What Are The Midface Effects of Bimaxillary Advancements If I Have Flat Cheeks?
Q: Dr. Eppley, Hi, I have just a major question for Dr. Eppley (maybe he can answer it on his blog)?
I am considering getting either orthognathic surgery (I have been given the option of DJS or LJS), which would be covered by insurance due to my mild sleep apnea and TMJ, or doing a genioplasty and rhinoplasty with you. I have a class 2 overbite + I don’t like my small chin, and the jaw surgeon recommended a LeFort 1 with CCW rotation and possible 5 mm advancement, and up to a 10 mm BSSO advancement of my lower jaw once my teeth have been put in braces.
One concern that I have seen folks getting upper jaw advancement/impaction present with is sagging cheeks and more pronounced undereye circles. This seems to happen due to pre-existing flat cheekbones and lack of orbital rim support (which I think I may have). I have attached photos below of me pre-filler. With my existing facial structure, would the risk of my malar fat looking “droopier” be there?
A:Your fundamental question is really about the concept of surgical tradeoffs. The exact midface/cheek concerns you have expressed are very likely to happen as the cheekbones get ‘left behind’. It is a very common aesthetic sequelae in Bimax advancements and while the chin may look better the midface will pay the price for that exchange. Bimax surgery is worth it if significant functional improvement is needed (sleep apnea) or the lower 2/3s of the facial skeleton is recessed and needs to be moved forward. (fat face) In our case it really comes down to the value of sleep apnea elimination and correction of your Class 2 bite. But inevitably it will not be your last surgery as the undereye hollows and the cheek deficiency and low soft tissue cheek fullness that results may likely be undesired aesthetic effects.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
North Meridian Medical Building
12188-A North Meridian St.
Carmel, IN 46032
Phone: (317) 706-4444
WhatsApp: (317) 941-8237