How Cab This Midface Fullness Be Reduced Which Appeared After A LeFort 1 Osteotomy?

Q: Dr. Eppley, How can I get rid of this lower fullness in my midface that did not exist prior to a LeFort I osteotomy?

A: In regards to trying to reduce lower midface fullness after a LeFort I osteotomy, a significant maxillary advancement does create a bony shelf that was not there previously. This bony shelf combined with the indwelling hardware can create some projection after surgery that was not present before where the face of the maxilla was concave and now has some bony ledge in the middle of a normally completely concave maxillary surface. In these cases removing the hardware and burring down the bony ledge to recreate a completely concave maxillary surface may help reduce some of the lower midface fullness.

As this relates to you, it can be seen that you have four plates and 16 screws and that your maxillary advancement probably was no greater than 5mms. (as judged by the bend in the lateral plates) This is not the type of maxillary movement that creates a large bony shelf. But it is possible that removing the plates and screws and burring down any existing bony ledge will provide some reduction in your lower midface fullness. But probably going back to exactly what it was before your surgery is not possible as some of the fullness is related to irreversible soft tissue changes.

Dr. Barry Eppley

Indianapolis, Indiana