Q: Dr. Eppley, I read about you on Real Self and would like to have surgery under you. I have an short face (abnormally short lower third of face) but, oddly, also mandibular prognathism. Could you push my jaw back and at the same time lengthen my face? I have attached my original front and side photos, and also some virtual post-surgery photos to aid in your diagnosis. The lower third of my face is already equal to 1/3 of the length of the midface. After bimaxillary orthognathic surgery (see the post surgery photos), notice how my lower third becomes extremely short. Although the post surgery side profile is good, the post surgery front profile is horrendous! I am also concerned about the unaesthethic effects on the nose of lefort 1 as well as the risk of bimaxillary protrusion. I was wondering whether you could beautify my side profile without making the lower third shorter, perhaps with orthognathic surgery alone, vertical distraction + orthognathic surgery or lefort 2 alone. Please let me know of any other options. Thanks!
A: The virtual after surgery photos that you have shown are not realistic nor would they look that way. You undoubtably need a LeFort 1 advancement osteotomy but whether you need or can have any change to your lower jaw is unknown based on the information you have presented. What will happen or be needed to the lower jaw completely depends on your occlusion (bite) and how it fits when the maxilla comes forward. You can not just move your lower jaw any way you want, it does not work that way in orthognathic surgery. You may need the lower jaw set back somewhat with the maxilla coming forward but that will not change the vertical height of the lower 1/3 of your face in any significant way. You do not need anything more complex than a Lefort 1 advancement with or without a mandibular setback.
Dr. Barry Eppley