How Can I Make My Midface Dramatically Shorter?

Q: Dr. Eppley, I have long face syndrome and also have a gummy smile (with some gum showing when I smile). I would like to ask whether there is any surgery that can significantly shorten the length of my nasal bone and maxilla. Ideally, I want to shorten it by 2 cm. I am willing to accept extensive soft tissue removal, as well as scarring and possible nerve damage. Is this possible? I have already consulted doctors in South Korea, Japan, and Italy. Their general recommendation is a high LeFort I osteotomy to shorten the midface bone by approximately 10 mm, combined with philtrum shortening and a facelift to reduce the soft tissue. However, I personally really love the appearance of an extremely short maxilla and nasal bone. Those doctors suggested I ask around the world whether shortening more soft tissue or adding a LeFort II osteotomy with nasal root advancement could make the maxilla even shorter. 

A:There is no further midface reduction you can do than a LeFort I impaction and some limited soft tissue adjustments. You’re going to have to realize that there are limits as to how much your midface can be shortened and your ideal goal of a an extremely short maxilla and nasal bones is never going to be able to be achieved. The limitations are primarily in the soft tissues. Many patients erroneouslyview this as an engineering project on the bone when in fact that is not the limiting factor at all. You have fallen into that exact same thinking.

Dr. Barry Eppley

Plastic Surgeon