What is the Best Approach to Correcting My Facial Symmetry?

Q: Dr. Eppley, I have facial asymmetry with my right side being smaller than my left. I would like to know what needs to be done to make the right side look closer to the left. Should I have orthognathic surgery and fix my bite and will that correct it? Or should I leave my bite alone and have implants to build up the deficient side? If I fix my bite with orthodontics alone will that help to improve my facial asymmetry a bit? If I was to have orthognathic surgery should my cheek and skull asymmetries be done first or after?

A: In answer to your facial asymmetry correction questions:

1)With a 3D CT scan and computer designing the differences in the right face could be treatment planned based on the dimensions of the left face. What that would include exactly remains to be determined based on what the scan shows. But based on your pictures alone the decision has to be made whether to augment the left jawline or reduce the right jawline for better symmetry between the two sides. That is an aesthetic preference.

2) The timing of orthodontic therapy is irrelevant IF one is not going to purse subsequent orthognathic surgery. But you should have a full orthodontic evaluation to determine if orthognathic surgery may be a good option since you are already aware that is one treatment option. If done that would serve as the foundation for anything under the eye area first.

3) The ipsilateral right skull and cheek asymmetries would be treated by custom designed implants. Those issues can be pursed independently of the jawline asymmetry which awaits a full orthodontic-orthognathic surgery evaluation.

Dr. Barry Eppley

Indianapolis, Indiana