3 weeks ago I had le fort 1 osteotomy to correct a gummy smile. The plan was to raise the upper jaw by 5mm and correct a weak chin at a later stage with genioplasty. Prior to surgery I had a perfect occlusion. After surgery the nose was incredibly upturned and very noticeably off-centre (to the left). The central nasal bone was clearly visible in the left nostril.
The upper jaw (which was in fact raised 8mm) was misaligned (3 mm to the left and protruding). I was also left with an overjet of 5-6mm.
I had second surgery 2 days later. The nose was realigned but, the upper jaw was moved to the right just 1mm and the lower jaw advanced by 3mm. I still have an off-centre top jaw and nothing was done to lower the upper jaw.
Where as before I showed some gum, I now show no gum at all even when laughing (unflattering for a female). If I force my jaw to close where the bite is absolute and where the elastics are training it to go my lower jaw juts over to the left as does my bottom lip.
Profile-wise I now have a protruding lower lip (top lip has disappeared and in short I look like a bull-dog. I am unsure as to how much this is due to swelling (3 weeks on). I have a very heavy lower face and a lot of saggy skin. The left and right profile are very different from each other but the face-on view is appalling.
In your opinion, how soon can a patient return for corrective surgery? Also, is this bull-dog look due to swelling or a common result from such surgery? If I were to have the top jaw lowered by 3mm (to comply with the 5mm as planned) would this improve the profile? Also am I correct in thinking that if the upper jaw was moved backwards and into its previous position, this would help minimise the protruding top lip? What are the implications of advancing the lower jaw (I have a square jaw naturally and feel that the heavy, jowly look I have now is masculine). How long before I know the true results of this surgery ie how long before swelling subsides?
Your questions are complex in nature and you deserve a comprehensive examination and explanation of your concerns.
My first recommendation is that you should openly communicate your concerns with your doctor. If you are not fully satisfied with their reponse then you should seek a second opinion consultation by a Board Certified Oral and Maxillofacial Surgeon who routinely performs these procedures.
Second, it is best to re-operate to align the bones before they have healed if the result is not expected by the surgeons treatment plan. Once the bones have fused they will need to be re-cut again.
Third, swelling can take several weeks if not months to fully resolve and can masked where the actual bones are positioned. By way of radiographs, your surgeon should be able to determine if there are any discrepancies as to the actual position of the bones vs. the planned position.
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