Q: Dr. Eppley, Is BSSO mandibular advancement reversible at all and what are the complications of that? Whatever was wrong with my face got accentuated with this procedure, e.g. flatness of my cheeks, flatness on sides of my face, nasolabial distance, short nose, etc. There was a few mm space between my teeth and I just didn’t expect much change to my face nor was told there would be much change nor a bad outcome to my facial structure. My face wasn’t great but with some good cosmetic procedure would have been looking good but now I am not sure what to do about it and how can this be at least partially reversed and if reversals are performed and with what results? I just want this jaw shorter and simply removing the genioplasty probably want give that much of an improvement, I feel I would have a long jaw with flat chin and the effects of my face wouldn’t be reduced, the pulling down part. I don’t gain weight easily on my face nor at all so it’s not like any fat is going to cover this bad outcome and the most I don’t like how the face got all pulled down and how bad it looks, I didn’t really know that would be the outcome of this surgery. If reversal is possible, what would be reversed in the facial structure, would it just be a bit of length of the jaw or would the changes to gonial angle/movement of ramus bone be reversed to any degree? I guess it doesn’t work for every facial type, certainly didn’t work for my face. My orthodontist told me there could be some adjustments over time to my jaw, but I am certain there wouldn’t be any as so far there wasn’t any adjustments and it’s been over 5 months now. The more the swelling went down, the worse my face began to look. I feel now it’s probably the final result except for still swelling on my chin area a bit.
A: At five months after facial skeletal surgery, I would agree that you are essentially looking at the final result. Like the genioplasty, the BSSO mandibular advancement is reversible but the implications of doing so are not as simple as that of the chin. Moving the mandible back is going to change your bite to an unfavorable realtionship. The whole effort at presurgical orthodontics and then the surgery was to change you into a new and good bite relationship. While the BBSO can be undone and moved back, the bite will subsequently be off. Whether that is subsequently in the range of being correctable by orthodontics is a question for your orthodontist since I have no idea what your bite was before surgery or now. There is also the repeat risk of nerve injury (numbness to the lip and chin) with the repeated BSSO procedure.
It would be extremely helpful to see some before and after surgery x-rays (lateral ceph films) which your orthodontist and surgeon undoubtably have. That would provide the critical answers to how far was the mandibular and chin bone segments advanced. (in mms) That would tell me what contribution each made to your now overprojected mandible, where the most likely bone setbacks should be done for the greatest change and the risks involved in doing so. As I had stated previously, undoing the chin is far simpler and has less risk than undoing the BSSO.
Your pictures actually look satisfactory to me and I see no major facial imbalance problems. (I see a slightly strong chin and high gonial angles) But…this is your face and clearly the structural changes are unacceptable to you. While it is common with any form of facial skeletal surgery (what I call facial structural surgery) to have a period of psychological adaptation to their new face, generally that has happened by 6 months or so after surgery.
Dr. Barry Eppley