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Asymmetric Face Correction Surgery

Homepage Star of April 2012
[ Author:Fushun Ma | Time:2012-04-25 01:10:40 |  Font Size: [Large Medium Small]
Tags: asymmetric face, crooked face, correction surgery, face surgery

Dr. Fushun Ma already mentioned in this website for several times that the human face is naturally asymmetric. If a person's face is perfectly symmetric he or she may not be considered beautiful by average viewer. However the degree of asymmetry should be limited. If one side of a person's face is profoundly different from the other in size or shape this face will not look good too. The asymmetry of the face is the key in making a person unique and characteristic. While a profound facial asymmetry let the face lose its balance and look unnatural. So significant asymmetrical face should seek the assistance of plastic surgery.

Asymmetric face also know as crooked face, twisted face, imbalanced face or deviated face etc. For most of the sufferers there is no proved etiology. It is believed to be related to hereditary factors, congenital or acquired developmental disorders, life style and some kinds of stomatological disease. Only a small amount of asymmetrical face sufferers whose cause of facial asymmetry is clear. Most of the sufferers can't find out why their face is so asymmetric. No matter if the cause is clear or not the common character for asymmetric face is that the size and shape are fundamentally different from one side to the other of the sufferer's face. The most noticeable difference normally is the width of different sides of the face. However for every asymmetrical face there always has an obvious height difference, the difference of the vertical length of the face, between each side of the face coexist. The observer often concentrated on the width difference and neglect the height difference.

asymmetric face correction surgery
One side of the face is obviously different from the other. After correction surgery the face is more symmetric.

crooked fac correction surgery
After surgical correction there is not much change in profile though the face looks more symmetrical in front view.

removed tissue from imbalance face correction surgery
During surgery for a imbalanced face correction the size of the facial bone is adjusted. On top of that some of the soft tissue is also trimmed off to make the face more symmetric.

The photos of this girl showed that her face is obvious asymmetric, the right side is much wider than the left. This asymmetry is mostly noticeable in the middle and lower third of the face. From the photo there is no facial middle line deviation. So no middle line correction surgeries is needed. For this kind of facial asymmetry facial outline correction surgeries will get a good final result. This girl's surgeries include right mandible bone and masseter muscle reduction, right side buccal fat removal. Her operation and post surgery recovery went smooth. The photo on the right side of this page depict the muscle, fat and bone pieces removed from the right side of the face.

The photos in this page was token 4 months after surgery. At that time the right side of the girl's face had already shown the narrow effect and her face looks basically symmetric already. However this is not the finial result because the right side of the face would get even smaller in the coming months.

After surgery the girl's face is symmetric from the front view by the reduction of the right side face. But if we take a look from the side the shape and size of the right mandible didn't change much. The right side mandible angle still exist and the degree of the angle remains the same. This is exactly the result we should pursue for this kind of asymmetrical face correction. As this girl's asymmetry before surgery only show in the frontal view not much on the profile and degree of her mandible angle was already greater than normal. In this instance an ostectomy at the mandible angle will make the degree of the mandible angle every bigger thus giving the profile of her face an unnatural look.

In the process of asymmetric face correction the most challenging aspect is to determine the amount of tissue removal. The right amount of tissue removal should correct the asymmetric deformity and avoid create iatrogenic asymmetric deformity by over reduction. In the pre-surgery design of this girl a method of facial outline analysis is utilized. As in the image below a facial outline sketch is derived from the full frontal view photo (the left side image). The vertical red line is the middle line of the face. The length of line A-B and line a-b is bigger than that of line A-C and line a-c, indicating that the width of the right face is bigger than the left. Then A-B to A-C and a-b to a-c ratios are calculated. According to this ratio and the actual width of the face a width difference between the two sides is figured out. For this girl the maximum width difference between the two sides of her face is 9MM. That means a 9MM reduction from the right side of this girl's face would make her face back to symmetrical status. Referring to this figure certain amount of muscle, fat and bone tissue were removed from the right side of her face. The right side image shows that the post surgery facial outline analysis is basically symmetric.

analysis of deviated face
Facial outline analysis for measuring the width difference of two sides of the face. After surgery the difference diminished.

x-ray image of asymetric face
The occlusion level of the teeth is not parallel to the line between the orbits. However the tilting level between these lines is less than 15 degree, meaning no obvious deviated maxillary bone.

The surgical plan for asymmetrical face correction should be case specific. No single surgery is suitable to any kind of facial asymmetry. First of all the cause of the asymmetry should be find out, whether the facial bone or soft tissue disorder makes the face asymmetric should be distinguished. Secondly the scale of the disorder should be investigated in order to determine the operation site. In asymmetric face caused by the facial bone developmental disorder the width of each side of the face is obviously different. On top of that, as one side of the face was overgrowth or undergrowth, one side of the face is longer than the other. This imbalance in turn causes middle facial line deviation. If this deviation is severe enough a crooked middle line correction should be the priority of consideration. Only after the middle line go back to straight position surgeries such as facial outline reduction then can be performed.

A simple way of diagnosing the facial middle line deviation is using X-ray image. It is based on testing if a plan on the lower face is parallel to the control plan in the upper face. Parallel means there is not deviation. Not parallel and the tilting angle exceeds certain amount means the middle line of the face is deviated. This girl's X-ray image is showing on the right. The red line at the bottom represents the teeth occlusion level. The red line on top represents the level of the lower edge of the obitals. It serves as a control plan for testing the facial middle line deviation. If the two lines run parallel to each other there is not facial middle line deviation. If the two lines run not parallel and the tilting angle is more than 15 degrees, there is a obvious facial mid line deviation.

The X-ray image analysis of this girl shows that her lower face testing plan is not parallel to the upper face control plan. However the tilting degree between this two lines is less than 15 degree. So she is not suggested to do the middle line correction. As a matter of fact her post surgery result is satisfactory. For asymmetric face correction the key is to analyze the individual candidate's situation carefully and then a specific surgical plan is formed accordingly. The principle for asymmetric face correction surgery is to achieve maximum facial balance with minimal surgical trauma. For candidates who have obvious facial middle line deviation the priority of surgery is to make the middle line straight and than other surgeries, such as facial outline correction could be performed. Only by doing this an ideal cosmetic result and possible co-exist dysfunction could be best recovered. No camouflage surgeries could really cover the middle line deformity up.

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