Moris Aynechi, DMD, MD

it looks like excess scar.  Most likely can be excised or re contoured.  It depends how deep and firm the area is as well.

Dr. Aynechi

Sorry to hear about your issue.  The first thing you need a full comprehensive evaluation along with professional photos, 3D CT scan reconstruction and mirroring the facial bones in order to understand your deficiency.  If orthognathic surgery is not an option, custom made facial implants made specifically to your needs could be a great solution.  

Dr. Aynechi

AS you already know the more time passes the more bone loss will occur in a grafted site.  Depending on your particular situation, it is possible to do multiple bone grafting procedures on a site in order to achieve the ideal result.  Keep in mind the procedure becomes more technical as multiple treatments are rendered.

Dr. Aynechi

As you may know no surgery is fully and 100% corrective, but significant improvements is possible with a well planned surgery along with realistic expectations.  Depending on the type of surgery, it differs whether it can be done during growth vs. need to finish growth.  Also as for the cheek implant, a custom made zygoma implant could have dramatic effect on the overall aesthetics of the face.  Given all that, a comprehensive and multidisciplinary evaluation needs to be performed prior to rendering any recommendations.

Dr. Aynechi

Sorry to hear about your smile post botox injection.  Usually this is not something we see after TMJ botox injections.  After performing thousands of TMJ botox injections, I have never encountered such an issue, but nevertheless it could happen to anyone even myself.  The units of botox used on you are actually very small.  My patients usually require 100 - 200 units depending on their size and symptoms.   The injections are performed every three to four months until relief is achieved. By staying deep into the muscle and following correct anatomical locations these issues can certainly be minimized or avoided altogether.

wish you all the best.

Dr Aynechi