There are many discussions around the best hardmaxxes for poor jaw development. People say "Bimax" or "Trimax" for every case but the issue is that it does not fix the actual width of the mandible. You can also get implants on your gonions to increase bigonial width but it does not increase the width of the mandible body unless it is a wraparound implant which often looks uncanny. It is essentially flaring the rim of the mandible which is not natural.

Implants can't increase the width of the mandible body like above, at least effectively. Wrap around implants often look obvious and uncanny:

Fagmaxxing

Obviously the bigonial width was increased too much, but you can also kind of tell that it is not natural as the actual jaw position did not move, they just flared the edges. Jaws nearly always grow vertically along the mandible body except for the gonion, which can be flared. You can see an example below:

You see how the wraparound implant changes the slope angle? That angle does not occur naturally except for the gonion. This is why to me wraparound implants are a poor solution and an "easy fix" that sacrifices aesthetics and canny-ness.

Then what is the better solution?

The Mandibular Midline Osteotomy

It is a purely surgical alternative to the alternate approach, MSDO. The midline osteotomy is a procedure where a cut is made down the center of the mandible through the chin and then the whole jaw is widened, slightly torquing the TMJs. This increases chin width, mandible body width, lower aveolar process width and bigonial width.

Importantly it also allows chin width to be expanded (with a split genioplasty) without creating a step-off. As you can see with a normal split genioplasty this happens between the mandible body and the chin segment:

This is worsened by the osteotomy being split. If widening the jaw with a midline osteotomy this effect is reduced.

You can do a cut like this instead of a midline cut but it is more intensive and does not widen the gonions:

To increase gonial width as well a cut down the middle to split the mandible seems like the best option.

Look how much the midline osteotomy this ascended this patient:

In addition this is likely to have significant airway benefits, especially when combined with a bimax. If you have sleep apnea, poor breathing or any issue of that sort it could probably nuke it in one go.

We are ALL getting midline ostetomies this summer.