What's the best way to fix my asymmetry and retruded mandible? (Photos)

The greater the severity of the problem, the more extensive will be the correction. You have a severe mandibular retrusion with a possible shortened ramus on one side. Orthodontics alone will have no effect. Orthognathic surgery is a big surgery and requires hospitalization but there is not a long and painful recovery. In fact, in most cases, the face remains "numb" for a few weeks which minimizes any discomfort. If you decide against orthognathic surgery, then at the minimum, I would consider a sliding genioplasty which can move your chin forward 10 mm and correct the asymmetry. This procedure can be performed in the office with sedation.

Dear Ladylady9002, If you do not have any current bite issues then a sliding genioplasty is not needed. Genioplasty is a very involved procedure and it has a long post operative recovery. You should be an ideal candidate for chin augmentation to provide more projection to your weak chin. This will balance your facial profile and overall facial aesthetic nicely. The small degree of asymmetry that you currently see will not require a custom made chin implant. I like to use a silastic chin implant and these come in many shapes and sizes. I prefer to use a small incision placed under the chin which allows the patient a speedy recovery and less risk of infection then an intra-oral incision. See some experts in the field and have imaging performed to show you how chin augmentation will improve your facial aesthetics. See many before and afters in the link below and the imaging process in the video attached. Best regards, Michael V. Elam, M.D.

 Hi, I have performed many facial shaping procedures, including Chin Augmentation with dermal fillers or silastic chin implants, for over 30 years.  From the photos, your chin is extremely weak with some asymmetry (left side of the chin is smaller than the right).  When the chin is weak, this creates an imbalance making the nose appear larger, the mid face top heavy, the lower face looks short, de-emphasizes the lips and allows early formation of a "double chin".  
 Proper placement of a silastic chin implant adds forward projection to the chin thereby creating harmony and balance to the lower face.  Using the same incision, liposuction can be performed to reduce the fat and further shape the neck.  Excess skin, from below the chin, can also be removed through the same incision.  
 I have found that placement of a silastic chin implant, through a small curved incision under the chin (also allows excess skin removal) to be very safe, quick, highly effective and far less invasive than a sliding genioplasty (requires extensive tissue dissection, bone cuts and placement of metal screws and plates to secure the cut segments of bone).  I perform chin implant surgery in 30 minutes or less, often using a local anesthetic alone.  In my opinion, you are a good candidate for chin implant surgery.   There are numerous shapes and sizes of silastic chin implants, some of which are rather old shapes that do not yield the desired "natural" aesthetic results.  An experienced chin implant surgeon can select the proper shaped sized chin implant to fit your needs.  The small degree of asymmetry will become fare less noticeable with proper placement of a silastic chin implant.  No need for a custom made chin implant in my humble opinion.  Proper placement is also key.  I prefer placement of a  silastic chin implant through a small, curved incision under the chin (submental) instead of through the mouth for the following reasons:
*The submental approach is sterile while the intra-oral approach is not.
*The submental approach requires limited dissection as it is much closer to where the chin implant needs to be placed along the center (front) and lower most sections of the chin on each side (where the wings are placed).  The intra-oral approach by contrast requires dissection all the way down the entire section of the chin in order to reach the same areas for chin implant placement.  This leads to several issues in my humble opinion.  The attachment of the chin muscle to the bone must be cut during the tissue dissection, the sensory nerves (mental) and motor nerves (marginal mandibular nerve) that move the muscles of the lips and mouth) are all in much greater jeopardy of injury because of the added dissection required.  Hope this helps.