We are often asked to evaluate patients who have previously had orthognathic surgery and are unsatisfied with their results. One would think that the most common problem after orthognathic surgery is an occlusion issue (the relationship of how the teeth fit). The reality is that the real issue tends to be more subtle and complex – simply “I liked the way my face looked before”.
The profile of a masucline vs feminine face is very different. Not only in terms of vertical height but when viewed on profile in terms of the relationship between the nose, lips, and chin. This relationship must be taken into account when performing orthognathic surgery in order to maintain a gender appropriate appearance of the face upon which surgery is being performed.
Surgical Techniques Often Solve One Problem – But Create Another Incidental Problem
After seeing dozens of such patients, one of the most common things we see is that the chin is sometimes elongated, making the face (and especially the lower face) too tall regardless of whether the maxilla was impacted or not. This is often because of the rotation of the two jaws.
Another common issue we often see is that as the occlusal plane has been flattened, the chin has overly rotated and become excessively prominent for femine proportions. These two surgical techniques may lead to a masculine appearing chin and or lower face. Ultimately, this may be hard for patients to describe to a surgeon without exceptional clinical knowledge – they just see the result in the mirror.
Another commonly noted thing among patients: when advancements of the mandible are larger, the corners of the jaw may appear unusually narrow and patients may lose definition of the jaw line. This often leads to people feeling that they have an aged appearance and that their neck and jaw are not as beautiful as they once were prior to having surgery.
What Are My Options?
Depending on your exact previous surgical plan, there are a few options to bring back a more feminine appearance. Don’t fret: treatment rarely ever consists of completely redoing the orthognathic procedure. Although this may be occasionally necessary, it is usually possible to improve the situation with less drastic measures.
It is often possible to perform a feminization of the chin, by shortening the height of the chin using very precise osteotomies (bone cuts) as well as a reduction to reposition the chin into a shorter space. In addition, it may be necessary to reposition the chin either forwards or sometimes slightly backwards in order to correct the position of the chin.
If the issue is loss of definition along the jawline, then a jaw contouring operation along with placing implants along the border and angle of the jaw can restore a more natural and harmonious appearance. The implants needed in this area often are surprisingly conservative. We have worked on a number of patients in whom we have placed implants and have learned that there is a very fine balance between placing an implant that is too large in this area and leading to a masculine appearance and of that of a patient having bruxism. Therefore we usually recommend very conservitive sized implants to correct this situation. The implants must be placed with finesse and often contoured to make sure that the implant edges sit flush with the bone so that the edges of the implant are not palpable and/or visible.
What Is My Next Step?
It’s always advisable to schedule a consultation with your surgeon as the possible scope of what may be needed is more complex than can be addressed in a short summary. Your surgeon should be able to give you suggestions as to what the problem is and what may be done about. Rarely is redoing the entire orthognathic operation the solution to these problems, because an acute understanding of the differences between masculine and feminine facial morphology and features is critical, be sure to select surgeons who specialize in Craniomaxillofacial surgery, have proven results you can see, as well as understand the minute details of facial proportion and balance.
Dr. Deschamps-Braly is a board-certified plastic and craniofacial surgeon specializing in facial plastic surgery, orthognathic (jaw) surgery, and craniofacial surgery for adults and children. He is also one of the world’s foremost leaders and innovators in facial gender confirmation surgery.