LeFort 1 Osteotomy
Q: Dr. Eppley, I had orthognathic surgery last year. (LeFort 1 osteotomy) This has left me hanging soft tissue, no jaw line, crooked nose, enlarged nostrils, flared nostrils, toothless smile, thin bottom lip and can’t even close my mouth without feeling pain, as though someone is pulling my chin backwards through my skull.
A: While I am just looking at a front view picture, you have many of the potential sequelae from the intraoral incision used for a LeFort I osteotomy which includes flared nostrils, widening of the nasal base and upper lip sag. This occurs because of the degloving incision and detachment of the facial musculature to the bone…not because the bone was moved back too far. (although that may be a contributing issue of which I can not speak since I don’t know the skeletal movements done) The nasal asymmetry can arise from a septal deviation caused by the bony movement.
Given that you are nearly a year after this surgery the soft tissue changes are stable. There are a variety of procedures to deal with these nasolabial changes from nostril narrowing, lip lifts and rhinoplasty surgery. Unless there is a significant bite issue, I would focus on the soft tissue issues and leave the jawbones where they are.
Dr. Barry Eppley