Q: When I was younger, around 14 years old, I was punched on the left side of my cheek which caused my left side (cheekbone) to be larger than my right side. I did not notice this until my ex-g/f, then current, informed me of this. It’s maybe 4 to 6mms bigger than the right side. I didn’t get it fixed since I didn’t realize there was a problem until the bones had already repaired itself. I suspect a lot of it is bone growth making my cheekbone larger. Could you tell me if this is possible to fix?
A: This is an unusual reaction to a traumatic facial injury. Usually the cheekbone would have gotten fractured causing the opposite problem long-term, cheek indentation or flattening. The observation that it got bigger would indicate that an actual fracture of the bone did not occur.
It is more likely that you sustained a traumatic hematoma (blood collection) to the tissues. This could result in either extra bone being deposited on the outer surface of the cheekbone (appositional bone development with blood as the stimulant which could happen in a growing bone such as a teenager) or scar tissue which has thickened the soft tissue.
The question is how do you make that determination as to which it is? A plain x-ray (Water’s view) would be a simple and useful diagnostic test. Or you could just treat the problem the only way you can which is cheekbone reduction. Even if it is soft tissue thickening, bone reduction would still be the treatment method. Through an incision inside the mouth, the outer surface of the cheekbone would be burred down. If the difference was greater, a cheekbone reduction osteotomy could be done. But for 5mms or less, simple outer cortical burring of the cheekbone is the best way to go. Because it is done through the mouth, there would be no scarring and just a temporary period (four to six weeks) before you would see the final result,.
Dr. Barry Eppley