Options in Aesthetic Treatment of Midface Hypoplasia
Q: Dr. Eppley, I’m contacting you in hopes of getting some information on how I might address an issue I have. I am a transgender woman, and have undergone Facial Feminization Surgery recently. This addressed several of my issues, but I still find that I have a quite flat, hollow, and long face. From my research, these issues (the first two, anyway) appear to be due to “midface hypoplasia.”
I would be interested in hearing what options exist for correcting this which Dr. Eppley is able to offer. From my research, the main approaches appear to be either a LeFort I osteotomy or facial implants (specifically, paranasal and submalar). I have concerns with the LeFort approach. This is partially due to the aggressiveness of the procedure, but also because I feel that the zygomatic bone and the region below it and approaching the maxilla are also underdeveloped. To my knowledge, a LeFort I osteotomy only corrects the maxilla itself. Ultimately, though, I am not a doctor and not really qualified to make the assessment as to what would or would not work myself.
To aid with an assessment, I have included a link below to a set of pictures. These include head shots of me from the profile (both directions), three-quarters angle (both directions), and front. These were taken in bright lighting from roughly 6 feet away. Resolution isn’t amazing, as I unfortunately do not have a high-quality camera. I have also included CT scan images of my skull from roughly the same angles.
A:Thank you for your inquiry and sending all of your pictures and 3D CT scan. Your diagnosis is an overall midface skeletal deficiency. You are correct in that a Lefort I osteotomy would only correct a subtotal portion of the problem….although you would need a LeFort I advancement combined with a mandibular advancement since your lower jaw is also over rotated as a result of the midface deficiency. But given that you have a normal occlusion such orthognathic surgery has additional limitations. From an implant standpoint augmenting the entire midface including the infraorbital and lateral orbital rims with a custom design would be the alternative and superior aesthetic outcome approach that would also be far less invasive with a quicker recovery.
Dr. Barry Eppley