Your Questions
Your Questions
Q: Dr. Eppley, I have had two prior facial asymmetry correction procedures on my jaw. I had an implant placed on my right jaw only which is the side that is imbalanced. It is imbalanced both in width and in depth/length if that makes sense and the surgeon only corrected the width – which he did in excess. Hence I still have the depth discrepancy and it really is simply imbalanced now to the opposite direction it was initially.
The revision was to shave down the initial implant as it was far too large. The revision did not do much and was done poorly – the end of the implant now has a lump that is obvious. I’ve attached pictures for you to review. Please let me know if you need additional or different angles. One of the things that really bothers me is that the fullness is such that my left side often has shadowing that my right does not which almost emphasizes the asymmetry the doctor created.
A: What your case illustrates is how hard is to do facial asymmetry correction surgery by the doctor ‘winging it’. (that is not a criticism of him per se) It is very hard to just eyeball the facial asymmetry and place an implant and have it be right. That rarely is a successful strategy. It often leads to revisional surgery which still doesn’t solve the problem. Also you can see how just a few millimeters one way or the other can make a big difference on the outside of the face. When one has had a failed attempts at facial asymmetry correction along the jawline, it is best to get a better view of the problem. A 3D CT scan is the best way to really see the bony asymmetry, see where the implant is situated and what it looks like and then design a better implant that is matched to the bone on the other side and fits the jawline intimately.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have some questions about facial asymmetry correction. After finally doing my research I have seen amazing reviews on you and before I make some big decisions, I am asking some help from the surgeon point of view. I have two questions I would like to ask.
1) Every time I take a photo and my phone flips it my face looks very asymmetrical and weird looking. What procedures from the photos I sent do you need to perform to look even?
2) How come when I ask my friends they don’t notice it with my eyes and eyebrows unevenly but in the photos I can notice it extremely.
Also I forgot to mention under my eyes too. Thank you.
A: Thank you for sending your pictures. When it comes to facial asymmetry correction it is first important to identify which facial features are the asymmetric ones. What I can gather from the one front view pictures is that you have significant eyebrow asymmetry. The right eyebrow sits lower than the left. Because a picture freezes the face for a continued assessment most facial asymmetries are easily seen. In real life the position of one’s face is constantly moving and rarely does one talk to someone dead on with a ‘frozen face’ so one can get a good assessment of facial symmetry or asymmetries. The treatment for eyebrow asymmetry would be a unilateral endoscopic browlift. This could be effective provided one has some eyebrow tissue laxity which can be assessed by whether you can manually raise up the eyebrow with your fingers.
Your undereye hollows are the result of deficient inferior orbital rim bone. While this can be treated by fat injections, it is probably best treated by infraorbital rim implants with an overlay of fat injections if needed.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, the right side of my face looks bigger and more elevated than the other side, and the position of my right eye socket is higher than that of my left one. My jaw is also asymmetrical. When I bite, I can feel that the left side of my upper jaw and lower jaw is higher than the right side. I can also feel that the bone between my right eye socket and.my upper jaw is bigger than that on the left side when I touch. Is it possible to make my right side identical to the other side? If so, could you advise me on what procedures I should take and their costs? Thank you.
A: For your facial asymmetry correction, there are some structures that can and can not be changed. It is not possible to lower a higher eye socket. (orbital box) A lower eye can be raised somewhat but a higher eye can be lowered. Your maxillomandibular cant (jaw asymmetry) can be corrected by a LeFort I osteotomy to shorten the longer side. (vertical maxillary reduction) To keep your current occlusion (bite) a sagittal split ramus osteotomy is needed to rotate the lower jaw back into occlusion as well as complete the vertical shortening of the right lower face.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am 28 year old female.When I was12 whenever I opened my mouth very wide the left side of my face clicked under my ear. Therefter it became more painful to open and I had great difficulty in eating chewy foods. By the time I was 18 my face looked obviously asymmetric. My jaw is not properly aligned. I have been to an orthodontist and was told that I would need corrective jaw surgery which I can not afford and he also said it may not necessarily make my face look straight even if my jaws were better aligned. What can I do to straighten out my face?
A: Your face is significantly asymmetric due to an underdeveloped left side. That extends from the cheek bone down to the jawline with a significant left chin deviation.Your non-major orthognathic surgery options include a combined procedure by repositioning the chin bone (opening wedge genioplasty), a left cheek implant and fat injections to the left side of the face. These three procedures will help fill out the left side of the face and straighten it by aligning the chin with the midline of the face.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Here I’m sending you this picture to show you the degree of my facial problem. What can you please tell me about the procedure by looking at my picture now. What can be done to improve my facial asymmetry?
A: Thank you for sending your pictures. What I can see is that your facial asymmetry is caused by a near complete left facial hypoplasia or underdevelopment. This can be seen over the entire left face by a lower eyebow position, left upper eyellid ptosis (2mms, smaller cheek bone and deficient jawline and jaw angle. Like all forms of facial asymmetry surgery, the patient must decide which side of their face they like more. Even though you have focused on bringing in the more protrusive right cheek/zygomatic area, that would be just one change that you could make. There are numerous other ones as I have illustrated in the attached computer prediction imaging such as an endoscopic left eyebrow elevation, left corner of the eye tightening, left cheek augmentation and left jaw angle augmentation. Your facial asymmetry is more than just one bigger cheek and a deviated jaw, it is the entire left face that is smaller.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, My face is twisted with the right side smaller than the left. Honestly, I’m not exactly sure what all I will need done. I want a softer look overall, less square, more symmetry, and a more youthful appearance. I am a 35 year old female. I know perfect symmetry is unnatural but I know my face is less symmetrical than normal. Pics do not lie.
A: In looking at your pictures, there is an overall comprehensive approach that can be done to improve your facial asymmetry. The fundamental problem is that the right side of your face is smaller than your right, accounting for the entire right facial deviation in development. What I see that can be helpful is the following from top to bottom; right endoscopic browlift, right lateral canthoplasty, right cheek implant, rhinoplasty and a chin osteotomy that moves the deviated chin point to the left to make it centered. These would be the collection of procedures that would make the biggest difference in improving your facial symmetry. I have attached a frontal imaging prediction to show the predicted changes. The most challenging part of any facial asymmetry improvement is in the eye area. I am unsure how much orbital dystopia you have so there still remains the possibility for right orbital floor augmentation to raise the right eyeball as well.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in getting a jaw angle implant for just one side. I have facial symmetry on my right side which is smaller. Not sure why. I’m saving up for that type of procedure now. Is there anyway you can give me a ball park estimate of how much something like that would cost and is any part of it ever covered by insurance? Also, is the surgery normally done when you are asleep or awake and if it’s asleep will I wake up with a tube down my throat? I know it sounds like a dumb question but the thought of it makes me nervous. And lastly, how much of an improvement would this make because I know it won’t make me look perfectly symmetrical and everyone’s results are different. I just want to make sure it’s the best thing I can do.
A: If your facial asymmetry is relegated primarily to the posterior face in the jaw angle area, then unilateral augmentation can be very helpful. You just have to make sure that the asymmetry is located down by the bulk of the masseter muscle area. The effectiveness of jaw angle implant augmentation depends on the size and shape of the implant. How much width and if any vertical lengthening is needed are critical question before surgery to select the proper implant. Because this surgery is for cosmetic enhancement (appearance), it is not ever covered by insurance. The surgery is done through an intraoral approach and involves lifting up the masseter muscle. Thus this is a procedure that requires general anesthesia with endotracheal intubation. The tube will be removed before you wake up so this is not a concern.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in correcting the asymmetry of my face. The right side of it, particularly in the jaw angle area, is tilted upwards and shorter. I have read that a jaw angle implant may be able to correct this tilt.Would this implant make the right side look closer to the left and would I feel the difference? Would a cheek implant help along with the mandibular angle implant to even out the balance? I don’t want the right looking more full and balanced then the left. Would braces help fix or improve the jaw tilt/angle?
A: In the ideal correction of facial asymmetry, it rarely is just one facial area that is shorter or asymmetric. In most cases of facial asymmetry, the entire side of that face is shorter. For this reason, jaw angle and cheek implants together are often done and produce the greatest amount of facial lengthening and correction of the shorter side.
Braces change how the teeth fit together but will not change the tilt of the jawline.
The goal of facial asymmetry correction with facial implants, the most common treatment method, is to try and get the best match between the two sides as possible. While perfect symmetry is never possible, the closer the two match the better. In the spirit of that goal, it is always better to be slightly less full than too full when deciding about implant sizes.
Dr. Barry Eppley
Indianapolis, Indiana