Hemifacial microsomia surgery, upper/lower jaw and genioplasty

[dressagequeen]

Hi, I had my surgery last Friday 6th March, today I am 1 week post op and would like to share my experiences.

I have always known that my face was uneven, and have hated any photos of myself. I have a long face with a large forehead and I felt a masculine look to my profile. I had this surgery after approx 18 months of top and bottom braces. The plan was to lengthen my right mandible, shorten my left mandible, plane and move my maxilla forward to match the new mandible and move my chin to the left and forward. I have wanted to achieve more evenness and fullness in my lower face.
I will be following up with botox/fillers to achieve further aesthetic results and to do something with my right orbit, which is approx 5mm lower than the left.

My recovery in hospital was very easy as I had well controlled pain and no elastics. I was discharged on Monday morning and had elastics put on on Tuesday. I also got a prescription for endone as my surgeon only gave me panadol forte and nurofen which was way underpowered! I am still struggling with controlling pain, but the swelling is going down. My blood pressure has also remained low, which makes me nauseas and difficult to time taking the endone.

Please let me know of what you think of my early results and any questions. I'm hoping once the swelling goes down my left and right sides will be more symmetrical.

Edit sorry I can't work out how to make the pictures rotate correctly

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[dressagequeen]

More pics


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[Alue]

Thanks for positing this.  First time I've seen someone else mention hemifacial microsomia on this forum. 

I was told I have a very slight case of hemifacial microsomia, then another surgeon told me it's not hemifacial microsomia but rather hemifacial hypertrophy.  I haven't really looked at enough panos to recognize the difference (overgrowth of one side vs undergrowth of the other). 

When they shortened your left mandible did they do a condylectomy or something else? 

It will be hard to tell what the end result will be like with all the swelling, especially since you didn't exactly have the same procedure done on both sides of the mandible.

[dressagequeen]

Hi Alue, my surgeon was concerned that it could be condylar hyperplasia or even agromegaly, he sent me off for blood tests and a consult with an endocrinologist to rule that out (although I do have high Hgh). I don't believe he touched the condyles as he confirmed that they had stopped growing. In photos and scans there is a marked difference in my skeletal development on both sides with obvious changes in soft tissue growth. The surgeon's aim was to make me as symmetrical as possible and with more fullness in profile.
I gave him pictures of Margot Robbie and Angelina Jolie as examples of what I was after. Obviously not achievable, but I just want to feel normal and not ugly and flat faced. I have a super high left eyebrow/low right eyebrow, hopefully this can be fixed with botox in the right muscles.

[Alue]

I didn't know blood tests could rule out condylar hyperplasia (I know it can show acromegaly though).  How did he confirm the the condyle had stopped growing? 

[girl]

I also have hemifacial microsomia and haven't seen much about it on this forum or elsewhere.

Thanks for posting your pictures. How did your upper jaw look before surgery - was there a cant? It sounds from your description like the issues were more skeletal - my jaws are noticeably canted as well as having the issues you describe (plus a long face).

[dressagequeen]

They were able to rule out agromegaly/condylar hyperplasia by doing a scan where I was injected with a radioactive dye, if the condyles were still growing they would absorb more dye and be very obvious on imaging. There were also various blood tests to check my hormone levels, which were all normal except for high human growth hormone (which may be lifestyle related, I intermittent fast, work shift work and lift weights).

Ragirl my maxilla had a definite cant (which I had never noticed), the right side was higher than the left due to the difference in growth.

I have had a couple of appointments with my surgeon, one to change my elastics - I now have 3 on each side going from the upper jaw 4 teeth from the centre to the lower jaw incisors. These are to pull my maxilla forward as the surgeon has (intentionally?) given me a crossbite by bringing my mandible forward. Please excuse the tomato soup stain on the elastics!

Has anyone experienced agonizing ear pain after surgery? I'm sure it's surgery related, it feels like there is a buildup of fluid/pressure and it has been extremely painful. I'm going to see my GP about it tomorrow morning, just to check it isn't an infection and to get some more pain relief - my surgeon is a real tight arse when it comes to pain killers.

I'm hoping once my maxilla comes forward that I will have more vermilion show in my upper lip.

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