Posts Tagged ‘facial asymmetry surgery’
Wednesday, March 6th, 2013
Q: Dr. Eppley, I have an asymmetric face, jaw, and bite and looking to even things out. The left side of my face is bigger. I’m seeking to make my jaw and cheekbone on the left side smaller to match the right. Also, my right eyelid and eyebrow are lower than the left.
A: I have taken a look at your frontal facial photo and looked at making changes that would provide the best benefit. These would include a left cheek narrowing vertical osteotomy, a left jawline/angle narrowing ostectomy and a right endoscopic browlift. I don’t know your age and you mentioned a bite that is off so there is the possibility of orthodontics and orthognathic surgery as well which would always need to be done first. If you have never had an orthodontic workup this would be a good evaluation to do so you at least know your options.
Facial asymmetry is usually very difficult to get the best symmetry when only one side is done. This is why there remains the option of a
small high right cheek implant or even a small right jaw angle implant…as the bigger left side can never be made quite as small as the opposite smaller right side.
Dr. Barry Eppley
Tuesday, February 26th, 2013
Q: Dr. Eppley, I am only just researching these procedures. I have lived my entire life with an asymmetrical face and flat head, being told that one half of my face looks young and the other like an old man. I’m 23 years old. This deformity is my biggest most unavoidable insecurity which has hindered my confidence since my teenage years. I don’t wear baseball caps or winter toques. I avoid having my picture taken as much as possible and I keep my hair long in front to cover my very uneven eyebrows. My question is will I ever be able to afford a surgery like this?
How much generally is a surgery like this? Any support and advice on this would be so much appreciated.
A: Facial and skull asymmetry takes on many variations. It is impossible to say what procedures would be beneficial without seeing pictures and talking to the patient about their concerns. Every patient must create a priority list of their concerns and then a surgery plan is made around that list. Cost of surgery follows making that listyso it would be impossible to provide any estimates at this point.
Dr. Barry Eppley
Monday, September 3rd, 2012
Q: Dr. Eppley, I am interested in implants to correct my jaw asymmetry. My jaw angles are very asymmetric and I feel I would be more attractive if my facial asymmetry was corrected. I have always been curious about art with respect to beauty. What is beauty? I’ve concluded that beauty is not only in the eye of the beholder but also in the symmetry of the viewed. When you see a symmetric butterfly, it looks beautiful. When you see the symmetry of a supermodel, it is beauty. So this is something that I have become aware of over the years… and others have as well. In fact, there is now an iPhone app that can rate your attractiveness by measuring your symmetry… and guess what actor ranks the highest… It’s Brad Pitt. His left side of his face is exactly like his right side.
I have read your comment about not being able to reach a perfect match on anyone’s facial asymmetry, but instead improving on it. I like that realistic goal. I personally would be highly satisfied if I used a string that was measured and cut to reach from the corner of my left outer eye to the corner of my left corner back jaw (mandibular ramus) and have that string reach the same distance on the right side of my face as well. It currently does not match. But if it did, I would be a happy man. And I also understand that even if I had this result, the symmetry would not be perfect since the position of the corner jaws may be different in the 3-D x-y-z coordinate system.
A: While I have found that perfect symmetry can be difficult to achieve in facial surgery, that does not mean it is not the goal. There are different methods in trying to achieve that symmetry regardless of the location of the implants. Traditional, and still the most commonly done, method of facial implant surgery is to pick out the implants based on a more or less artistic assessment of the patient’s needs. There is no precise method of matching the implants to the underlying bone shape or knowing exactly what the outward changes will be. As unscientific as that is, it works most of the time when the patient’s facial bones are symmetric and the patient isn’t overly detailed or looking for perfection. When it comes to improving facial asymmetry, however, it is easy to see how an unexact science applied to a variable problem is prone to some degree of a persistent level of asymmetry.
To counter these issues, an ideal approach is to make custom implants off of a 3-D model. When this is economically feasible, it is easy to see why this is better than ‘eyeballing’ it.
Dr. Barry Eppley
Sunday, July 29th, 2012
Q: Dr. Eppley, I am interested in yourresults in treating facial asymmetry. I have a pronounced vertical orbital dystopia (I’m not sure if this is the result of plagiocephaly, though I highly suspect it is given the other imbalances in my face). I would like to know my options for treating this. I have attached pictures for your review.
A: Thank you for sending your pictures. I can clearly see that you have a mild to moderate case of right orbital dystopia. (5mms of horizontal pupillary discrepancy) The entire orbital box is situated lower than that of the left side, affecting every surrounding structure from a lower eyebrow/brow bone down to an orbital rim-malar deficiency.
There are two fundamental strategies for dealing with these orbital discrepancies. The first is a complete orbital box change. Dealing with changing the fundamental problem through an orbital box osteotomy is too extreme is my opinion for the magnitude of your dystopia. Therefore, I would recommend an alternative approach of multiple camouflage procedures. At the minimum, I would use an orbital floor-rim implant with hydroxyapatite cement which could be extended out on to the lower cheek bone. One could also use other types of implants such as Medpor or Gore-Tex which can be custom carved to fit during surgery. Ideally I would get a skull model fabricated from a 3-D CT scan to make an exact implant that reconstructs the bone levels to the opposite side. The lower eyelid would then be resuspended/tightened which would move the lower lid level up, particulalry the outer half. One could also treat the upper orbit through either an endoscopic browlift approach with brow bone modification through an upper eyelid approach. You can see with this camouflage approach it is a function of how far you want to go in treating all components of your orbital dystopia.
Dr. Barry Eppley
Tuesday, December 13th, 2011
Q: Dear Dr. Eppley, I was born with a condition known as right hemifacial atrophy, also known as Romberg’s syndrome. I was operated on two years ago with corrective orthognathic surgery. Both my upper and lower jaws were cut, leveled and my bite put back together. The result is good but I still have some right facial asymmetry. I want to reshape my right cheek bone, nose and orbital region. I would appreciate if you can give me some advice on what procedures I need. I have attached some pictures and x-rays from my surgery.
A: Thank you for sending your pictures. You have made good improvement from your orthognathic surgery. To further improve your hemifacial hypoplasia/asymmetry, I would recommend the following right-sided facial reshaping/augmentation procedures:
1) Right orbital floor-infraorbital rim implant
2) Right lateral canthoplasty
3) Right cheek implant
5) Right jaw angle implant
6) Opening wedge genioplasty (right side lengthening) – I was little surprised they did not do this during your orthognathic surgery
This would be my optimal plan to address all of your right facial issues. While all of these procedures do is to lengthen and expand the shorter right side of your face. I think you would get as good, if not even better, aesthetic improvement than you have had from your prior orthognathic surgery.
Dr. Barry Eppley
Friday, November 25th, 2011
Q: Dr. Eppley, I am interested in creating a more symmetrical look to my face via fillers and eventually implants. As a result of my jaw being asymmetrical, the right side of my lower face appears fuller and more defined than the left. I have attached some pictures for you to see.
A: Thank you for sending your pictures. I have taken a careful look at them and the fundamental issue is that the two sides of your face are different. The asymmetry is that the entire right side of the face is lower than that of the left. This can be seen from the eyebrow down to the bottom of the lower jaw. the right eyebrow is lower, the right orbital box and eye is lower as well as the lower eyelid, the cheek is lower and more recessed and the inferior border of the mandible is more inferiorly positioned. In short, you have a classic case of facial asymmetry where the two halfs have developed differently. For the sake of any correction, you have to take the position that the left side of the face is the good side or the objective for the right side to try and achieve. No form of injectable filler can make any significant difference in such facial asymmetry. A variety of surgical procedures can be considered from top to bottom including right endoscopic browlift, right orbital floor-infraorbital rim implant, right lower eyelid tightening by canthopexy, right cheek implant and right inferior border mandibular shave reduction.
Dr. Barry Eppley
Wednesday, September 14th, 2011
Q: Dr. Eppley, Ive come to highly respect your opinion, especially regarding the lower face as you’ve done some beautiful work. I have an asymmetric face. In seeing an orthodontist, he said I am not a candidate for jaw surgery. I think he is wrong. I think jaw surgery is probably the only real solution that will properly address my lower face. My jaw is clearly longer on one side than the other in both the ramus and the condyle, its visible in X-rays. The cheekbone is also visibly lower on one side both externally an by Xray.
My questions aside from obvious rhinoplasty and chin augmentation, can anything at all be done to address this “tilted” look to my face and eye area? It bothers the heck out of me . Your feedback would be highly appreciated. I think surgery is my real need and only true solution.
A: I do not have the advantage of seeing any x-rays so my comments can only relate to your photographs. The most significant component of your facial asymmetry is in the orbits with the one being lower than the other. That is potentially improveable through a brow shaving procedure through the upper eyelid and a lateral canthopexy corner of eye tightening procedure done on the lower orbit. That is relatively low risk and is an operation commensurate with the magnitude of the problem.
Straightening your nose through rhinoplasty is of obvious benefit as well as chin augmentation, via an implant or osteotomy, as you are already aware.
As for jaw surgery in terms of orthognathic repositioning…no. Your orthodontist is correct based on what I see in the photographs. I have no clue as to what your occlusion is but this would involve a major effort and years of orthodontic work. There would have to be a major malocclusion to justify that effort. You are far better off camouflaging the jaw asymmetry with chin augmentation and possibly a lower border shave/ostectomy on the elongated side.
Dr. Barry Eppley
Sunday, July 10th, 2011
Q: Dr. Eppley, I want a consultation about my profile. I am confused as to what I may need. My bite is not bad and I have never had braces. My dentist told me my upper teeth forms a c-shape. I think my jaw line is asymmetric, my chin points to the left and my right side profile looks concave or flat. This had been bothering me for a while but I don’t know what will be the best to make my face look more symmetric and balanced. I have attached some pictures so you can see what I mean.
A: When looking at a face there are two views to consider. The patient themselves sees the frontal view and, understandably, often considers it to be the most important. The profile and oblique views are what other people see and how the patient will usually see themselves in photographs. In your description of concerns, you mention both the profile and frontal view concerns.
As you have described in your frontal view, the chin and jaw angles are asymmetric (right chin deviation and left angle deficiency), and the right cheek is flatter or less pronounced than the left. If you look at other features of your face, you will see that there is an overall right facial deviation compared to the cranial base. This rotation is also why the right facial profile seems flatter in the cheek area.
I can not speak for your bite (occlusion) as it is not contained in any of the pictures you have sent. However, I doubt if your bite is severely off or misaligned and I don’t think it has any contribution to your facial asymmetry.
To improve your facial asymmetry, you have to think of ‘camouflage’ procedures for improvement. I would recommend left jaw angle and right cheek implants and either an asymmetrically-placed chin implant (with minimal horizontal increase) or a chin osteotomy with rotation and shifting to bring the chin point in the midline.
Dr. Barry Eppley
Wednesday, February 9th, 2011
Q: Hi I would like to inquire about information for the correction of facial asymmetry. I have been irritated by the clear tilt in my cheeks and jaw for sometime. My head just doesn’t appear to sit on my neck correctly. After reading your artilesl very carefully I feel I may be a candidate for this. I must stress I understand perfection is unobtainable, however, this has bothered me for sometime. I hope someone can get back to me.
A: The origin of many facial asymmetries is developmental, the facial skeleton is rotated based on a skull growth issue. In craniofacial biology, it is well recognized that how the skull forms through plate expansion and underlying brain growth has a major inflence on how the facial bones develop. If the skull is twisted to any degree so will be the face. This can affect everything resulting in asymmetries of the forehead, brow bones, orbits, cheeks, nose, and jaw.
This facial asymmetry can be camouflaged, or made less apparent, by making adjustments to any of the facial prominences/flattenings. This could include bony reductions or shavings or augmentation through the use of implants. It takes a careful analysis to choose a balance of bony reductions and augmentations to achieve the look of improved facial asymmetry. What procedures would be of most benefit to any particular patient would depend on their individual anatomic issues. Common procedures include forehead augmentation, brow bone reduction, cheek implants, chin osteotomies and jaw angle implants.
Dr. Barry Eppley