Can Custom Facial Implants And Orthognathic Surgery Be Done At The Same Time?
Q: Dr. Eppley, I’m a 33 year old female. As a teenager 4 of my premolars were extracted for braces, and later 4 wisdom teeth. My facial profile is very flat with no frontal projection of the cheekbones as a result (I lost several mm of volume in my face). I tried to have my upper and lower palette expanded with removable appliances with a dentist at age 32 but my mandible was left retruded.
I have UARS and struggle with choking, asthma chronic fatigue syndrome, and flimsy nostrils. Both both my nose and throat are obstructed. I’m suppose to get surgery on my nostrils to breathe better, but I know real problem is that the entire nose lacks support both from the loss of cheekbone fullness to support the nostrils and a retruded maxilla.
I’m in the early stages of looking for a jaw surgeon to correct my airway issues but I know that no amount of surgery can bring back fullness to my cheekbones and upper alveolar process because of the bone loss from so many dental extractions and retraction from braces.
I was curious if you ever work closely with a maxillofacial surgeon to address some of these aesthetic concerns while they address functional ones? I’m hoping to find a surgeon who is able to do a counterclockwise rotation.
Ideally I’d love if these procedures can be completed before 9/17/22 because I’m suppose to be married on that date.
I’ve included multiple photos to show my face and jawline from the side, front, and at various focal points. (The ones not taken in doctors offices were from this year, and I included several from various doctors to account for any discrepancies in focal point, etc., of the photos)
I think a lot of these issues have to do with my upper palette growing more narrow as a child and preventing proper tongue posture/jawbone growth resulting in a subtle lengthening of the entire face over time, exacerbated by braces and extractions. This lengthening is best shown in side photos of my gonal angle, and the resulting lack of projection in the lower 1/3rd of the face. This elongating also effects my eyes, which are a few milimeters closer together than they were before braces/extractions at age 16 and my nose, which appears larger as a result of the set back maxilla and mandible.
A:Thank you for your detailed inquiry and sending your pictures. My interpretation of your current facial issues are that you may need bimaxillary orthognathic surgery (double jaw surgery) for opening up your airway but, as you have acknowledged, such surgery will not likely adequately address your aesthetic issues. (and may create some new ones as well) While some form of facial augmentations may eventually be of benefit, such aesthetic facial implant surgeries are never performed at the same time as the orthognathic surgery. This is due to not only an increased risk of infection but also because the true aesthetic needs can not be accurately determined. Thes two surgeries are separated by at least six months and also requires an after orthognathic surgery 3D CT scan for treatment planning and implant design.
Dr. Barry Eppley