Facial asymmetry - what do you think?

[Plasticman]

Hi Everyone,

I am about to have a bimax in 2 weeks to solve a facial asymmetry. I have no functional troubles so it's 100% aesthetic.
Today I went to my ortho and I told him about my fears of the jaw surgery. He answered me frankly, saying that if he was me, he wouldn't go for it. I am lost. I have prepared myself for this surgery for a year now.
Here's a picture of my front. What do you think ?

Thanks a lot for your advice

[kavan]

Unless he gave you some reason, either disregard or ask the attending surgeon what concerns you. Also relay the ortho shook your confidence.

[Plasticman]

Thanks for your reply

The ortho said I am good looking, that the Best is the enemy of the Good. He sees the asymmetry of course but in his opinion it is not strong enough to take the risk of a bimax. At the end it's up to me.
The thing is that I have a light asymmetry compared to what I can see in others, but still strong enough to be taken seriously by professionals.
My surgeon is the best here. A thousand of op / year. The counterpart of his success is that he is very expeditive during our meetings. In addition, my case seems to be an easy piece to him.
He plans a 2 - 3 mm impaction of the maxilla to shorten the longest side of my face.
To finish, I really trust his knowledge and experience, what scare me the most is not recognizing myself afterward.

[CCW]

Do you have a ceph? Asymmetry is very hard to fix, and it may even become more noticeable after bimax.

[Plasticman]

Yes, the front ceph is in my previous post. Here is the profile:

Clearly it seems that retrognathia or prognathia are easier to deal with. There's not so many before / after of asymmetry treatment (except extreme case which are always impressive.)

[strongjawman]

How much of your asymmetry is soft tissue and how much of it is actual bone?

Does your maxilla/bite have a cant? If it does then there is clear unilateral overgrowth/undergrowth of the upper and lower jaws.

I have a very similar situation to you, except I don't really have a can't. My teeth are straight, but I have an edge to edge bite at the front, normal class i at the right and cusp to cusp/class ii on the left.

I am having scans and a 3D printed model in detail of my skull from the chin to mid orbit on Monday to determine what degree of my asymmetry is bone and what is soft tissue. I already know both are involved, but I want to know exactly how much my jaws are contributing to the issue.

I will likely have bimax to correct my bite/improve my profile and hopefully jaw related asymmetry, genio to move my chin slightly to the left. If the asymmetry is still prominent after that I will look into subtle fat grafting to the left cheek area and maybe buccal fat removal (not all just a bit) on the right.

You are the closest person I've seen to myself on this forum except for the bite.

Who is your surgeon?

I'm seeing 2 in Spain the week after next.

[Plasticman]

It's mainly bone.
I have a malocclusion on the left side and yes, one side grew a bit much than the other.
My teeth are straight and aligned.

I didn't know about this technique to determine bone vs soft tissue degree of asymmetry. It looks impressive, what's the name of it?

Are you not afraid of the bimax to solve your problem?
I'll send you the name of the surgeon in private message.

[strongjawman]

It's not something any Doctor recommended, I am just going out of my way to understand my own anatomy in it's entirety before I trust someone to operate on me.

If I feel like the asymmetry is primarily soft tissue then I'll go the route of fillers/fat transfer. The problem is that I already had a surgeon who concluded that my bite can't be corrected with orthodontics only, that I would need surgery to move my lower jaw.

I am going to bring the model and all the information/questions I have available to the surgeon and go from there.

It's a cost : benefit ratio.

My teeth are wearing, I can't fully bite through certain foods and aesthetically I know I could look better.

It comes down to the pros and cons. If I could fix my teeth without surgery, I might not get it. If I can't then I have to decide if I put up with the way they are for the rest of my life.

I'm sure it's not an easy decision to make, I sympathise with you. Have you written down exactly the reasons you want this? The pros and cons?

[kavan]

The more developed side of your face is the more attractive side. Right side of face, left side of photo. The asymmetry is VERY apparent.

To my eye, it does not look like a situation where the salient problem is that one side is 'longer' than the other. Or at least that looks like the LESSER issue.  To my eye, one side is more NARROW than the other and less developed which is SIDE of face including cheek area and jaw area. Also NOSE area where you don't see the nose hole (nostril) on the undeveloped side.


In essence, your asymmetry is MORE of a WIDTH issue than a length issue and from what you say, the doc will just be focusing on resolving the Length part of the asymmetry.

That said, you should establish that your doc will be prioritizing establishing more symmetry to the UNDEVELOPED side of your face.

[strongjawman]

The more developed side of your face is the more attractive side. Right side of face, left side of photo. The asymmetry is VERY apparent.

To my eye, it does not look like a situation where the salient problem is that one side is 'longer' than the other. Or at least that looks like the LESSER issue.  To my eye, one side is more NARROW than the other and less developed which is SIDE of face including cheek area and jaw area. Also NOSE area where you don't see the nose hole (nostril) on the undeveloped side.


In essence, your asymmetry is MORE of a WIDTH issue than a length issue and from what you say, the doc will just be focusing on resolving the Length part of the asymmetry.

That said, you should establish that your doc will be prioritizing establishing more symmetry to the UNDEVELOPED side of your face.

I think this is a really good point.

OP,  with a technetium-99m nuclear medicine bone scan, a surgeon will be able to tell if your right side has an increase in uptake/increased activity compared to the left. There is a difference between hemimandibular hyperplasia and hemifacial microsomia. One is excessive growth of one side of the face/bones and one is underdevelopment of the otherside.

I'm sure your surgeon has considered all of this however. The OMENS classification takes into account the eye, cheek area, nose and ear.

Your asymmetry looks largely bone as you already stated.

Bimax seems like it makes the most sense. You can only move the jaw bones in so many directions without completely segmenting it, so this might be the best solution

https://www.youtube.com/watch?v=Oz4GWUI8SIU

[Plasticman]

@strongjawman
Thanks for your message and your kind words.
It's a real mess in my head. There are a ton of cons but also the hope that one day I could just get rid of this problem and not have it always in mind especially in social situations. I am 35. I did a first attempt 10 years ago and I gave up. My goal is not to be perfectly symmetric. It's impossible and I guess it's part of who I am. But I would love to make it less important in my life.
You seems to do things very well. Without any doubts, it will help you to take the right decision.

@kavan
Thanks for your analysis and for having taking the time for it. The first picture is a little tricky, my nose is not straight (deviated) and it gives the impression the right side / left in picture is wider. I don't feel this is the case.
Both 3/4 views are different (like twins  ). I find more attractive the other side (left side of face / right in pictures).
Looking at this makes me think that most of the asymmetry is in the nose and somehow, my deviated chin compensate the fact the nose is not well oriented. This also why I fear the surgery, it could break this fragile balance...

[Jilkster]

Send me the name of the surgeon too please. My asymmetry is of a similar degree, I'll send you pics.

[strongjawman]

@strongjawman
Thanks for your message and your kind words.
It's a real mess in my head. There are a ton of cons but also the hope that one day I could just get rid of this problem and not have it always in mind especially in social situations. I am 35. I did a first attempt 10 years ago and I gave up. My goal is not to be perfectly symmetric. It's impossible and I guess it's part of who I am. But I would love to make it less important in my life.
You seems to do things very well. Without any doubts, it will help you to take the right decision.

@kavan
Thanks for your analysis and for having taking the time for it. The first picture is a little tricky, my nose is not straight (deviated) and it gives the impression the right side / left in picture is wider. I don't feel this is the case.
Both 3/4 views are different (like twins  ). I find more attractive the other side (left side of face / right in pictures).
Looking at this makes me think that most of the asymmetry is in the nose and somehow, my deviated chin compensate the fact the nose is not well oriented. This also why I fear the surgery, it could break this fragile balance...

I have the same problem when I look left and right. It's definitely your mandible/maxilla. Your nose and chin just follow your facial bone growth. My nose is slightly off as well.

Can you PM me the name of your surgeon please?

[kavan]

@kavan
Thanks for your analysis and for having taking the time for it. The first picture is a little tricky, my nose is not straight (deviated) and it gives the impression the right side / left in picture is wider. I don't feel this is the case.
Both 3/4 views are different (like twins  ). I find more attractive the other side (left side of face / right in pictures).
Looking at this makes me think that most of the asymmetry is in the nose and somehow, my deviated chin compensate the fact the nose is not well oriented. This also why I fear the surgery, it could break this fragile balance...

Well, your face is sort of on the 'long' side. So, that's why the more developed side (side with more width to it) would be considered more attractive by most people. It's because width or more width can visually offset some excess length. As to the nose, you might be looking at a rhinoplasty later down the line to address your nose issues. They use grafts for augmentation.

[april]

I think this is a really good point.

OP,  with a technetium-99m nuclear medicine bone scan, a surgeon will be able to tell if your right side has an increase in uptake/increased activity compared to the left. There is a difference between hemimandibular hyperplasia and hemifacial microsomia. One is excessive growth of one side of the face/bones and one is underdevelopment of the otherside.

I'm sure your surgeon has considered all of this however. The OMENS classification takes into account the eye, cheek area, nose and ear.

Your asymmetry looks largely bone as you already stated.

Bimax seems like it makes the most sense. You can only move the jaw bones in so many directions without completely segmenting it, so this might be the best solution

https://www.youtube.com/watch?v=Oz4GWUI8SIU

So if it's hemifacial microsomia it won't show any uptake? I've had this scan done (but to investigate condylar resorption), my left side had marginally higher uptake/activity compared to the right but they also said it was insignificant. I have asymmetry a bit like Plasticman - which no surgeon or ortho can seem to see Very different on 3/4 cheekbone/cheek view (like completely diff people), ears are at different heights (possible head tilt), deviated nose, and also strangely one eye is smaller than the other. Plasticman, how are your eyes out of curiosity? Symmetric or asymmetric?

Looking at this makes me think that most of the asymmetry is in the nose and somehow, my deviated chin compensate the fact the nose is not well oriented. This also why I fear the surgery, it could break this fragile balance...

I feel with the nose, unless it's corrected, it will always throw everything a bit off. I'm no expert, but I'd imagine after bimax the deviation might become more apparent. But its hard to say what will happen after the surgery. Some noses look better, other's become deviated. But you are obviously a good looking guy and not many people in daily life would be looking at you through such a microscope. I would just prepare myself for rhino or septo afterwards.