Causes of facial asymmetry surgery and how to correct it?Dr Sanchaita Kohli
We all seek symmetry and balance in our lives and more so, in our appearance. The problem with facial asymmetry can be explained by anyone who claims to have a “good side of the face” while getting their pictures clicked.
No face is a 100% perfectly symmetrical. A small amount of facial asymmetry exists in almost all faces, but these aregenerally imperceptible and acceptable, and therefore, not so troublesome. Many conditions, however, can cause large discrepancies in the size and shape between the right and left sides of the face. This is an extremely distressing situation for anyone afflicted with this condition and almost always has severe psychosocial implications one one’s life.
When the deformity is this severe, it usually arises from a difference in size and shape of the facial bony skeleton lying under the face skin. Maxillofacial surgeons in Delhi commonly encounter these conditions associated with defects in jaw bone growth or following facial trauma.
In the following sections, we will see discuss the causes offacial asymmetry of this degree and the treatment options including jawline contouring, corrective jaw surgery, fat grafting, distraction osteogenesis and facial trauma management.
What are the causes of Facial Asymmetry?
There are a number of conditions that can cause soft and hard tissues of the face to develop more on one side than the other. Some of the most common deformities that can cause gross facial asymmetry include:
- Hemifacial Microsomia:
Children born with a condition known as hemifacial microsomia present with undergrowth of both hard and soft tissues of one side of the face, causing an obvious facial asymmetry. This deformity usually worsens as the child grows older and can range in severity from mild to extreme. The face and the smile becomes tilted to one side and many jaw functions are also impaired. Extreme cases often require correction at multiple stages of life. Maxillofacial surgeons in Delhi time the operations in such a way that the final deformity is controlled and requires less radical correction.
- Facial Fractures:
Untreated or improperly treated facial fractures on one side of the face can lead to varying degrees of facial asymmetry and also disturbance in face functions like breathing, vision, smell, chewing, etc. The affected side of the face is usually rendered deformed, depressed and dysfunctional.
- TMJ Ankylosis:
This is an extremely bothersome condition resulting from an injury to one of the two jaw joints that causes fusion of the lower jaw bone to the skull on the affected side. This not only leads to loss of joint function, but also results in reduced lower jaw bone growth on that side of the face. This is due to the fact that the jaw bone growth center gets damaged from this disease on the affected side. This causes severe facial asymmetry, especially when this condition affects someone during childhood.
- Condylar hyperplasia or hypoplasia:
Certain conditions like injury or disease can cause the jaw growth center to grow at an abnormally fast or slow rate on one side of the face. Rapid growth rate is called condylar hyperplasia while an abnormally slow growth rate is seen in condylar hypoplasia. In either case, the affected side of the jaw grows at a different rate than the normal side. This results in obvious facial asymmetry.
These diseases and deformities are encountered routinely by maxillofacial surgeons in Delhi and are treated according to the cause and their severity.
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What are the Treatment Options forFacial Asymmetry?
Obvious facial asymmetry is a deformity that almost exclusively requires surgery for optimal correction. Depending on the severity of the deformity, any of the following treatment options may be advised by your maxillofacial surgeon:
- Jawline Contouring:
Mild facial asymmetry can be corrected without entirely cutting and repositioning of the lopsided bones. This is done by means of jaw contouring, wherein the excess bony tissue on the longer / larger side of the face is shaved or trimmed off.
The amount of shaving off to be done is decided on pre-operative scans by comparing both sides of the facial skeleton and measuring the exact difference in the length and width of the bones on either side. This difference is then trimmed away on the larger side of the face using drills and osteotomes to achieve symmetry and balance.
- Augmentation with fat / implants / bone grafts:
Just like jawline contouring corrects mild facial asymmetry by reduction of excess tissue on the larger side of the face, augmentation procedures are done to correct mild asymmetry by enlarging the smaller side of the face.
This enlargement may be done by means of grafting or inserting an augmentation material. This material may be a prefabricated or custom-made implant, or it can be the patient’s own body tissue in the form of fat or bone.
Greater degrees of precision in symmetry can be achieved with 3D printed customized implants that are tailor made according to the patient’s measurements. However, the material chosen for augmentation depends on the nature and size of the defect and needs to be planned for each case.
- Corrective Jaw Surgery:
Orthognathic surgery or corrective jaw surgery involves surgically detaching the jaw bones from the rest of the facial skeleton and rotating and reorienting them to achieve symmetry and harmony. The bones are then fixed in this new desirable position using plates and screws.
Mild to moderate cases of facial bony asymmetry can be predictably and permanently treated using this procedure. The entire surgery is performed from inside the mouth and excellent results can be yielded which are apparent immediately after surgery.
- Distraction Osteogenesis:
Distraction osteogenesis is an advanced surgical technique that allows for bone and soft tissue lengthening on the shortened side of the face. This option is advised for severe deformities, where a combination of bone and soft tissue deficiency exists on one side of the face.
When the deficiency is large in amount and requires greater degree of correction, it cannot be reliably treated with corrective jaw surgery. Distraction osteogenesis surgery in these cases allows for augmentation by creation of patient’s own tissues without the need for placement of grafts or implants.
This is done with the aid of a metallic distractor device placed across the surgical bone cuts that provides gradual traction across the cut to elongate the bone and tissues on the shortened side of the face. The amount of lengthening required can be assessed based on the symmetry of the face achieved after each traction cycle. The results are permanent, stable and often transformational.
Following this discussion on facial asymmetry, it can be summarized that each individual case of asymmetry is unique and different in terms of the cause of the problem, severity, type of tissues involved and the nature of the underlying disease. The net result is that a “one-size-fits-all” approach cannot be used while treating facial asymmetry.
Every case needs to be planned thoroughly and independently by a skilled maxillofacial surgeon to determine the best treatment approach and timing for the individual’s specific condition. Dr. Sanchaita Kohli is an expert maxillofacial surgeon in Delhi experienced in treating a wide variety of cases of facial asymmetry. Her extensive experience and training in advanced technologies enables her to deliver the supreme levels of care, safety and aesthetic results for all her patients. She plans each case with diligence and precision and uses the latest planning and surgical equipment and techniques to ensure predictable results and safe outcomes.
Dr. Sanchaita Kohli
Oral and Maxillofacial Surgeon
Dr. Sanchaita Kohli is an Oral and Maxillofacial Surgeon with over 13 years of training and work experience at the country’s leading dental institute, Maulana Azad Institute of Dental Sciences, enabling her to plan and manage an extremely wide variety of craniofacial deformities, jaw diseases and facial trauma.