Soft tissue problem

[ScottyB]

I had double jaw surgery through the NHS in the UK a long time ago. I got a BSSO well over 1 cm and lefort 1 impaction around 5-7 mm (gummy smile). Sorry, I can't remember the exact details now.

The surgery went well enough but I've had some annoying soft tissue changes ever since. I think they over impacted a bit, probably around 2 mm less would have been ideal. When i smile I get horrible lines and skin bunching under my eyes extending across the cheek bones. I really hate it. I've spoken to eye surgeons but they won't operate as my skin is ok at rest. Dermatologists have no idea what to do except botox and fillers which don't do much for this. I asked a plastic surgeon and he wasn't sure either.

It seems such a trivial issue! The surgeon mentioned that i could develop extra lines under my eyes before the surgery so it can't be an unknown issue. He retired a long time ago so I've not been able to speak to him. I should have done it closer to the surgery but I just wanted to forget all about it and I tried to accept all the small changes. These changes do get more noticeable with age but the surgery was the cause.

It seems difficult to predict soft tissue changes. The literature always refers to nose changes (which i do also have), nasolabial folds and upper lip length. But i can't find anything on this skin bunching. Someone did mention that it is possibly excess tissue versus bone as the lefort 1 removes bone and therefore a bit of tissue support.

Anyone came across anything like this before?

Thanks for any help offered.

[snapdresser]

I haven’t heard of your skin bunching/wrinkle issue before but it sounds like a reasonable outcome of over-impaction. Just know that a couple mm over-impaction would only have a slight impact on that skin bunching. Your 5-7mm impaction is the real cause and you likely would have some skin bunching even if you hadn’t been over-impacted by a couple mm. Is the overall aesthetic affect positive? If so, I would focus on that and not so much the inevitable wrinkling that we all will eventually see.

[Raindrop]

I've had impaction as well and notice similar changes. When I smile my cheeks are puffier than before. A surgeon explained to me that this is logical as they removed bone, but the tissue is still here and when I smile it has to move somewhere, which equals to puffier cheeks - as you mentioned in your post it's due to loss of tissue support.

I also think I was over impacted

I haven't noticed an increase in lines around my eyes though. But we'll see, I'm only 4 month post-op....