How Can I Fix My Right Jaw Asymmetry?

Q: Dr. Eppley, Hello, I have a jaw contouring/ jaw reshaping concern. My right side lower jaw is bigger and draws the right side of my face downward. This is clear when seeing my lips, as the right side of the lips are pulled in a downward angle. It’s fairly clear to me that the right-side lower-jaw is overly large and extends excessively downward. Please let me know your thoughts!

A:As you have correctly surmised your jaw asymmetry is due to the right side being lower. This is a very typical form of Joel asymmetry and, for whatever reason it is usually the right side which is lower. The only effective treatment is an inferior border shave on the right side. This requires some x-rays for proper planning. At the least a Panorex X-ray will clearly show how much lower the right side is from the left as well as the location of the nerve as it runs through the lower jaw. This is known as the inferior alveolar nerve which supplies the feeling to the lower lip and teeth. This runs directly through the bone in the middle of the lower jaw and exits anteriorly through the mental foramen. Usually when the Joel is lower so is the nerve in the bone and we have to know exactly where that is to avoid injuring it in any type of bone removal. Most likely given where your jaw overgrowth is the nerve is probably got a safe distance away. But it is obviously important to know rather than to guess.

That issue aside the more relevant issue is the approach needed to remove the jawbone. The Jolla angle poses considerable technical challenges for proper access. Since what is needed is a specific linear cut of bone from the back of the jawline  forward to the point where it matches better to the opposite side the only way to do that is an external approach. This requires  an incision at the back end  of the jaw angle. The alternative is an intraoral approach but this places the bone cut at an odd angle, a nonlinear cut,  and it is very hard to be exactly specific as to the resultant bone shape that is created. It creates a curved shape unless the bone cut is placed very high which would then make your right side higher than the left and just cause the reverse problem.

Dr. Barry Eppley

World-Renowned Plastic Surgeon