No organs or parts of the human body is perfectly symmetric. However an obviously asymmetric face could affect a person’s appearance and also his or her confidence in everyday life and in social activity as well. So it is necessary to  correct the severe asymmetry  of the face surgically. On the other hand as asymmetry is universal in human body a cosmetic surgeon should identify the nature of every patient’s asymmetry and do the correction job accordingly in planning and performing the surgery. At least not to do anything exaggerates the level of the asymmetry.

Mandibular asymmetry is one of the most common facial asymmetrical problems caused by various factors during the developing phase. The severity of the asymmetry varies from case to case and facial asymmetry commonly affect more than one parts of the face. Correction surgery of the accompanying asymmetry can be done together with the asymmetric mandible correction. A lot of times if the accompanying asymmetries are not very obvious the correction surgery can be focused on the mandible area solely. Normally both side of the mandible bone and masseter muscle should be trimmed in deferent degree to make the mandible and the lower face more symmetric and slimmer at the same time. Operation on both side of the face in asymmetric facial correction grants the surgeon more freedom regarding how and where the surgery could been done and thus avoids iatrogenic facial asymmetry after the surgery.

Photo Analysis of  Asymmetric Mandible Correction and Reduction

correction and reduction surgery for asymmetric mandible
At the time of asymmetric mandible correction a lower face reduction result can be achieved at the same tilme, one stone two birds.

In the front view the left side of the face is way more bigger than the right side before the surgery. This girl’s facial problem is caused predominantly by the mandibular asymmetry accompanied by asymmetries of the cheek bone and the corners of the mouth. The lower part of her face is wide also. Post surgery the face looks more symmetric and so as the jaw. The left mouth corner is lower than the right side pre-operatively. After surgery both side of the mouth corner level off because of the stretch force imposed by the big mandible body on the left side is relieved after bone reduction. Though the asymmetry of the cheek bone still exist it doesn’t make the face looking abnormal. The surgery let this girl’s face slimmer,  prettier and younger also.

profile of the asymmetric mandible correction
A smaller amount of bone and muscle is removed from the right side. The shape of the right mandible keeps the same as before surgery but the area represent the right mandible bone is not as full as before the surgery.

profile of correction and reduction surgery for asymmetric mandible
A larger amount of bone and muscle is removed from the left side of the lower face. This make the hump under the chin (at the tip of the red arrows) smaller and the neck longer.

In profile this girl’s neck gets longer after operation. The length of the neck can be judged by referring to the two ambiguous horizontal folds. The location of these folds is relatively lower in the post surgery photo. That means the top part of the neck above the folds becomes longer and so the whole neck is longer. Originally the mandible angles of the girl were not big and hanging down. The stress of reduction for this girl was not put on the angle of the mandible. A small amount of bone was removed from both side of the mandible angles leaving the shape of the angle and lower edge of the mandible line almost unchanged, only the fullness of the lateral side of the lower face is reduced. The red arrows show the changes of the front part of the mandible line. On the left side of the mandible bone a big piece of bone has been removed from this part. So the originally hanging line at the front part of the left mandible edge is raised. and sagginess look of the skin is improved.

bone and muscle removed from asymmetric mandible reduction surgery
Bone and muscle removed from asymmetric mandible reduction surgery. The amount of tissue removed from the left side of the face is way more big than that from the right side in order to balance the size and shape of the asymmetric mandible.

Picture on the right depicts the removed mandibular bone and masseter muscle. On the top the the picture is muscle on the bottom is bone. On the left side of the picture are tissues token away from the right side of the face and the right side of the picture are tissues from the left side of the face. Even the picture is blurred we can still tell the big difference of the tissue removed from deferent side. It is very difficult to assess how much of the tissue to be removed from each side of the mandible bone and the masseter muscle in order to make the asymmetric face symmetric. Never the less some measures such as pre operation photo analysis, split CT scan and 3D CT image reconstruction etc can help the surgeon to do the surgery more confidently.

Background Story

When this beautiful girl went to see Dr. Fushun Ma she only wanted to correct her asymmetric face. She said:”I don’t care what you do. Just let the size and shape of both side of my face equal.” And she was wandering if reduction surgery on the big side of the face only will do the job. Considering surgery on one side will restrict the freedom of the surgery planning and may also cause iatrogenic asymmetry Dr. Ma suggested her to do surgery on both side of her mandible bone and her masseter muscle first and then waiting to see how the result is going before planning consequent surgeries to make the face more symmetric. She toke Dr. Ma’s suggestion and deferent volume of the bone and muscle were removed from each side respectively.

13 months later this girl came back to Dr. Fushun Ma again and complained to Dr. Ma that she felt her face is still not symmetric. She asked Dr. Ma to do more surgeries to make her face more symmetric. After examination of her face Dr. Ma told her asymmetry do exist on her face like every body else’s face. The degree of her facial asymmetry dose not justify her suffering any more surgeries. At the beginning she didn’t believe in Dr. Ma. After Dr. Ma showed her before and after operation photos she realized that the asymmetry of her post operation face is really not that serious. As she enjoy her surgical results she agreed Dr. Ma’s petition of sharing her happiness with other fellow plastic surgery candidates on Dr. Ma’s website. Thanks for this beautiful girl’s generosity and open heart!

By: mafushun

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