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Q. My face looks the same even after correcting my facial asymmetry. Please help.

Answered by
Dr. Krishna Swaroop Achanta
and medically reviewed by Dr.Meera Premanand
This is a premium question & answer published on Feb 01, 2022

Hello doctor,

I had double jaw surgery a month ago to correct facial asymmetry. My left side of the jaw was too long, pushing the chin off-center. They did a Le Fort 1 to rotate the maxilla 5 mm and pushed forward 8 mm. The jaw was also moved and turned 5 mm to the left, and the chin was supposed to be centered to the midline and brought it forward. My face still looks the same as before the surgery, and I still look crooked. When I told my surgeon about it on the first consultation after the surgery, he said it was still too soon and that the face was too swollen to tell the soft tissues, bones, and muscles needed to adapt to the new position. With all honesty, the more the swelling goes down, the more crooked my face looks, so for me, it is not correct. They also messed up my chin by cutting or shaving the chin bone on the right side too much, that is, the shorter side. So I look like I have an only half chin. The doctor did not mention relapse or bone resorption, not even condylar hyperplasia. He just asked me if my TMJ joints hurt, and I said no. What can I do now? Please suggest.

Thank you.

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#

Hi,

Welcome to icliniq.com.

I understand your concerns. I recommend that you wait a week more and see whether any significant changes have occurred after the swelling subsides, as should be the final result. Judging by your description, you are still in that phase of uneven swelling. As for correction of any surgical errors that your surgeon may have committed by chance, there are other options like liposuction, alloplastic implants in specific regions of the jaw, or maybe bone grafting that would be a bit expensive overall but would aid you in a better prognosis. If you had uploaded any pictures, I would have judged the asymmetry pre and post-operatively better. If you do not have any TMJ pain, that is good. Let us wait and watch, atleast for a few weeks, ideally after facial asymmetry surgery. If you need more options, I will let you know to go to another specialist to handle your case because not all surgeons will be tactile in such complicated issues. I think blepharoplasty can also be considered if it is a soft tissue sagging that is causing the asymmetry. Orthognathic treatment though a bit more time-consuming, can also yield good results. I hope this helps.

Thank you.


Treatment plan:

Blepharoplasty and
orthognathic treatment.

Thank you doctor,

How do I know if I have condylar hyperplasia? And why did my surgeon not anticipate this? Please advise.

#

Hi,

Welcome back to icliniq.com.

Many surgeons do not link up with orthodontists to plan orthognathic surgery, which is essential for preventing facial asymmetry from relapsing after surgery. Condylar hyperplasia is a deficit of the dentoalveolar segment that you might have had from puberty or maybe before 18 years as well. It is just that you are noticing it now because you have not undergone orthognathic surgery or orthodontic treatment. It is more pronounced now than before the surgery. The doctor's approach may vary, but you should let your dentist know if you are not satisfied with the final result of overcoming this unilateral deviation. In your case, the deficit is towards the left chin. So is blepharoplasty advised, or is orthognathic surgery and a combination of orthodontic treatment as well is needed or not is a decision that should be taken by consulting the orthodontist. The surgeon alone cannot give an opinion on this because jaw dysfunction can worsen further without orthodontic treatment. Maybe some surgeons do not anticipate that. So my opinion is that you get your jaw checked by an orthodontist and then plan with an expert maxillofacial surgeon, both of whom can set this deviation right and get the facial profile on a straighter track. It may take time, but it is worth the effort and a word of caution, do not go for a procedure called colectomy because, in some cases, it worsens condylar hyperplasia. It will always help clear any doubts you may have. I hope this helps.

Thank you.


Treatment plan:

Orthodontist consultation in clinic and
orthognathic surgery may be needed.


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