How Can I Shorten A Long Lower Face?

Q: Dr. Eppley, I have a specific question and i want your opinion. In general i have long face…especially lower jaw.

The problem is that the nerve on lower jaw is ery close to the bottom edges of mandibular body.According to the dr, the CT shows that inferior alveolar nerve is laying very close to the end of lower jaw edges. So it is not possible to reduce lower jaw due to the nerve.

I really want to reduce my face because it is very long especially the lower jaw. Now i wanted to ask you, on your experience, is there any way to reduce lower jaw without injuring the nerve, maybe by making a horizontal resection on the middle of the  mandibular ramus and moving the lower jaw upward? I’m confused about what to do and i just wanted an opinion from you if there is any option to reduce (upward) the lower jaw.

A:While that is an operation that can be executed on paper, doing so in real life is a very difficult proposition. Besides that fact that it has to be combined with a LeFort I impaction procedure (which may have undesirable aesthetic effects with loss of all maxillary tooth show) it would be technically very difficult to rigidly fix the bones back together. Thus this is a not a practical procedure.

It would be very unusual, in my experience, to have a naturally low position of the inferior nerve that makes an inferior border shave impossible/unsafe. I would have to see the x-ray on which that judgment was made to provide further insight.

The alternative bony method to shorten a long lower face, at least anteriorly, is a vertical reduction genioplasty…an operation that avoids the nerve issue.

Dr. Barry Eppley

Indianapolis, Indiana