Can The Bunched Up Cheeks, Change In Smile and Wide Nostrils After Upper Jaw Osteotomy Be Reversed?

Q: Dr. Eppley, After a septorhinoplasty and jaw surgery (upper jaw expansion, impaction and advancement, and lower jaw advancement), I have found that my nose and smile looks much like Bryce Dallas Howard’s after picture on the right. I don’t like how the sides of the nose seem to cave in and the cheeks seem to bulge out and appear artificially bunched up. I much prefer the natural look of the before, and I am not sure what the reason is for looking like that after. Is it due to overexpansion of the upper jaw or is it due to the septorhinoplasty (or other)? Can it be reversed? 

A: These are many of the unspoken soft tissues changes of the midface that can occur after LeFort osteotomies due to soft tissue stripping from the bone and the change of the bone’s shape. Most of these changes are irreversible. The only one that isn’t is nostril widening, the most common adverse aesthetic effect seen after a LeFort osteotomy. This can be treated by secondary nostril narrowing techniques through an external approach.

Dr. Barry Eppley

Indianapolis, Indiana