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Dr. Barry Eppley

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Posts Tagged ‘facial asymmetry surgery’

Case Study: Jaw Angle Augmentation in Facial Asymmetry Correction

Saturday, September 21st, 2013


Background: Facial asymmetry can occur from a wide variety of bone and soft tissue deficiencies or even, more uncommonly, overgrowths. (hypertrophy) One of the most common components of facial asymmetry occurs in the jawline of the lower face. Growth abnormalities emanate from the rami of the mandible, the meeting point of the vertical and horizontal bony limbs of the lower jaw.

Developmental or growth abnormalities always alter the rami or jaw angle shape in a variety of dimensions. Given that the jaw angle actually has four dimensions (height, length, width and degree of angulation) even subtle changes in development can create visible facial changes. These would be seen in the amount of flaring of the jaw angles, evenness of the jawline as it comes forward and the centric position of the chin as seen from the direct frontal view.

In correction of lower facial asymmetry, the first decision is whether the chin has a midline position. If so then correction can focus on the jaw angle region exclusively. If not then the treatment plan must incorporate a combined jawline approach that augments the chin back to the jaw angle area.

Case Study: This 35 year-old female presented with concerns about asymmetry of her face. She felt that the left side of lower jaw was not the same size as her right side. It was flatter and did not have as sharp a jawline or angle shape. The remainder of her face was symmetric and without concerns.

Under general anesthesia, a width only (3mm) jaw angle implant was placed through an intraoral retromandibular incision. It was situated only over the bone with the intent of adding a small amount of jaw angle width and definition.

The usual significant jaw swelling occurred that was largely gone by three weeks after surgery. By six weeks after surgery the full result was seen with nearly symmetric jaw angle prominences and a significant improvement in her facial asymmetry.

In using a jaw angle implant for correction of a lower facial asymmetry, it is unusual that only width expansion is needed without some vertical component. As most jaw angle deficiencies involve a component of retraction (vertical shortening) as well as lack of width development.

Case Highlights:

1) Jaw asymmetries frequently originate from the rami or angle regions and can affect both the vertical and horizontal dimensions of the lower third of the face.

2) Jaw angle augmentation is a frequent need for correction of lower third facial asymmetry.

3) Jaw angle implants are put in through an intraoral incision and different styles and sizes allow for either width expansion, vertical lengthening or both.

Dr. Barry Eppley

Indianapolis, Indiana

The Concepts of Facial Asymmetry Surgery (FAS)

Thursday, June 6th, 2013


Facial attractiveness is highly influenced by the symmetry of its composite parts. It is well known and studied from the scientific analysis of beauty that the more two facial halfs (one half and its mirror image) are, the more attractive one is perceived to be. This is true whether it is of the male or female gender. While one does need to have a face that is perfectly symmetric to be perceived as attractive, the closer the better.

Interestingly, many faces have some degree of facial asymmetry and in many cases this is just viewed as having a little character. In fact some would say that a little asymmetry is even more attractive than perfect symmetry. But there is a limit as to when the asymmetry crosses the line and becomes less attractive rather than more. Quantitatively measuring how much facial asymmetry is unacceptable is scientifically impossible but it becomes a problem when a person thinks that it is so.

There many causes of facial asymmetry from birth defects, like hemifacial microsomia and hemifacial hyperytrophy, induced by traumatic injuries to one’s natural genetic-driven facial development. It can come in very severe degrees of asymmetry, usually from birth defects, to more milder forms. Almost always facial asymmetry affects more than one part of the face and at multiple tissue levels. (skin down to bone) It is far more common that the asymmetry is caused by underdevelopment or tissue loss than it is from overgrowth or too much tissue.

The various problems in facial asymmetry are numerous and can include such presentations as chin/jawline deviation, vertical facial shortening, cheek flattening, orbital floor/eyeball inferior isplacement, eyebrow lowering, forehead and brow bone protrusion or retrusions and nasal root and tip deviations. Due to the constellation of facial problems and tissue deformities, facial asymmetry surgery (FAS) requires a number of techniques borrowed from the plastic surgery fields of aesthetic, maxillofacial and craniofacial surgery. In many ways, FAS is very similar to facial feminization surgery which also requires a broad knowledge of plastic surgery techniques to achieve an overall facial change.

Facial asymmetry surgery (FAS) can include changes  from the top of the skull down to the below the jawline and everything in between. It encompasses the following procedures; skull reshaping/cranioplasty, forehead/brow augmentation/reduction, temporal line augmentation/reduction, browlift, orbital rim reshaping, orbital floor/rim augmentation, eyelid canthal tendon adjustments, cheek augmentation/reduction, rhinoplasty, buccal lipectomies/perioral mound liposuction, soft tissue fat injections, lip land corner of mouth lifts, chin reshaping with osteotomies/ostectomies and implants, jawline/jaw angle reduction and narrowing, jawline implant augmentation, submental and neck liposuction, face and necklifts and ear reshaping.

Treatment planning for FAS requires a physical examination, facial photographs and computer imaging. A 3D CT scan is the radiographic assessment of choice if needed. From these one can determine what exact procedure(s) would be beneficial and which ones provide the greatest degree of facial asymmetry improvement. It is always a good idea in treatment planning to generate a list of the problems in order of importance to the patient. Then the procedures for correction can be chosen and the patient can invest their efforts wisely to get the most change with the minimum number of procedures. In most cases, all selected procedures are done during a single stage operation.

All FAS procedures are done under general anesthesia and certain patients will require an overnite stay in the facility based on the number of facial procedures performed and whether they are traveling alone or with someone. Each FAS procedure has its own unique methods of being performed, many involve bone or implants whole others are done by more traditional aesthetic surgery techniques such as soft tissue suspension or fat removal or injection augmentation. Based on the number of facial procedures done, one should expect a moderate amount of facial swelling and even some bruising. Total resolution of swelling and bruising for public passability is two to three weeks.

Risks and complications from any FAS are based on each individual procedure but remember those risks are additive. The biggest overall issue to understand is that FAS is about lessening the degree of asymmetry and perfect facial symmetry is usually not possible. In many patients, it may take more than one surgery to get the best result possible.

Dr. Barry Eppley

Indianapolis, Indiana

Dr. Barry EppleyDr. Barry Eppley

Dr. Barry Eppley is an extensively trained plastic and cosmetic surgeon with more than 20 years of surgical experience. He is both a licensed physician and dentist as well as double board-certified in both Plastic and Reconstructive Surgery and Oral and Maxillofacial Surgery. This training allows him to perform the most complex surgical procedures from cosmetic changes to the face and body to craniofacial surgery. Dr. Eppley has made extensive contributions to plastic surgery starting with the development of several advanced surgical techniques. He is a revered author, lecturer and educator in the field of plastic and cosmetic surgery.

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