Q: Dr. Eppley, I had in orthognatic surgery several years ago for a bad bite that gave me a lot of problems with my teeth and pain in my jaws every morning. While the surgery went fine from a technical standpoint (my bite is better) it left me with a very bad look. I think it is because he made some mistakes with repositioning the masseter muscle as my face shrunk on the sides and left me with a lot of loose skin. This makes me look 10 years older then my age. I’m now 50 and I look older. I am used to always looking much more younger than I am. I’m very unhappy and I don’t think normal lifts of skin will help because what is missing is underneath, it needs to be filled in. I need deep tissue filling not just stretching the skin. Here are some photos for you to see what I mean.
A: What I see on the photos is lack of jaw angles and loose jowl and neck skin. The jaw angles actually appear both high and indented or concave. I think the jaw angle issue is a result from your orthognathic surgery but it was not a mistake by the surgeon. Mandibular osteotomies involves elevating the masseter muscles off of the bone to perform them. There is no such thing as having to reposition them during the surgery as they simply fall back into place. But what can happen is muscle atrophy/shrinking from the trauma of the surgery and I believe this is what you have experienced. Because of the lack of a jaw angle, you would benefit by small lateral augmentation style of jaw angle implants. This could be combined with a limited neck-jowl lift (facelift) to create a more youthful jawline and nek appearance.
Dr. Barry Eppley