My face is uneven post-surgery. Is orthognathic revision needed?

Question

Hi doctor,

I had double jaw surgery a month ago to correct facial asymmetry. The left side of my jaw was too long, causing the chin to be pushed off-center. They performed a Le Fort I procedure to rotate the maxilla five millimeters and advance it forward eight millimeters.

The jaw was also moved and turned five millimeters to the left, and the chin was supposed to be centered on the midline and brought forward. My face still looks the same as it did before the surgery, and I still appear 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.

To be honest, 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 only half a 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.

Answer 1

Hi,

Welcome to icliniq.com.

I understand your concerns. I recommend that you wait a week longer and see whether any significant changes have occurred after the swelling subsides, as this 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.

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.

If you had uploaded any pictures, I would have judged the asymmetry pre- and post-operatively better. If you do not have any TMJ (temporomandibular joint) pain, that is good. Let us wait and watch, at least 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 tactful in such complicated issues.

I hope this helps.

Thank you.

Answer 2

Hi,

Welcome back to icliniq.com.

Many surgeons do not collaborate with orthodontists to plan orthognathic surgery, which is crucial 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 located towards the left side of the chin. So, whether blepharoplasty is advised, or whether orthognathic surgery and a combination of orthodontic treatment is needed, is a decision that should be made by consulting the orthodontist.

The surgeon alone cannot provide an opinion on this, as 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.

A word of caution: do not undergo a procedure called colectomy, as it can worsen condylar hyperplasia in some cases. It will always help clear any doubts you may have.

I hope this helps.

Thank you.