Skeletal misalignment of the jaw and/or distinctive chin? Request for possible help!

Dear Casey,

Hmmm... You are a young man with an interesting face. I’m not saying this to reassure you; if you read my postings you will recognize that I post honest opinions and your face is simply interesting – provided you are a man... for a woman, the facial features would be rather rough...

I would estimate your age at about 18-25... At this age, women ask "how is he”? Don’t worry; you will soon reach an age where women will ask “what is he” and later still, they will ask “where is he?”

Basically, the issue concerns mating rituals... I hope that one day you will search for happiness not in a partner, but in yourself. I don’t say that out of viciousness, but out of full sympathy.

A relationship means 1+1=3… 2 are not enough. Most people enter into a relationship according to the motto “A sorrow shared is a sorrow halved” – but that doesn’t work, even though it is the common thinking in our region thanks to the western civilization we live in. Unfortunately, we are also raised according to the motto "Only togetherness is worth living for." That’s disastrous... When you find your happiness in yourself, you will radiate and be a force that other people on your wavelength will recognize and you will become a three…

I really don’t find your face in need of “rehabilitation.” However, you are the boss, and a genioplasty is possible, but I don’t think it will liberate you from your suffering…

In my younger days, I had never been able to score with women myself; I was a small, nice, red-haired ‘Pumuckl.’ It was only when I opened my mouth and people listened to me for longer periods that I won their attention. That’s a difficult undertaking in a disco, I know… Thus, it was always my friends who got the girls and I had a lot of time for learning and thinking.

Today, I wouldn’t want to change anything with my formerly ‘handsome’ friends. The tide has turned – it’s up to you what you do with your life…with or without a distinctive chin.

Thank you for your extensive statement, but I am not satisfied with it at all.

You are right in your assessment of my age as I am a young man of almost 20 years of age.

The fact that a face appears to be interesting does not necessarily mean, however, that it’s interesting in a positive sense. Let me say it diplomatically: Accident patients suffering from severe facial deformations also appear interesting at first sight.

I’m not interested in mating rituals/finding a partner or the like – I’m interested in looking more normal for my own personal sake. That’s why I don’t understand your statement regarding why a genioplasty/jaw surgery wouldn’t provide relief in the end.

I really find it emotionally troubling that I can’t dare to join a photo shoot because almost all the photos taken are then ruined. I suffer emotionally and don’t want to be in any pictures because of my looks; I feel that doing so would make the photos useless.

A number of times, I have let myself get carried away in an inebriated state. When I see myself in party shots, there is never a normal photo among these, like my friends have. They can take snapshots all the time and none of them look abnormal, but look simply, how shall I say this…well, they look normal.

I miss that feeling. After all, I’ve already been told that I’m too flat in the face (statement by the orthodontist), which could point towards a malocclusion.

Furthermore, it happens more and more often that when I open my mouth wide in order to eat something, the jaws make a loud crack.

In my opinion, there are two types of faces that can be interesting: The first ones are the harmonious ones that stand out, and the second are the disharmonious ones that are also striking, but in a negative sense.

Dear Casey,

Thank you for your extensive statement, but I am not satisfied with it at all. You are right in your assessment of my age as I am a young man of almost 20 years.

I am sorry. On the other hand, I write my personal opinion, and not in order to satisfy you. If your face were worthy of improvement, I would write that – we perform such procedures and earn money through them...

The fact that a face appears to be interesting does not necessarily mean, however, that it’s interesting in a positive sense.

If it were interesting in a negative sense, I would have told you that, but whatever – you’re the boss, a correction is possible...

I’m not interested in mating rituals/finding a partner or the like – I’m interested in looking more normal for my own personal sake. That is why I don’t understand your statement regarding why a genioplasty/jaw surgery wouldn’t provide relief towards that end.

As I said, I don’t find your facial expression so unfavorable. Sure, in women it’s a clear matter: High cheekbones, full lips, eyes slightly rising towards the back, pug nose... Everybody knows about that. With regard to men, a distinctive chin/nose is viewed as erotic by most women above 28... That’s just the way it is... You’re only 20 – an age where girls have a tendency towards metrosexuals, i.e., no hair on the chest, etc...

I really find it emotionally troubling that I can’t dare to join a photo shoot, because almost all the photos then become useless.

If you really suffer that much from it, you should do something about it...

Furthermore, it happens more and more often that when I open my mouth wide in order to eat something, the jaws make a loud crack.

Nonsense...

So, do you assume that my chin is merely too long or could there be a skeletal misalignment as well (as my orthodontist confirmed)?

I suppose that you can’t see that just based on the photos, right?

Basically, the only thing stopping me from surgery is the enormous costs I would have to bear.

I don’t have anything against a distinctive chin, but mine is much too distinctive, I think!

Dear Casey!
So, do you assume that my chin is merely too long or could there be a skeletal misalignment as well (as my orthodontist confirmed)?
I suppose that you cannot see that just based on the photos, right?

Unfortunately, I cannot determine that based on your photos. Upload a photo of the closed rows of teeth...

I don’t have anything against a distinctive chin, but mine is much too distinctive, I think!

As I said, I don’t see it that way...

Hello,

I’m writing you once more.

On Wednesday, I went to a dental clinic in Cologne. The orthodontist seeing me was much friendlier and more competent than the one in Aachen.

He told me that there is indeed a misalignment of the jaw, but that my former orthodontist had compensated for it by straightening the teeth, so to speak.

So my teeth are perfect, but the jaws are not!

For this reason, jaw surgery is not possible; only the chin can be reduced.

What is you opinion on that?

Dear Casey,

Sounds plausible to me: A skeletal misalignment, compensated by realigning the teeth. A genioplasty is one option. But I would wait a couple of years to decide if you really want to go through with it because your skull has not yet finished growing.

Hello,

I’m writing you once again.

You say that the growth of my skull is not complete yet? No doctor has ever told me that before. What makes you reach that conclusion?


Last month, I visited the university hospital in Krefeld. They diagnosed the following:

Maxillary retrognathism, but due to the straightened teeth, surgery is not possible, since the “beautiful large teeth have compensated for the misalignment” – at the expense of my looks...

However, afterwards, I was told in the forum that it’s not true that surgery is impossible when the teeth are straight.

Instead, the forum members said that university hospitals don’t take looks into consideration much. Sure, if there’s a misalignment with a malocclusion then they do – but otherwise, they don’t?

Besides that, I also received a letter from my orthodontist regarding the requirements for treatment.

The clinical examination showed that your child has a malocclusion or jaw misalignment, which is not paid for by your health insurance. With regard to treatment requirements, I have diagnosed a level E/1, according to the orthodontic guidelines. Your health insurance may only assume costs at level ‘3’ and up.

Did I miss something? Isn’t that proof that there is one?

What type of specialist should I turn to, provided they are available in Germany? Anything else would be unrealistic.

And one more question that I posted in a board and the answer I received:

However, the correct orthodontist told me weeks earlier that I am too flat in the cheeks, etc. (But that is not a sign for the chin being too long, is it????)

Yes and no. It’s rather a sign for a concave facial profile, i.e., deeper in the middle between the forehead and the tip of the chin. But in many cases, it has to do with a misalignment. The (more attractive) counterpart would be a more round, “forward oriented” (bulging) face with distinctive cheekbones.

This is corrected through OK-VV, UK-RV, a chin reduction or an augmentation of the cheekbone. Or all of that combined.

I have just looked at your pictures on the first page again and I claim to be quite knowledgeable about misalignments and disharmonies in the face by now, but I do indeed find it very difficult to say what your problem is! So I can understand the differing opinions among doctors – you’re anything but a clear case. Maybe your face really has to bulge out (in the sense of “becoming more handsome”), i.e., the nose would have to be pulled up a bit, if you understand what I mean... That would mean OK-VV, but since your teeth have a good occlusion, the lower jaw would have to be done as well, i.e., a BiMax. The part at the chin could be cut at the front, but I don’t think that’s necessary. Hmm, difficult... Better not have me do the surgery... If Berlin is an option, go and see my surgeon – I can recommend him 100 %, especially regarding aesthetic issues.

Do you have any advice?

Kind regards!

Dear Casey,

I’m writing you once again.

Good...

You say that the growth of my skull is not complete yet? No doctor has ever told me that before. What makes you reach that conclusion?

Assumption via the web and the images... Your looks could be better assessed in a clinical setting where one could get a better picture of your developmental stage. So it was only an assumption...

Maxillary retrognathism, but due to the straight teeth, surgery is not possible, since the “beautiful large teeth have compensated the misalignment,” at the expense of my looks...


Well, one could de-compensate the bite and then realign the jaws... But every treatment also bears risks...

However, afterwards I was told in the forum that it’s not true that a surgery is impossible when the teeth are straight.

It’s always possible to do something. The question is whether it makes any sense. For example, one would have to completely realign the bite again. That might not make any sense, considering the risks/benefits. Thus you hear something different from what you read, because the practitioner examining you has more information for his assessment...

Instead, the forum members said that university hospitals do not take looks into consideration much. Sure, is there is a misalignment with a malocclusion, then they do – but otherwise, they don’t?

Krefeld has a good department for mouth, jaw, and facial surgeries. I think you will always get differing opinions in the forum due to the reasons mentioned above...

[…] diagnosed a level E/1 according to the orthodontic guidelines. Your health insurance may only assume costs at level ‘3’ and up. Did I miss something? Isn’t that proof that there is one?

I’m not familiar with these levels... Germans very much like to put things into categories. But in any case, it seems that your malocclusion was deemed to not be developed enough...

What type of specialist should I turn to, provided they are available in Germany? Anything else would be unrealistic.

I assume that they would all perform the surgery/treat you, if you pay for it yourself... Whether that makes sense is a different question…