Your Questions
Your Questions
Q: Dr. Eppley, I have what to me is extreme facial asymmetry, and have wondered all of my life if anyone could correct my face. I destroy all pictures of myself I am so ashamed of what I look like. Is there anything you can do for me? If I take a reverse picture using a mirror, I look pretty normal ( pictures attached). Is there a way I can look like that without using a mirror to reverse my image? Thank you very much.
A: Thank you for your inquiry and sending your pictures for assessment of your facial asymmetry. In critically looking at your pictures, I see four very specific difference between the two sides of your face. They include the following and are based the way I am seeing the picture (which may well be reversed in real life based on how the picture was taken)
1) Cupid’s bow asymmetry of the upper lip. The right of the cupid’s bow is lower than the left. (correction – cupid’s bow vermilion advancement)
2 Nostril asymmetry. The left nasal base is wider and more elevated than that of the right side. (correction – left alar base lowering and inward relocation)
3) Left eye asymmetry. You have a significant left lower eyelid ectropion/sagging) This is probably the one facial feature that is the oat obvious. (correction – lateral canthoplasty and lower eyelid repositioning)
4) Left eyebrow asymmetry. The left eyebrow is lower than the right. (correction – left endoscopic browlift)
When these four facial asymmetries are out together it can create a rather significant facial asymmetry.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, What if anything can be done for my orbital and overall facial asymmetry? Its clearly affected the entire side of my face not just my eye. I have to tilt my face for pictures and even then its way off. Thoughts? The second pic is with my head tilted…I am tired of having to do so and has really hindered my confidence my entire life.
A: Thank you for your inquiry and sending your picture. Eye asymmetry (orbital dystopia) rarely occurs in isolation and is often part of an overall facial asymmetry. The brow bone, cheek, nose and even the jawline may be lower or deficient on the ‘lower eye’ side. Tilting the head helps ‘lift’ the deficient side to make it more even. The key is this type of facial asymmetry is to pick the procedures that would make the greatest difference. The hardest choice is deciding what to do with the eye as this is the most important part of the facial asymmetry correction. The eye must come up as well as the outer corner of the lower eyelid. One caution here is to keep an ‘eye’ on the position of the upper eyelid so the raised eye does not get buried under the upper eyelid creating a pseudoptosis appearance.
Vertical brow bone reduction, cheek augmentation and jawline reduction/widening and a straightening rhinoplasty are all other options to consider in facial asymmetry correction.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in facial reshaping. I absolutely hate my face and how it looks different on both sides. What would I need done to make myself look more symmetrical. I only like the left side. I hate people even looking at my right side and I wont ever take face forward shots. I attached a picture to show you. I just really hate it and very insecure. I feel like everyone can notice that one side of my entire face is higher than the other and that one eye is bigger than the other.
A: Thank you for sending your picture and expressing concerns. I can clearly see the differences between the two sides of your face and most, if not all, of the asymmetry is in the periorbital region. (around the eye) Because the picture you sent may be inverted (mirror image) I am not sure which is the right or the left. But there is one side where the eye is bigger and the brow bone and cheek bone on that side are more developed. While the opposite side has a smaller eye and a slightly lower brow bone edge and smaller cheek.
When it comes to facial asymmetry and facial reshaping surgery that involves the eye, the bigger eye or higher side can not be lowered. Only the smaller side can be made more open or raised. Thus on the smaller side the brow bone can be shaved to raise it, the cheek augmented to make it fuller, the eyeball raised to make the pupil more even with the other side and the upper and lower eyelids raised to expose more of the white of the eye.
Dr. Barry Eppley
Indianapolis, Indiana
Dr. Eppley, I am interested in facial asymmetry surgery. I have an an asymmetrical face due to irregular growth of the jaw bone. Will the chin reduction on the right side correct it? I also notice that the right side of my face has less soft tissue so will the jaw angle implant balance out my face? Thank you.
A: Your facial asymmetry correction surgery approach certainly appears to be the correct one. Based on your pictures, the right side of the chin is longer and the width of the right jaw angle is more narrow than those two jawline areas on the left side of your face. So a right vertical chin reduction and right lateral width jaw angle implant should create improved facial symmetry. The only question is whether one wants to make the judgments for the amount of vertical chin reduction an the amount of width needed in the jaw angle up to the surgeon’s aesthetic sense or whether to make a more scientific quantitative assessment of them. That may be best done using a 3D CT scan or, at the least, get a panorex and lateral cephalometric x-rays to make some preoperative measurements.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in facial asymmetry correction. My son was born with torticollis. He had physical therapy for a few years but he still is self conscious about his eyes and the fact that his nose and chin don’t align. Is this something that you could improve?
A: It can be seen that he has right sided facial shortening type facial asymmetry. The vertical length of his right face from eyebrow to chin is shorter than the left side. As a result there is a deviation of twisting of the face to his right. Because of his congenital torticollis he may or may not have a chronic head tilt to the left side. My comments will be based on that he does not.
The top and bottom of the vertical facial axis is the key. A right endoscopic browlift with upper blepharoplasty (to create a visible supratarsal fold like the left side) is what is needed superiorly. Inferiorly the chin need to be rotated over to the left with a vertical opening wedge on the right to straighten and lengthen it. I think these would be the two key areas to improve for his facial asymmetry surgery.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am seeking your professional opinion on how to treat my facial asymmetry. What do you think can be done? When I was 17 I underwent double jaw surgery to correct sleep apnea. I believe the right side of my face is lower than my left, my smile moves predominantly to the right, and my left eye is higher than the right. I do not know exactly what has caused this. I would like to know what is your diagnosis and what is a possible treatment. Thank you so much.
A: What you have is facial asymmetry with your right facial side being overall lower than that of the left side of you face. This is evident from the eyebrow down through the jawline. Given the fact that your facial asymmetry is not severe (I know it is to you but in the big picture it is not) any corrective procedure options should be considered from the perspective of what can be done with the lowest risk of aesthetic complications. (trading off one problem for another)
The most visible part of your facial asymmetry, as it is in a lot of facial asymmetry patients, is around the eye area. An endoscopic browlift on the right side with orbital floor augmentation (to raise up the eye) and lateral canthoplasty (change the location of the corner of the eye to a higher position) would make the greatest improvement in your facial asymmetry. Possibly a small cheek implant as well, I would leave your jawline along and there is no surgery that can be done to improve your smile asymmetry.
Dr. Barry Eppley
Indianapolis, Indiana
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 am on a search to find the right doctor to fix my facial structure problem. I’ve been very dissatisfied with the worsening of this birth defect as I age and skin becomes more loose. I started to notice it when I was in my early teens but was very skinny at that time in my life. I am average weight and I tried just having chin liposuction which helped a little but is back to where it was and never really was even close to enough to fix my issue. It’s not only completely hinged crooked (bottom jaw bone) but I think the top of my skull is also off balance (which might not be a big deal in the end if not fixable with fillers/botox) I need professional analysis and advice. I don’t know how much bone I have on that side but i basically can only take photos on one side or it looks like i h ave a huge swollen tooth (I get asked, it kills my self esteem). I need to do this now. I can’t keep living my life with the constant reminder and pain that comes with it. Not if it’s something that I know can be fixed at least some. I also have an eye issue that will not be something that has to do with this surgery other than the fact that I think my entire face being on a tilt has caused strain on a muscle or nerve causing my limited vision on one side (luckily for me the way I can look straight with both eyes is also the side that I can pose to camouflage the extreme jaw imbalance). Please help! You have a lot of background knowledge and studies that go beyond most others I’ve seen. I need to know the long term problems etc. This is a risky and major surgery but is becoming more common. I was originally told locally that I would have to have my jaw broken, re-aligned, and all my teeth realigned as well which is not something I’m prepared to endure at 31years old. I’m looking for results that aren’t going to take years of adjustments and cost to fix while suffering through the pain. Let me know if you think you can help. Thank you!
A: What I see just in these two picture you have attached is a craniofacial asymmetry of which appears to be a hypertrophy problem on your left side. The first place to start is to make an accurate diagnosis and determine the extent of the facial bone differences between the two sides of your face. While there are a wide variety of facial procedures to help, careful analysis must first be done. This information can be obtained by getting a 3D craniofacial CT scan. This will allow both a visual and quantitative of your craniofacial asymmetry. With that information, treatment recommendations can then be made.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Hello! I am sending this request with my photos. As you may notice, the right side of my face is “larger” than my left, I feel its mostly the cheek bone. Hence I wanted to inquire about “cheek bone reduction” for my right side. I know it is not that simple, but to not make this very long I am writing in the most general way possible. I understand perfect facial symmetry with surgery is realistically impossible, I just wish to find a way that my facial cheek bones may be more proportioned, (with out the use of an implant or fillers), this cheek bone asymmetry is an insecurity I have when people look at me. I look forward to hearing back and thank you for taking time to read.
A: I can see the asymmetry in your cheek area and, for now, we will assume this is due to a difference on the zygomatic (cheek) bones between the two sides. Right-sided cheek bone reduction can be done but it would be very important to know where the differences in the bones are so that the right bone reshaping technique can be used. In make that assessment, a 3D CT scan of the face is needed so that exact location and magnitude of the cheek bone differences can be seen and the right surgical plan done. Whether yours would be a ‘typical’ cheek bone reduction (anterior and posterior bone cuts) or just anterior awaits what the 3D CT scan shows.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have sent you a lot of pictures and will try to explain my questions! I definitely have some skull asymmetry. The back of my head is kind of flat and it looks really weird when I have s short haircut. I also feel that the space between my chin and neck is very small.
I also have facial asymmetry and one side is bigger than the other. One eye is than the other although I feel both sides of my face are not matched. My neck on the lower eye side also feels tight and I can’t move my head straight.
It’s a mess and doctors here say I was born like this but it has gotten worse over the years.
Thanks for reading this. Hope to here from you.
A: By your pictures and your description of symptoms and physical findings, you appear to have a relatively classic case of craniofacial scoliosis caused by occipital plagiocephaly as an infant. There are three potentially improvable craniofacial problems:
- The back of head flatness can be corrected fairly well through skull augmentation by either bone cements or a custom skull implant.
- You asymmetric eyes (orbital dystopia = one eye lower than the other) is improveable by orbital floor augmentation with or without eyelid elevation. Fortunately the eyebrow appears to be in a symmetric position.
- The tightness in your neck may be unsolveable. Unless there is a very distinct and palpable band (cord) along the sternocleidomastoid (SCM) muscle (i.e., band torticollis), the tightness may be a function of congenital shortness of the neck muscles. If there is a band, then it can be surgically released although this would be an unusual finding in an adult. One non-surgical option to consider is Botox injections into the tightest area of the SCM muscle.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’m not sure what is wrong with my face. My eyes seem misaligned and not symmetric. The thing is when I look in the mirror I can’t see much wrong with my face it’s only on photos. I’m not sure if the pictures make it 10x worse or if the mirror makes it look like nothing is wrong. I don’t really know the aspect in which people see me. I have a great deal of anxiety due to this and i’m not sure what’s wrong or how it needs to be corrected. What can you recommend ?
A: I think there is no question you have a significant orbital dystopia of the right eye. In the perfectly oriented facial photo, you can see that the right eye is lower than the left as well as the eyebrow on that side is also lower. This is somewhat masked in your other pictures because you tilt your head to the right side, probably as a subconscious reaction to mask the facial asymmetry as it makes it appear more symmetric than it really is. The difference in the horizontal pupillary levels is about 5mms lower on the right than the left. Also you can see that your nose is deviated to the right, one side of the chin is slightly longer on the affected side and the eyelid on that side has some laxity with a more ‘droopy’ position. If you had a 3D CT scan of your face you would see how different the right orbital ‘box’ is compared to the left.
All of the most significant signs of orbital facial asymmetry could be improved by a collect of procedures done around the eye. These would include orbital floor augmentation, right lateral canthoplasty and a right eyebrow lift would be helpful for improved facial symmetry.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in facial asymmetry correction. My face is crooked, particularly my chin and jaw. When I smile my chin pulls to the left and makes the jaw asymmetry look worse as it points to the left. The rest if my face on the left side is also uneven. My left eye and eyebrow are lower and my cheekbone seems smaller. When I look in the mirror I don’t look too bad but it looks much worse obvious in pictures. Can my facial asymmetry be fixed?
A: Like many cases of facial asymmetry, it rarely is just one area of the face. What you are describing is a more complete unilateral or one-sided facial underdevelopment. This is evidenced by a lower eyebrow and eyeball position, a flatter cheek and a shorter jawline distance from chin back to the jaw angles. In essence the vertical length of the face is shorter on your left side than your right. The jaw asymmetry in particular is magnified when you smile as the soft tissue of the chin is pulled back and deviates to the less developed side.
There are a variety of facial asymmetry procedures that can be done from the eyebrow down to the jawline. What you would do depends on how much of the facial asymmetry you want to treat. The chin/jawline often displays the most severe aspects of facial asymmetry and is often the most important area for many patients to correct. This can be treated by a sliding genioplasty to realign the bony chin to the midline. This can be possibly combined with a small jaw angle implant in the back to completely lengthen the entire jawline.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in jaw implants to help correct my facial asymmetry. Although it is not noticeable to others, if taking a picture straight-on and in certain lighting, it shows that my face is extremely asymmetrical. I was wondering if this would best be corrected with asymmetry surgery or could be corrected with customs jaw implants. Also- if corrective asymmetry surgery was performed, could you also add custom jaw implants at the same time to provide the most optimal facial makeover?
A: In looking at your pictures, your facial asymmetry is caused largely by a significantly deviated chin position. This has also has caused some jawline and jaw angle asymmetry although not as significant as that of your chin. There are two approaches to correcting your jaw asymmetry.
The first technique is to correct the chin by a sliding genioplasty that moves it back to the midline. Then the jawline and angles behind it could be augmented by standard jaw angle implants.
The second approach is to go completely with custom implant designs, leaving the chin bone where it is. Computer designing can make jawline-jaw angle implants for each side (that are obviously different but designed to create symmetry) that attach to the sides of the chin.
Either approach can make a big difference and each one has it advantages and disadvantages.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, the left side of my face is different from the right side. It seems to be missing jaw bone. Is it possible to even up my face with the jaw implants? I have attached a picture.
A: Thank you for sending your picture. It is not the best picture (from an angle standpoint) but it does show that you do have significant facial asymmetry which appears to affect the jawline the most. It would be optimal if I had some different picture angles of your face that had your chin more upward and not pointing down. But to provide some basic answers, some form of a jawline implant is needed. Whether this could be a done with a stock preformed implant or would be best done with a custom implant would require a little more in-depth information with some x-rays. At the minimum a panorex x-ray is needed, more ideally a 3D CT scan is best. That information will answer what type of implant is needed and how it would be done. Also, fat injections to fill out the overlying soft tissues is always needed as well as the facial asymmetry is caused by more than just a bone deficiency. Think of improving your facial asymmetry from the bony foundation underneath outward to the skin.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have a slight asymmetry that affects most of my face, though the only place I noticed it was in my lower jaw. My chin grew too far to one side, and that side was under developed. I had implants put in to make the developed side fuller, my chin was filed down and capped to make it symmetrical. The problem was that after the surgery the side of my face didn’t have implants put in then looked very small. My dad said I looked like the “Janis” Roman coin with a different face on each side. I saw the same surgeon for a corrective procedure where he took out the chin piece almost entirely and only added a piece to make it symmetrical on that side. The result was a very odd look. I think because the jaw implant was designed to go with the chin implant, when the chin implant was gone it no longer worked. I look like I have constant swelling on one side of my face. This was all five years ago. I didn’t have the heart to ask my parents to pay for another surgery. I have been saving since then and I think that I can afford it now. I recently started orthodontics again and can send you current photos of my face and can send you x-rays that show the implants.
I have several concerns, which you will probably need to see these pictures to answer. The first is, do I have unreasonably expectations. I think that I could expect to have symmetry, and a face I don’t try to grow a beard to hide, but I don’t have your experience. This is a tremendous amount of money for me and I won’t have the money to try again if this surgery is unsuccessful so I would rather not go for it if I can’t expect good results. I imagine the previous implants are grown in, I don’t know what that means for your surgery.
Facing me, my right side is too full, my chin is too weak. I would ideally like to pull out the chin implant that is there now and create a new implant that wraps from (facing me) my left side to the implants on the right side. This would lengthen the chin so I wouldn’t have the fat face effect. It would also add filling to the left side so I wouldn’t have the janis effect. Hopefully, it would be symmetrical. Because my whole face is off slightly I worry that a 3d rendering of my jaw may allow for a perfectly symmetrical jaw, that does not look symmetrical. I am sure you could address that.
A: When you have a significant facial asymmetry that has failed previous attempts at ‘simplistic’ correction (estimating the amounts of augmentation), one can assume that this is partly a function of the planning stage. While one can never predict with absolute certainty as to how any bone surgery will create a change on the outside, it is reasonable however to strive for optimal facial symmetry. This is best done with a 3-D CT scan and model fabricated to properly diagnose the problems and design/fabricate custom facial implants that would best correct them.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, my left orbital and the left side of my jaw are fairly asymmetrical. I am interested in possible left cheek implant, andleft jaw/chin implant. I would actually also like to build out the left side of my nose and frontal bone if possible and fix my eyebrows as they are different heights. Also if you have suggestions I would like to hear them. I saw two plastic surgeons already, both said they could not help me . They did not actually look at me for more than a couple of seconds before they said that though.
A: Thank you for sending your pictures and indicating your objectives. To summarize your facial asymmetry concerns, I list the following items:
1) Left jawline asymmetry (based on the arrow in the drawing this is located at the prejowl area which is the junction of the back end of the chin and the body of the mandible
2) Left cheek deficiency
3) Left brow bone-nasal deficiency
4) Left eyebrow excessive elevation
I don't know if any of these are from prior facial injuries or just your natural facial development. But either way, I can make the following comments/treatment recommendations:
1) It is not possible to improve your eyebrow asymmetry by lowering the higher left side. There is not a procedure that can accomplish that movement. Eyebrows can be lifted but they can not really be lowered. It is certainly possible to do an endoscopic periosteal release of the supraorbital tissues and see of that will accomplich some lowering (and there is little to lose by so doing) but I can't guarantee if that would really be effective.
2) The medial brow bone and upper nasal deficiency (which is bone based) can be built up by the onlay of a material through an upper eyelid (blepharoplasty) incision. While a wide variety of materials exist, I would opt for either an hydroxyapatite cement or a mersilene mesh onlay.
3) The cheek bone deficiency could be augmented by the use of a cheek implant placed through an intraoral incision.
4) The jawline deficiency (unless I am misinterpreting what your concerns are) appears to be a 'spot' area along the left jawline. I would build up that area with a mersilene mesh onlay to fill in the prejowl deficiency through an intraoral approach.
The three select facial skeletal deficiences (jawline, cheek and left brow-nasal) could be assessed in exact anatomic detail and custom implants made off of a 3-D skull model, but I don't think we have to go to that extent to get a good result. It may be ideal but I don't consider it absolutely necessary in your case.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have some skull and face asymmetry from positional plagiocephaly. The main issue is that the right side of my forehead bulges, is it possible to reduce this bulging so my forehead doesnt have such a broad appearance when viewed from one side? Also the left side of my face is less prominent, maybe you could say “weaker” than the right. Would some sort of implant help with the asymmetry and make the left side as prominent as the right?
A: Plagiocephaly produces the exact face and skull asymmetry that you have described. Your right-sided forehead protrusion and smaller left face are common. Although I have not seen any pictures of you, your theory for improvement in facial symmetry would be the correct approach. Reduction of the right forehead bulging and augmentation of the left face, most likely that of the left cheek and jaw angle, could offer visible improvement. I would need to see some pictures of you, particularly a straight-on frontal view, to confirm if this approach would be helpful.
The left facial implants can be placed from inside the mouth so there are no scar trade-offs for those improvements. That can not be said for the forehead reduction in which the scalp scar trade-0ff must be considered very carefully, particularly in the a male patient.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am a 37 year old female with microtia of the left ear. I have thought long and hard about pursuing the reconstructive surgery but I have decided not to proceed with it. I think I have become a little more comfortable with the situation just understanding more about the condition and I am also deterred by the uncertainty and expense. I am however interested in any minimally invasive option to improve my facial asymmetry. Are facial implants an option to do so?
A: Thank you for sending your pictures. As I suspected in left hemifacial microsomia, the jaw on your affected side is smaller with no jaw angle present. Surprisingly the rest of your face above the jawline has minimal to no effect in terms of underdevelopment. You are correct in assuming that a jaw angle implant would be helpful. An implant could be placed that builds out the left jaw angle and jawline as it comes forward. This implant would be placed through the mouth and then screwed into the existing jaw bone. There are two ways to go about choosing the jaw angle implant style and shape. The ideal way is to custom make an implant off of your jaw model that would be made from a CT scan. While this is ideal, it adds considerable expense to the cost of the surgery. The other way is to use an off-the-shelf jaw angle implant and modify it during surgery to fit. It would not create as good a result as a custom implant but it would still make good improvement for you.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, am very unhappy with the right side of my face. My face is assymetrical; the right side looks smaller, there is less volume in the cheek, and my right eye and eyebrow are lower than the left. Also, the right side of my lower lip is smaller than the left. I feel that the left side of my face is the “good” side. I am very self-conscious of my appearance and avoid having my picture taken. I also feel that my nose is fairly wide from the front, although my profile is not that bad. Most surgeons in my area seem to focus on anti-aging procedures. I am too young (31 years old) that the right facial volume loss is due just to aging. The fact that I have always slept on my right side probably did not help. Please let me know what procedures you would suggest. I’ve attached a picture of my face straight on and also one of my right profile.
A: I would agree with you that you do have some degree of facial asymmetry. All features you have pointed out I can see and agree that it exists. The question is given the asymmetry what is reasonable to consider to do for improvement. I would also agree with youir three procedures of interest. A small right cheek implant with fat injections to the submalar (buccal space compartment) and the perioral mound area are very straightforward low risk procedures that can occur from visible improvement. While asymmetry issues exist in the eyebrow area, I would live with those for now. From a nose standpoint, a tip rhinoplasty to narrow the tip would work nicely. I would leave your profile and the upper portions of the nose alone.
The only point in which I disagree with you is that sleeping more on the right side of your face would not have caused the problem. This is a congenital ‘deformity’ and is a result of in utero development not from postnatal molding influences.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I want symmetry in my face after a few events that changed it. I want to breathe better. I want my nose to be as it was before trauma, might need cartilage graft on left side. I want my jaw to be more angular and symmetrical with osteotomy after having broken jaw. I want my left eye to look like my right eye, cause could be previous rhinoplasty or trauma involving prolonged eye poke. Here are some pictures of me.
A: Thank you for your inquiry and sending your pictures. I can clearly see your concerns in all three areas. In looking at your pictures, I can give you the following suggestions for these areas as follows:
1) Nose – a septorhinoplasty is needed to straighten the septum, harvest a septal cartilage graft, decrease the size of the inferior turbinates, and reconstruct the external nose with a right middle vault spreader graft. Your external nose may benefit by other changes but that is as much as I can say based on these two pictures.
2) Jaw – To correct your asymmetric jaw, I would not do a traditional jaw osteotomy. This requires preparatory orthodontics and a whole change in your bite. The asymmetry could be better camouflaged with a sliding chin osteotomy to correct the midline of the chin and jaw angle implants to create a more angular and defined look.
3) Eye – Your lower positioned eye needs to have the orbital floor built up with an implant and possibly both the orbital floor and the orbital rim needs to be augmented. This would raise the eye up and help bring it more forward as well.
Your pictures are not really adequate to do good computer imaging but I have attached the best I could do with the one picture.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am looking for help in fixing facial deformities and asymmetries. I have been to an Oral surgeon and a Maxillofacial surgeon before but they didn’t seem to care. I have a right sided facial deformity that bothers me alot. I would like to find some help for this problem. The right side of my face is under developed and I can see it and even feel it. My left and best side is more fuller and straighter. My right side is smaller and recessed and less defined. Can an angled tilt in the jaws on one side be fixed? I have attached some pics for you to see.
A: Thank you for sending your pictures. I can see quite clearly the tilt to your jawline and the less full right mandibular angle area. It is not possible to cut the jaw bone and angle it downward without changing your bite on the right side. But it can be more simply and effectively treated by a mandibular angle implant, using specifically a type of jaw angle implant that extends the length of the jaw angle downward as well as making it more full. This would be done through an intraoral approach.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in trying to make my face more symmetric. My main problem is around my eyes and they are not even. One eye is definitely higher than the other one or it could be that one eye is lower than the other. I am not sure which eye is the right one, all I know is that they are different. I think though that the left eye is too high as I like where the right eye is as it sits on my face. I have attached a front picture for you see what I mean. Is there anyway to make the eyes more even?
A:I would have to say that the vast majority of your facial asymmetry is based in the eye area as you know by looking at your pictures. The position of the two orbits/eyes is the most striking issue. Either eye position is acceptable but it is just that they are different and they are side by side. While one can have a debate about which one is the ‘goal’ to achieve (the good looking one), that discussion is largely irrelevant since you really can not correct one fully to be level with the other. Their differences are too great. The left eye can not really be brought down as far as the right and the right can not be brought up as far as the left. They are also lid issues with those movements, particularly the position of the medial and lateral canthi.
That being said, the only approach I envision that could work is a combination of making changes on both eyes, build up the floor on the right orbit and drop the left eye down. Each could be moved 2 to 3mms and together this ‘ying and yang’ approach could overcome the 5 to 5mm difference that currently exists in the horizontal pupillary levels. This may not create perfect orbital symmetry but it would be an improvement.
Indianapolis, Indiana
Q: Dr. Eppley, I was born with a face that to me looks a little crooked. It seems my jaw line is shorter on one side and it looks like my face is bent in one direction. Would you be able to look at the pictures I am enclosing and please tell me what you think. My face is definitely not even and my chin is crooked. I think it is too big, but is it also receded? I am so self conscious that I hide behind my hair and makeup. Thank you so very much for your time and please, any advice and recommendations would be greatly appreciated!
A: I have taken a look at your pictures and your concerns. I think there is no question that you have facial asymmetry that is almost completely due to the shape of the lower jaw. The differences in the jaw length has resulted in frontal chin asymmetry with the midportion of the chin being deviated to your right side. This can be corrected (straightened) through a chin osteotomy, sliding it over to the left until its midportion is in alignment with that of your nose and upper and lower lips. This may also require some vertical chin adjustment with a reduction of the left side or an opening lengthening on the right side, depending upon which aesthetically looks better. Your side view shows a mild amount of recession which, given that an osteotomy would be done, I would take the opportunity to give more horizontal projection to the chin as well. I have attached some predictive imaging of the potential outcome with this sliding chin osteotomy procedure.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Hello, I have a rare problem. I think, although I am not sure, I have always slept on the left side of my face. Ad a result, I have an extremely strong left chin and not hardly a right chin at all. I was hoping for implants on the weak side or a reduction on the strong side whichever is best. I’m fine with what ever as long as I can look more symmetric. I have attached some photos so you can see what I am talking about. Thanks!
A: Thank you for sending your pictures. Based on your pictures, you do not have chin asymmetry. Rather you have facial asymmetry. The left side of your face is bigger than your right and this is most evident to you along the jawline and at the jaw angle. That is very evident in looking at your side views where the right side lack the prominence at the jaw angle that is seen on the left. Your chin is actually fairly straight. Usually with such facial asymmetry the chin will swing over to the right and be off midline. But this fortunately has not occurred in you.
You would benefit from a right jaw angle implant augmentation to try and get a better match to that of the left side. The jaw angle implant will both lower the angle and add width to it. The width of the jaw angle implant is actually the most important in your case. This will improve your facial symmetry considerably through this relatively simple jaw implant procedure.
Dr. Barry Eppley
Indianapolis Indiana
Q : My jaw is asymmetrical. It is tilted and is also bigger on one side. I have read some of the articles you have written on facial asymmetry and wanted to ask you about how best to correct my problem?
A: Jaw or mandibular asymmetry is often a major cause of facial asymmetry. Often the entire side of one’s face is different if one looks for it carefully. Sometimes it is the lower face (jaw) that is the most significant part, other times the cheek, orbital, and forehead bones are equally involved and part of the problem. It is critically important to assess both sides of the face from top to bottom with photographs and measurements from different angles to get an accurate assessment.
In most cases of minor to moderate facial asymmetry, camouflage techniques are used. This means the use of facial implants to lengthen and broaden the smaller and flatter facial prominences. These are good options for jaw angles and cheeks. Chin asymmetry is often better done with osteotomies where the bone can be differentially lengthened between the vertically shorter and normal sides. Soft tissue deficiencies can be simultaneously improved by fat injections.
If significant facial asymmetry exists and one’s occlusion (bite) is very tilted, another consideration is orthognathic surgery. In younger patients this may be a better option if one is prepared to go through several years of preparatory orthodontics and then jaw surgery to directly treat the primary bone, differential bone growth.
Dr. Barry Eppley