Metal Mouth Message Board

Hi All, sorry for the long post, but I'm very concerned about asymmetry in my face post-surgery (I had a Lefort I, BSSO, and genio two weeks ago). The first time I looked in a mirror afterwards I felt like things were off. My midline was off to the right, my previously straight nose was crooked to the left, and overall I just looked very uneven (I recognize that part of this was due to massive swelling). The day after the surgery, I had a cone beam done, and that night my surgeon called and said that my septum has been pushed to the left and to come into his office the next day for him to fix it. I went in, he shot some Lidocaine in, used a tool to push the septum straight, and inserted a nose trumpet in the left nostril, which stayed in for five days. After it was removed, my nose was still a little crooked but the surgeon said all the swelling was pulling it to the side. A few days later, I went back and expressed my concern again, and he said the septum had shifted again. He inserted nose trumpets in both nostrils to straighten it. No Lidocaine, it was absolutely brutal. The trumpets caused so much pain and pressure that they were taken out two days later; even with that short time, though, the surgeon proclaimed that the problem was fixed.

That brings me to today. I was in to have my elastics changed, and was told that I'll have the splint in for a total of six weeks and that my midline is off, just like I thought when I first saw my face after surgery. He said that the midline was fine after the surgery and that it must have shifted in the past week. I'm not a doctor, but I find it hard to imagine how that could possibly happen considering all of the plates, screws, splint, and bands holding everything in place. He placed the bands differently to try to pull the midline back to the left. He also acknowledged that my nose is still off and has recommended a rhinoplasty or septoplasty (I can't breathe at all through my left nostril). I'm really upset and angry at all of this. Those who have had to have revisions, are these the types of issues you had post-surgery that prompted the revision? I'm terrified that I'm going to need a revision, and I'm very upset that I already need another surgery to fix the septum issue, which did not exist before the surgery. Thank you for reading this post and for any thoughts or recommendations you may have.

Here are the measurements that the surgeon estimated for the asymmetries:
Nose 2 mm to the left
Midline 2 mm to the right (top and bottom teeth do line up with each other)
Chin is uneven

Do you have pictures?

2 mm sounds really tiny, but I'm not sure.

Here are some pictures. It was difficult to get a picture of the midline issue because I can't really smile yet, but you can definitely see the nose crookedness. If I can get a better picture of the midline I'll post it. Thanks for taking a look!

At 2 weeks, you're definitely still really swollen.

But... If your midline is 2mm to the right while the nose is 2mm to the left, I wouldn't think this is really something to be addressed by another jaw surgery. The jaw midline being 2mm off is super tiny, and would be less noticeable when the braces are off, too, I think. It probably seems more than it is because the midline and nose go in opposite directions. If you were to do anything, I think it should be just straighten your septum. It'll make things look more in line while being way less invasive.

It's probably still early to tell. I'd wait. But if anything, the above is my simple opinion.

I concur with jawregret1: if it bothers you a lot, I would go with the rhinoplasty/septoplasty. The midline is only very slightly off and if you get your nose straightened it'll hide it even further. There are big risks to having a revision. My chin is slightly off center too, but this is my new face and I've come to grips with it. I didn't expect for everything to be perfect after the surgery and it's not. It's better than it was tho, and it helped with my symptoms, so that's about all I can ask for. Good luck!

Thank you both for your replies, and I am starting to come around to the idea of just fixing my nose and being happy with the rest of it. Hopefully once I'm unbanded and can start reaping the benefits of better breathing and a better bite I'll be happier with the results. This recovery has been a lot harder than I thought it would be and I think it's really taken a toll on my mental state.

littlebird wrote:Thank you both for your replies, and I am starting to come around to the idea of just fixing my nose and being happy with the rest of it. Hopefully once I'm unbanded and can start reaping the benefits of better breathing and a better bite I'll be happier with the results. This recovery has been a lot harder than I thought it would be and I think it's really taken a toll on my mental state.

Yesssss that's recovery for you! The hardest part for me was learning to just be happy with my results instead of being critical about what wasn't perfect. It's hard but it gets easier

[quote="littlebird"]Thank you both for your replies, and I am starting to come around to the idea of just fixing my nose and being happy with the rest of it. Hopefully once I'm unbanded and can start reaping the benefits of better breathing and a better bite I'll be happier with the results. This recovery has been a lot harder than I thought it would be and I think it's really taken a toll on my mental state.[/quote]

Do you have an update for us? Has the issue sorted itself out? Have you decided to go ahead with the rhinoplasty?