What's the best treatment for flat face / possible recessed maxilla? (photo)

Question

When I was younger I had a slight underbite where my teeth would perfectly line on top of each other and my upper jaw did not have enough room for my canines to grow out. I got braces and expanders but now my top 4 teeth slant slightly outward. For this reason I believe I have a recessed maxilla that makes my face and apples of my cheek, appear flat when I'm at rest. What type of treatment would be ideal? I've been considering cheek implants, filler, or last resort jaw surgery.

Kyle Kimura, MD · Answer

Thanks for the great question and photos! 
While it is hard to definitively diagnose the issues from the photos, my suspicion given history of dental issues is you may have some bony facial asymmetries. A CT scan of the face may better unveil contributing factors and give better idea possible treatment options. In general, options would include something temporary like filler, midface/maxillary implant, or bony surgery like midface advancement (with oral surgeon). I think your best first step would be to schedule a consultation and get imaging to determine which option is best for you. 
Hope this helps and best of luck!Kyle Kimura, MD

Steve Laverson, MD, FACS · Answer

Before any type of medical or surgical treatment, one must know what the "problem" is, i.e. the diagnosis.  Otherwise, treatment may be incomplete, temporary, misdirected, or to accentuate the problem.  Consider formal evaluation with cephalometric analysis by maxillofacial or craniofacial specialist.  Then, if indeed there is a relationship you wish adjusted or improved, consider your treatment  choices in the context of clearly understood objectives.

Andre Panossian, MD · Answer

Thanks for your question. In looking at your side profile view, it would seem that the base of your nose is slightly behind the facial plane, which can give you the retruded maxilla look that you're concerned about. The point where your nasal base meets your lip is recessed and the angle is too acute. Often, a maxillary augmentation with an implant is the ideal way to open up that angle and improve the overall look of the midface. The incision is through the base of the nostril and is concealed very nicely. I will often combine it during rhinoplasty when I see someone with the same issue. I would recommend holding off on fillers, cheek implants, etc until you have corrected the main problem. Once that has been corrected, the face can be properly re-evaluated and additional recommendations given. Read about facial implants on DrPanossian.com.

What's the best treatment for flat face / possible recessed maxilla? (photo)

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What's the best treatment for flat face / possible recessed maxilla? (photo)

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