Sunken face - what are my options? (Pohto)

Question

I had an overbite and crowded teeth and wore braces. I didn't have any extractions. When I put my lower braces my face slowly got sunken and now post treatment I have no idea what to do. I am 34 female

Muhsin Yilmaz, MD, FEBOPRAS · Answer

At 34, if the main change you are noticing is a sunken or flattened midface, I would consider a midface lift as an option worth evaluating.
A midface lift can reposition the descended cheek tissues and restore better support and definition to the central face. This may be more appropriate than a full facelift at your age if the main concern is limited to the midface.
Of course, an in-person assessment would be necessary to determine whether the issue is primarily tissue descent, volume loss, or both.

Serdar Bora Bayraktaroglu, MD · Answer

A sunken face after braces is often caused by dental retraction reducing soft-tissue support. At 34, several targeted solutions can restore facial harmony:Orthodontic Review: Consult a specialist to see if gentle arch expansion or forward tipping can restore natural lip and cheek posture.Structural Fillers / Sculptra: Strategic deep-injection recreates bone scaffolding at the base of the nose and cheeks.Fat Grafting: Provides a permanent soft-tissue volume fix.Surgical Options: A customized chin implant or maxillofacial assessment can permanently re-establish lower facial projection.Consult a specialist to determine your ideal approach.

Semih Yildiz, MD, FEBOPRAS · Answer

From the photo, the concern appears to be mild hollowing around the midface and mouth area rather than loose skin. Braces usually do not remove facial fat, but changes in bite, tooth position, lip support, and facial muscle posture can make the lower face look different. It is worth having your orthodontist or a maxillofacial specialist confirm that the bite and jaw position are stable.

Cosmetic options may include conservative hyaluronic acid filler or biostimulatory filler to the cheeks, nasolabial area, and prejowl/perioral region, or fat grafting if a longer-lasting volume correction is needed. I would avoid aggressive filling and would not think of a facelift first at your age unless there is true skin laxity on exam. An in-person facial analysis is the best way to decide what is volume loss, dental support, or soft-tissue descent.

John Michael Thomassen, MD · Answer

Fat grafting to the submalar area can help improve this.  It may need a 2nd treatment 8-12 months later but it can look quite natural.  Sculptra is another option.

Ahmad N. Saad, MD, FACS · Answer

It is common to see facial changes after bite correction whether with braces or bone reconstruction. I recommend you see a plastic surgeon for an unperson evaluation in order to precisely evaluate these changes and your objectives.

Goretti Ho Taghva, MD, FACS · Answer

Thank you for your question. It's not uncommon to observe changes in the lower face shape following orthodontic treatments like braces. The adjustment of teeth alignment can sometimes impact the overall facial aesthetics, potentially leading to what you've described as a 'sunken' appearance.

The good news is that there are effective cosmetic approaches to address this concern. A popular and minimally invasive option is the use of dermal fillers. Fillers can help restore lost volume and improve facial contours. In particular, Sculptra, which is a poly-L-lactic acid-based filler, or Hyaluronic Acid (HA) fillers, are excellent choices. They can provide a natural and rejuvenated look, subtly enhancing the facial structure affected by orthodontic treatment.

If you're seeking a more durable solution or if fillers do not achieve the desired outcome, fat transfer is another option. This procedure involves using your own body's fat, harvested from another area, to add volume to the face. It's a natural, longer-lasting alternative that can provide significant improvements in facial fullness and symmetry.

I recommend a personalized consultation to assess your specific needs and determine the most suitable treatment plan. It's important to consider all options and choose what aligns best with your aesthetic goals and lifestyle.

Mats Hagstrom, MD (license on probation) · Answer

To make it quality assessment, we need quality pictures.
It would also be very important to understand if you’ve had any previous procedures other than the dental work you describe.
From the information included I’m guessing volume augmentation with the use of fillers is most appropriate.
Quality assessment requires quality information.
I suggest having multiple in person consultation with plastic surgeons in your community.
 Based on your description, you may want to consider consulting with oral surgeons as well. A lot of facial aesthetics are directly related to facial bone structure, and this impacts each individual persons facial appearance in a major way.
In fact, each individual persons, unique facial appearance is not so much based on soft coverage as it is facial bone structure. It is bone structure that gives each individual person, their unique facial appearance.
 And that says oral surgeons can sometimes shed great insight into getting quality assessment, and better understanding of why someone looks the way they do.
Best,
Mats Hagstrom, MD.

Sunken face - what are my options? (Pohto)

Answers (7)

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