Short Face Surgery
Q: Dr. Eppley, I am interested in short face surgery. I have a very short lower face. I had been on braces for the past 2 years and now on retainers. While the alignment of my teeth has improved and it’s almost a normal occlusion, I’m still not happy about my aesthetic facial results. Here are my main concerns:
My lips are actually over lapping each other and as you can see the upper lip actually rolls inside the upper teeth giving it a weird shape. I feel this is due to the deep seated maxilla and teeth which supports my upper lips inadequately. I do not show any teeth when I smile. I have a non-existent jawline and a slight double chin despite being relatively lean. My chin appears receding and gives me a chubby look.
Here are a list of my expectations : A proper support to my upper lips by my upper teeth and proper visibility of my upper teeth when I smile naturally and even when I talk . A balanced chin for my face and a visible jawline and to remove the bloated look on my face and give it some structure
Here are my questions:
1. Can you please explain the cause of such aesthetic issues for me.
2. What would be the best course of treatment in your opinion?
3. If you are gonna suggest double jaw surgery with vertical and horizontal advancement and genioplasty, can the pre braces phase be done away with , now that there is proper alignment between my teeth.
4. I get pain in the jaws when I chew on something hard. Would it also benefit from the surgery ?
5. Would my already prominent nose get wider if I opt for a maxillary advancement ?
6. Are there chances of relapse of the maxilla after surgery ?
A: In answer to your short face surgery questions:
1) What you need is vertical facial lengthening. The key to deciding which approach to do comes down to tooth show.
2) If tooth show is a very important aesthetic element then only a bimaxillary orthognathic procedure will accomplish that by dropping down the maxilla 4 to 5mms as well as bringing it forward a bit. The mandible comes with it of course which pulls down the lower face as well. Other soft issue procedures around it would be beneficial (buccal lipectomes, neck liposuction) but the vertical maxillo-mandibular lengthening is the key. (probably a lengthening bony genioplasty would also be done with it of another 5mms)
This approach increases tooth show and pulls the face longer which will also help make it thinner.
Dropping the maxilla down requires an interpositional bone graft with plate and screw fixation. This is the best way to prevent relapse.
Whether such an orthognathic procedure will improve your jaw pain can not be predicted.
To avoid increased nasal widening from a maxillary osteotomy procedure, alar base cinching is needed during the closure.
If one has a good and stable occlusion, then further orthodontic work is not needed for this surgery as the same bite is maintained. Like bimaxillary osteotomies for sleep apnea (large horizontal movements) this is not a bite-changing surgery.
3) If tooth show is not a primary aesthetic goal, then a 12 mm intraoral vertical lengthening genioplasty or a custom vertical lengthening total jawline implant can be done which will vertically lengthen the face effectively. This will need to be combined with maximal facial defatting procedures as well.
Dr. Barry Eppley