Revision jaw implants design + inframalars and genio

[tony10]

Just finished up this case and sent it to production.

Patient notes:
-Already has wraparound silicone implant.
-Misplaced badly on left side.
-Implant had unideal curvatures in general, too blocky.
-Patient liked the height of old implants, but requested a slightly wider design.
-Patient also desired more volume around the infras and malars.
-Already had nice eye area, with good soft tissue distribution.

New implant notes:
-About 8mm right and 10mm left widening on jaws.
-Both sides of jaw about 4.5mm height added.
-Concavity to jaw shape added/fixed.
-Inframalars are 4.5mm and 5.5mm from 3/4 view.
-Fixed general asymmetries.
-3.1mm saddle.
-Infra rim shape has a slight, but improved, curve to keep a natural look.

There will be a genioplasty as well.

Surgery is in May. You can check out @xsBrae on tiktok to follow his journey.

Pictures of his old and new implants have been attached. As always I'm happy to answer questions regarding the thoughts behind certain design choices or anything else. Cheers

Old silicone wraparound:

 

[yussimania]

Old design looks like something I see on Eppley's website

This is him right?

Why go through with 3mm saddled Infras but I mean make your money off these idiots bhai

He could just do a touch up with filler for angularity to achieve that concavity in a much efficient and cheaper way I mean @Orka what do you think seeing as your result for sure mogs whatever this result will be. Even his old design had mega flare to the gonions and it failed to produce that sharpness we saw with yours

Also the implants are medpor right? If so what's the contour "map" like the lowest it goes down to taper wise?

I also think the genio decision is not gonna be good as the shape of his chin will change from square (due to implant) to whatever it was before and it will narrow due to viewing angle

 

[usernakfw]

Old design looks like something I see on Eppley's website

View attachment 4834321

This is him right?

Why go through with 3mm saddled Infras but I mean make your money off these idiots bhai

He could just do a touch up with filler for angularity to achieve that concavity in a much efficient and cheaper way I mean @Orka what do you think seeing as your result for sure mogs whatever this result will be. Even his old design had mega flare to the gonions and it failed to produce that sharpness we saw with yours

Also the implants are medpor right? If so what's the contour "map" like the lowest it goes down to taper wise?

I also think the genio decision is not gonna be good as the shape of his chin will change from square (due to implant) to whatever it was before and it will narrow due to viewing angle

The original implant shifted along the left of my mandible, causing my masseter to contract on the left side of my face. It’s better to fix then keep this current junk in my face, silicone erodes the bone anyhow, it was a stupid decision to begin with. They perform a “staircase” genio in which there is horizontal advancement as well, widening the natural chin. I don’t personally like how wrap arounds taper along the mandible anyhow, blocky look, a chin implant also commonly can leave a mentolabial fold as well as mentioned since the underlying muscle remains in the same position. Infras because of negative orbital vector you can see just off of skull, kinda no brainer there but they are easy to mask with certain things ofc.

 

[yussimania]

The original implant shifted along the left of my mandible, causing my masseter to contract on the left side of my face. It’s better to fix then keep this current junk in my face, silicone erodes the bone anyhow, it was a stupid decision to begin with. They perform a “staircase” genio in which there is horizontal advancement as well, widening the natural chin. I don’t personally like how wrap arounds taper along the mandible anyhow, blocky look, a chin implant also commonly can leave a mentolabial fold as well as mentioned since the underlying muscle remains in the same position. Infras because of negative orbital vector you can see just off of skull, kinda no brainer there but they are easy to mask with certain things ofc.

No it's about the saddle not the projection

Are you aware of what saddled Infras do? You literally dont need them at all your PFL:height is good - unless you are squinting in that photo?

What is shown in the scan isn't staircase and advancement won't widen your chin at all you are being mislead by whoever told you that - it's simple parallax

Good luck on your ascension I would think about some of these choices do your own research

 

[Ascension75]

The original implant shifted along the left of my mandible, causing my masseter to contract on the left side of my face. It’s better to fix then keep this current junk in my face, silicone erodes the bone anyhow, it was a stupid decision to begin with. They perform a “staircase” genio in which there is horizontal advancement as well, widening the natural chin. I don’t personally like how wrap arounds taper along the mandible anyhow, blocky look, a chin implant also commonly can leave a mentolabial fold as well as mentioned since the underlying muscle remains in the same position. Infras because of negative orbital vector you can see just off of skull, kinda no brainer there but they are easy to mask with certain things ofc.

Why medpor though ?

 

[Jgns]

Why medpor though ?

apperently peek is banned in brazil which is where im guessing he lives

 

[usernakfw]

No it's about the saddle not the projection

Are you aware of what saddled Infras do? You literally dont need them at all your PFL:height is good - unless you are squinting in that photo?

What is shown in the scan isn't staircase and advancement won't widen your chin at all you are being mislead by whoever told you that - it's simple parallax

Good luck on your ascension I would think about some of these choices do your own research

The scan showed isn’t the actual genio design, Tony just added that for show. The actual design is done separately by my surgeon, and I’m aware of what saddled does, I wouldn’t say that photo is the best representation of me unfrauded.

 

[usernakfw]

Why medpor though ?

Why medpor though ?

What’s wrong with medpor, is there another alternative you prefer?

 

[nishka]

He could just do a touch up with filler for angularity to achieve that concavity in a much efficient and cheaper way I mean

what concativity? like the ogee curve / line?

like this?

 

[nishka]

No it's about the saddle not the projection

Are you aware of what saddled Infras do? You literally dont need them at all your PFL:height is good - unless you are squinting in that photo?

What is shown in the scan isn't staircase and advancement won't widen your chin at all you are being mislead by whoever told you that - it's simple parallax

Good luck on your ascension I would think about some of these choices do your own research

dude i hope i dont become like obsessed with surgery where i dont know where to stop lmao

 

[Jgns]

dude i hope i dont become like obsessed with surgery where i dont know where to stop lmao

hows ur trimax looking so far

 

[nishka]

hows ur trimax looking so far

kinda mogs ngl but my upper lip is still a little behind lower because lower lip is just naturally thick me and @yussimania have been going thru ideas on how to fix

 

[nishka]

kinda mogs ngl but my upper lip is still a little behind lower because lower lip is just naturally thick me and @yussimania have been going thru ideas on how to fix

still swollen btw so lets see but the buccal fat removal is the real wildcard as to how it will look after the swelling goes away

 

[Jgns]

fire asf hope it keeps getting better, ur initial meltdown was crazy tho lol

 

[Ascension75]

What’s wrong with medpor, is there another alternative you prefer?

what made you choose medpor over peek. Or just because your surgeon doesn't work with it?

 

[monecel]

What’s wrong with medpor, is there another alternative you prefer?

PEEK is pretty good

 

[monecel]

Plan looks good, I'll be watching

 

[monecel]

The original implant shifted along the left of my mandible, causing my masseter to contract on the left side of my face. It’s better to fix then keep this current junk in my face, silicone erodes the bone anyhow, it was a stupid decision to begin with. They perform a “staircase” genio in which there is horizontal advancement as well, widening the natural chin. I don’t personally like how wrap arounds taper along the mandible anyhow, blocky look, a chin implant also commonly can leave a mentolabial fold as well as mentioned since the underlying muscle remains in the same position. Infras because of negative orbital vector you can see just off of skull, kinda no brainer there but they are easy to mask with certain things ofc.

I've mentioned this before but wraparounds give an angle/flare to the mandible body which is not natural. The natural angle is vertical or near verticle. If you need to widen the jaw, then custom PEEK/ti64/medpor gonial implants are best, if you are severely lacking in mandible width then a split mandible osteotomy or MSDO is the best choice and possibly with gonial implants on top

 

[monecel]

dude i hope i dont become like obsessed with surgery where i dont know where to stop lmao

Just follow the (somewhat) objective craniofacial guides and use it as a reference. Don't go past the ideal range. And keep harmony in mind, you can't just enhance one area if the others don't match.

 

[nishka]

Just follow the (somewhat) objective craniofacial guides and use it as a reference. Don't go past the ideal range. And keep harmony in mind, you can't just enhance one area if the others don't match.

nah but the problem is like look at this dude he is so handsome yet he still wants more which is interesting to me

 

[yussimania]

I've mentioned this before but wraparounds give an angle/flare to the mandible body which is not natural. The natural angle is vertical or near verticle. If you need to widen the jaw, then custom PEEK/ti64/medpor gonial implants are best, if you are severely lacking in mandible width then a split mandible osteotomy or MSDO is the best choice and possibly with gonial implants on top

MSDO not good don't recommend

 

[LackEmpathyTherefor]

nah but the problem is like look at this dude he is so handsome yet he still wants more which is interesting to me

nah it’s kinda frauded you can tell he doesn’t look that good in motion (not saying hes ugly iam not hating, just a frauded pic for TikTok prolly like androgenic does ).
I do ts too for my tinder and hinge like perfect angle lighting hiding flaws

 

[monecel]

MSDO not good don't recommend

Explain your reasoning

 

[yussimania]

Explain your reasoning

In theory It fucks the JFA

You are widening the mandibular symphysis region and that will cause the mandibular arc to be more U shaped

If we think about it the cut and expansion will torque the condyles medially inwards rather than outwards

The gonions didn't widen

Also idk who you can find to do MSDO pretty sure it goes by DAME now and is done by this American surgeon I saw on Jaw Hacks but he's obviously gonna charge a bomb for it

If you have any aesthetic results show me

 

[monecel]

In theory It fucks the JFA

You are widening the mandibular symphysis region and that will cause the mandibular arc to be more U shaped

View attachment 4837696

If we think about it the cut and expansion will torque the condyles medially inwards rather than outwards

View attachment 4837697

The gonions didn't widen

Also idk who you can find to do MSDO pretty sure it goes by DAME now and is done by this American surgeon I saw on Jaw Hacks but he's obviously gonna charge a bomb for it

If you have any aesthetic results show me

Oh yeah I think I saw you mention this before

Split osteotomy is superior as you can add as much posterior expansion as anterior or actually even more back expansion if you torq the TMJs. You can do this while preserving the JFA

Though if your JFA is too flat MSDO could actually be a strategy to improve it

 

[tony10]

Old design looks like something I see on Eppley's website

View attachment 4834321

This is him right?

Why go through with 3mm saddled Infras but I mean make your money off these idiots bhai

He could just do a touch up with filler for angularity to achieve that concavity in a much efficient and cheaper way I mean @Orka what do you think seeing as your result for sure mogs whatever this result will be. Even his old design had mega flare to the gonions and it failed to produce that sharpness we saw with yours

Also the implants are medpor right? If so what's the contour "map" like the lowest it goes down to taper wise?

I also think the genio decision is not gonna be good as the shape of his chin will change from square (due to implant) to whatever it was before and it will narrow due to viewing angle

Yes, same design company Eppley uses.

I see Brae already replied, but I’ll just add a little bit: As he stated inframalars were indicated, so there was really no reason to not slightly tighten the contour of his infra rim simultaneously. The biggest effect from that implant will be from the 3/4 view tho.

Even if he never had encountered any problems with his wraparound implant, you can still see from the design that it adds some unideal bulk to the mid-mandible and in general not the most aesthetic contours from either the sides or front.

The genio will likely have a widening technique added to mimic the widening from the chin part of the implant

 

[monecel]

Yes, same design company Eppley uses.

I see Brae already replied, but I’ll just add a little bit: As he stated inframalars were indicated, so there was really no reason to not slightly tighten the contour of his infra rim simultaneously. The biggest effect from that implant will be from the 3/4 view tho.

Even if he never had encountered any problems with his wraparound implant, you can still see from the design that it adds some unideal bulk to the mid-mandible and in general not the most aesthetic contours from either the sides or front.

The genio will likely have a widening technique added to mimic the widening from the chin part of the implant

View attachment 4836798

Why not make the split genio a line down the middle? is there a benefit to this design? contact area?

 

[tony10]

Why not make the split genio a line down the middle? is there a benefit to this design? contact area?

Different techniques for different surgeons, I suppose. Raffaini is one of the co-writers for a paper on this technique.
With this one you have 2 big pieces of bones here with contact point, compared to for example the T-split which segments the chin into 2 small pieces which wont touch each other. So yea, you can argue there's an extra element of stability

 

[Lefor3Laser]

Yes, same design company Eppley uses.

I see Brae already replied, but I’ll just add a little bit: As he stated inframalars were indicated, so there was really no reason to not slightly tighten the contour of his infra rim simultaneously. The biggest effect from that implant will be from the 3/4 view tho.

Even if he never had encountered any problems with his wraparound implant, you can still see from the design that it adds some unideal bulk to the mid-mandible and in general not the most aesthetic contours from either the sides or front.

The genio will likely have a widening technique added to mimic the widening from the chin part of the implant

View attachment 4836798

I am not a big fan of genio widening since it can make a step-off between the mid body of the mandible and the chin (depending on the soft tissue and how much it was widened ofc), a genio + chin implant would be more ideal to create a much more natural contour.

 

[monecel]

I am not a big fan of genio widening since it can make a step-off between the mid body of the mandible and the chin (depending on the soft tissue and how much it was widened ofc), a genio + chin implant would be more ideal to create a much more natural contour.

This is true if the mandible is not split, but if you do a split mandible osteotomy then there will be no step off with chin widening

 

[Psl.sinper]

dude i hope i dont become like obsessed with surgery where i dont know where to stop lmao

why you say this lmao?