Actually Corrected Midline?

[Naderq]

I'm 2 weeks out of upper and lower surgery and am overall happy with the results. My nose is slight wider and off the right - but I think most of that will subside with the swelling. My biggest concern is my midline. By my estimates, the upper midline is off from the centre of my face by 2mm. My smile is a bit crooked because of this now. It's pretty noticeable but probably will subside as the swelling goes down more. However without surgery, what are my options to correct this midline issue? Has any had actual results correcting midline issues?

[snapdresser]

Well, they could redo the top, but you'd be looking at a higher chance of permanent numbness and complications. Most people just settle for the slightly off-center midline and learn to live with it.

[Naderq]

[quote="snapdresser"]Well, they could redo the top, but you'd be looking at a higher chance of permanent numbness and complications. Most people just settle for the slightly off-center midline and learn to live with it.[/quote]

I was inquiring what my options were without the need of surgery. I.e. Orthodontic work? Elastics? I don't want to go through another surgery.

[snapdresser]

Ah, I see you added "However without surgery" now. Unfortunately I don't have personal experience with that and most people on these forums just end up living with it if their bite is good. Good luck

[littlebird]

I posted a very similar question a week or so ago when I was 2 weeks post-op--nose crooked to the left, midline off to the right by 2 mm, crooked smile.

My surgeon adjusted my elastics (I still have the splint in and can't open my mouth at all) to try to pull my midline back to the center. It's helped a little but not much. I am happy to report that my nose is sort of straightening out and my smile is less crooked. I had a lot more swelling in the left, which the surgeon said was pulling my lips and nose sideways.

So my advice is to try not to freak out, and wait for the swelling to go down. My surgeon said I could get a septoplasty to fix the nose issue if I am still unhappy with it after the swelling is gone. I'm not happy about that prospect, but it is what it is. He also said that my orthodontist could help with the midline issue. What has helped me is noticing that other people's faces are not always symmetrical, even famous actors/actresses. So while we perceive these as major issues with our own faces, others likely wouldn't even notice.

[Naderq]

Thanks! It's great to hear from someone who is just a couple weeks ahead of me going through the same thing

Overall, I'm really happy with the results. It's just those little things that bother me and I'm sure aren't noticeable to other people. it's good to know the midline could possibly be adjusted. I have my 2 week appt today and will bring it up. Thanks!

[littlebird]

Hi Naderq, just wanted to check in and see if your crookedness has improved since your last post. My nose is still rather crooked, my lips are almost completely straight, and if I don't look too hard at myself in a mirror I don't notice the midline crookedness too much. I still have quite a bit of swelling in my cheeks.

Hope you're doing well!

[glennstanzalone]

My midline was perfect after surgery then shifted and is now perfect again. Also my smile was wonky until about 4 months post-op due to uneven swelling. Keep the faith!

[Naderq]

[quote="littlebird"]Hi Naderq, just wanted to check in and see if your crookedness has improved since your last post. My nose is still rather crooked, my lips are almost completely straight, and if I don't look too hard at myself in a mirror I don't notice the midline crookedness too much. I still have quite a bit of swelling in my cheeks.

Hope you're doing well![/quote]


Hey Littlebird,
Unfortunately it hasn't. My nose is still rather crooked as well and makes my midline look very out of whack. I've taken some pictures to see where the asymmetry is coming from and it's definitely from my nose. My teeth seem to line up almost perfectly with the rest of my face.

My OS and Ortho tell me that there is still a lot of swelling on the left side of my face which is causing the asymmetry so I'm hopeful that in a couple more months the issue will be resolved. But it's definitely the one thing that bothers me the most. I loved my nose before

[vaselina]

Hopefully your healing and results will be better than mine. My surgeon was supposed to correct my midline the first time (only reason I opted for upper surgery), but 11 months after the fact and it seems like my midline is worse and my nose is more crooked than ever. However, the open bite is gone so that's something.

[iamamused]

OP, you are still not that far from surgery so certainly swelling is in play - your nerves are also still likely numb and coming back.

A good way to tell if your midline is off, is to measure from the center of your eyes down to the middle of your teeth. The will take the visual impact of the soft tissue out the equation and give you a better idea on whether or not your midline is truly off. 2 MM is not much, and the presentation of an off midline in relation to the soft tissue, especially swollen soft tissue, can change when speaking, smiling, or at rest. A measurement take from the center of your eyes will be a much better indication.

The midline can be corrected with orthodontics, but typically only if the upper midline and lower midline are out of alignment from each other. The teeth require opposing forces to move, space to move, and an anchor point to perform those movements. Your ortho can use cross elastics to bring the midlines into each other. However, if the upper and lower midlines are in alignment, there is little from an orthodontic perspective that can be done. Shifting an entire midline can be quite involved / difficult vs. bringing the midline between the jaws into alignment with each other.

I'm 5 weeks post my second surgery. I posted a long write up on here titled: "Tips, Tricks, and Comments – From a guy who’s done double jaw surgery TWICE!". My 2nd surgery was to correct my midline and asymmetrical forward profile. My midline was off quite a bit though, over 6mm. Basically my jaws were in alignment, but in the wrong place in my head. Too much to the left.

If everything else seems centered on you. Your chin, your lips, and your teeth are centered to your eyebrow - don't worry. Its just swelling.

At 5 weeks in my 2nd surgery my nose and philthrum are still off center, but my teeth are on center with my head. A combination of swelling on the left of the nose and the nerves not back yet is pushing things to the right. Give it a few more months, you'll be fine. Typically if the jaw is on center the nose won't be crooked due to anything besides swelling - it can appear widened, pushed out, or pulled down - due to the skeletal movements in the upper jaw, but not slanted once swelling has subsided.

My 1st surgery gave me a slanted nose, things already look less slanted than the final outcome from that, and like I said I still have swelling.

[Lizzybae]

Could you post pics of your midline off centered after post op? and pics after ortho corrected through rubber bands?

How long did you wear the rubber bands for and do you recall the placement?

I am 37 days post op double jaw, bottom forward by 5 to 6 mm, top widened and pushed back approx 2 mm. My concern is that from day 5 post op, my OS and I noticed midline off centered to the right of my face even though top and bottom teeth align. Prior to surgery top and bottom were aligned and centered with my face. Never was told by OS that this might be a possibility so you can imagine how difficult it’s been. I don’t know what to do?

I have an appointment with OS next week at my 6 week post op?