3 mm

Downgrafting doesn't seem to produce the step-off. I heard/seen 3 cases now of downgrafting (3mm, 5mm and 6mm) with Ram, and there is no indication of a step-off. It seems to only be a risk for horizontal movements. Him being risk-averse with the lowcuts as you explained x large horizontal movements seems to increase the risk a lot.

 

[lurking truecel]

I mean what I don’t understand is that Ram can do complex genios, like he’s published papers about the Tetris Genioplasty which he developed.

But he’s still just shit at them? I think he’s just got a bad philosophy about gemioplasties, rather than actual surgical technique

I think ram overall always want to shorten the face to much, he prob hates the longface syndromes so much. And with low cuts genios you should never do big advancements because it will look pointy and shit.

Also since he doesnt do big maxilla which limts lower jaw movements he sometimes need to compensate with to much chin that look pointy and bad

 

[lurking truecel]

Downgrafting doesn't seem to produce the step-off. I heard/seen 3 cases now of downgrafting (3mm, 5mm and 6mm) with Ram, and there is no indication of a step-off. It seems to only be a risk for horizontal movements. Him being risk-averse with the lowcuts as you explained x large horizontal movements seems to increase the risk a lot.

Yea i mean any step off from bsso or genio is when you vertically shorter. In bsso you cant get step off if you dont ccw rotate. Or its possible if the bsso cut is so huge the bone dont grow back but ccw is making the risk of step off huge. Same with vertically shortening genio or even having the same height of the chin but moving it forward since you glide it with the jaw and creates a step off

 

[Nahorscend]

I think ram overall always want to shorten the face to much, he prob hates the longface syndromes so much. And with low cuts genios you should never do big advancements because it will look pointy and shit.

So let's say you are doing just a horizontal advancement genio, no downgrafting or shortening. How many mm horizontal advancement would you consider as big and aesthetically risky?

 

[yussimania]

Bruh that's my screenshot where my tag at

 

[LEFORT17]

Yea i mean any step off from bsso or genio is when you vertically shorter. In bsso you cant get step off if you dont ccw rotate. Or its possible if the bsso cut is so huge the bone dont grow back but ccw is making the risk of step off huge. Same with vertically shortening genio or even having the same height of the chin but moving it forward since you glide it with the jaw and creates a step off

ig im gonna get gonials with the 10degree ccw

 

[EverythingMattersCel]

You can get a higher cut genio(balcony genio plasty), which has more risks because you will need to detach the muscle which also higher the chronic lower lip numbness risk.

View attachment 4715305

As we all know ram is risk adverse, and does often standard genio cut, like this one:

View attachment 4715290

Something like this where you make it vertically shorter and low cut, this has the potential to give the step off in the cuts esp if not bonegrafted which unfortunately ram doesnt do that much(its not needed really but for aesthetics it helps with bone growing and filling the gaps)

Then most people can correct the bone for symmetry, but since most people have fat there and the correction of bone symmetry can shift the fat so it seems to be assymetric when its more the fat and soft tissue

Can I dm you? I got a couple of questions, if you don't mind.

 

[Ascension75]

I don't like rams results at all

 

[LEFORT17]

I don't like rams results at all

clearly overhyped never was a fan of him.

 

[vernowwww]

I had a good trimax, but the custom genio he did looks not great

 

[EverythingMattersCel]

I had a good trimax, but the custom genio he did looks not great

What were your movements for the genio part?

 

[vernowwww]

What were your movements for the genio part?

6.5 mm forward but had it widened and downgrafted idk how much though, needed a bigger forward movement but ramieri rejected

 

[EverythingMattersCel]

6.5 mm forward but had it widened and downgrafted idk how much though, needed a bigger forward movement but ramieri rejected

Did you get a step-off, asymmetry, or any other problem from the technique/cut? Or was the problem just Ramieri being too conservative with the forward movement?

 

[vernowwww]

Did you get a step-off, asymmetry, or any other problem from the technique/cut? Or was the problem just Ramieri being too conservative with the forward movement?

The downgrafting was good, it was more the widening it’s created a odd shaped ball chin and from the front has created a step off from mandible

 

[Nahorscend]

6.5 mm forward but had it widened and downgrafted idk how much though, needed a bigger forward movement but ramieri rejected

Why did he reject it?

The downgrafting was good, it was more the widening it’s created a odd shaped ball chin and from the front has created a step off from mandible

So you have a step-off from the widening part? But you don't have a step-off from the forward movement like the ones in the original post of this thread?

 

[LEFORT17]

The downgrafting was good, it was more the widening it’s created a odd shaped ball chin and from the front has created a step off from mandible

did he bonegraft

 

[vernowwww]

Why did he reject it?


So you have a step-off from the widening part? But you don't have a step-off from the forward movement like the ones in the original post of this thread?

Idk I had a big bsso movement so he said I would of needed pre molar extractions for more movement I didn’t really understand it but cause his communication was so bad only had 1-2 days for it to be planed, and I don’t really know if it’s from the forward movement or the widening tbh, but my widening does not look good

 

[vernowwww]

did he bonegraft

I think on my maxilla and maybe the widening of my chin, I was never given a pre planing consult so I don’t actually know half of these things sorry

 

[Acquiescence]

Perhaps I should switch to Pag for genio

 

[EverythingMattersCel]

Idk I had a big bsso movement so he said I would of needed pre molar extractions for more movement I didn’t really understand it but cause his communication was so bad only had 1-2 days for it to be planed, and I don’t really know if it’s from the forward movement or the widening tbh, but my widening does not look good

So you only got the surgery plan 1-2 days before the actual surgery?

 

[vernowwww]

So you only got the surgery plan 1-2 days before the actual surgery?

No I had it custom, so they had to order the plates and implants in so was all squeezed in around 10 days before which wasn’t amazing

 

[EverythingMattersCel]

No I had it custom, so they had to order the plates and implants in so was all squeezed in around 10 days before which wasn’t amazing

The custom plates only took 10 days to arrive?

 

[Lefor3Laser]

Why did he reject it?


So you have a step-off from the widening part? But you don't have a step-off from the forward movement like the ones in the original post of this thread?

Probably because of the muscles and nerves, you'd have to always take those into consideration.

 

[vernowwww]

The custom plates only took 10 days to arrive?

well im assuming its an italian company that makes them so wouldnt take that long

 

[Nahorscend]

Probably because of the muscles and nerves, you'd have to always take those into consideration.

That's what I assumed but I thought the limit for nerves is much more than 6.5 mm in anyone, I thought it's at least 8 mm.

Idk I had a big bsso movement so he said I would of needed pre molar extractions for more movement I didn’t really understand it but cause his communication was so bad only had 1-2 days for it to be planed, and I don’t really know if it’s from the forward movement or the widening tbh, but my widening does not look good

And this isn't it because genio has no relation to the occlusion, you would not need premolar extractions to allow a bigger genio movement.

 

[EverythingMattersCel]

The downgrafting was good, it was more the widening it’s created a odd shaped ball chin and from the front has created a step off from mandible

tbh it sounds like he over-widened the chin. Is your chin wider than your mandible or the same width? That's probably why there is a step-off.

 

[monk321]

The downgrafting was good, it was more the widening it’s created a odd shaped ball chin and from the front has created a step off from mandible

it's not only about the widening but can make it even worse ye, however plenty of people have it even without it , it's about handling the soft tissue in a proper manner and adding bone graft if needed, also the angle of the cut matters too.

 

[vernowwww]

That's what I assumed but I thought the limit for nerves is much more than 6.5 mm in anyone, I thought it's at least 8 mm.


And this isn't it because genio has no relation to the occlusion, you would not need premolar extractions to allow a bigger genio movement.

its whats ramieri says made no sense to me either tbh

 

[vernowwww]

tbh it sounds like he over-widened the chin. Is your chin wider than your mandible or the same width? That's probably why there is a step-off.

no my chin is very narrow still, just the connect from the mandible to the chin dosent look right from the front in the mirror

 

[EverythingMattersCel]

Bruh that's my screenshot where my tag at

You seem knowledgeable on surgeries. I will DM.

 

[eahhhhhhh]

no my chin is very narrow still, just the connect from the mandible to the chin dosent look right from the front in the mirror

I am having surgery with Ramieri, I was going to ask him to widen my chin but now I’m not sure. Do you regret it? What would you suggest?

 

[EverythingMattersCel]

I am having surgery with Ramieri, I was going to ask him to widen my chin but now I’m not sure. Do you regret it? What would you suggest?

I DM'd that guy, he sent a pic, and honestly, his chin looks fine. No sign of stepoff or uncanniness from the front profile.

 

[_Lucius]

First patient might not have wanted to go fully with a bimax and just wanted a genio, since its cheaper and less invasive

 

[EverythingMattersCel]

First patient might not have wanted to go fully with a bimax and just wanted a genio, since its cheaper and less invasive

Ramieri should have rejected his case then tbh, but the patient should not have requested such a big genio.

 

[muragoat]

I had a good trimax, but the custom genio he did looks not great

u got genio widening?
show the ct

 

[vernowwww]

u got genio widening?
show the ct

 

[yussimania]

View attachment 4779478

Damn nice gonions

 

[EverythingMattersCel]

Damn nice gonions

Where is the chin widening? Do you see it?

 

[yussimania]

Where is the chin widening? Do you see it?

If it was widening you would see a bone graft in the middle or a midline gap but I can't see it

You can see the bend in the plate as it goes down suggesting that it is advancement

 

[vernowwww]

Damn nice gonions

unironically they look shit irl

 

[muragoat]

View attachment 4779478

i assume u got also inframalars by the screws. send the design

 

[vernowwww]

i assume u got also inframalars by the screws. send the design