Facial Skeleton Disproportion Correction 

Correction of Facial Skeleton Disproportions

Facial skeleton disproportions are mismatches in the size, position, or shape of individual anatomical facial structures: the upper and lower jaws, cheekbones, orbits, and chin. The causes may be congenital, related to developmental anomalies, acquired, resulting from trauma, surgery, or disease, or constitutional.

Unlike isolated bite correction, correction of facial skeleton disproportions is a comprehensive task that requires planning the entire face as a single system. This is the approach used at Iskusstvo Clinic in Moscow: surgeons trained in the school of Professor A.I. Nerobeev evaluate not an isolated anomaly, but facial harmony as a whole.

What Is Considered a Facial Skeleton Disproportion

Mismatch between the size of the upper and lower thirds of the face

Asymmetry, meaning a difference in height or width between the right and left halves of the face

Underdevelopment or excessive growth of the midface, including the upper jaw and cheekbones

Profile mismatch, meaning protrusion or depression of different structures in the sagittal plane

Abnormal facial height, such as a “long face” with vertical excess or a “short face” with vertical deficiency

Combined anomalies, when the proportions of several areas are affected at the same time

Principles of Planning

Comprehensive correction of disproportions begins with a detailed analysis: CT imaging of the facial skeleton with three-dimensional reconstruction, cephalometric analysis, and photographic documentation in standardized projections.

Based on these data, a digital model of the future result is created through Virtual Surgical Planning, or VSP. The patient and surgeon can see the predicted changes before surgery.

The key difference between planning for disproportions and standard orthognathic treatment is the need to consider several structures at the same time and find a solution that is harmonious for the entire face.

Sometimes the optimal result is achieved not by maximally moving one bone, but by balanced correction of several structures.

Surgical Methods

Bimaxillary Osteotomy

This is simultaneous surgery on the upper and lower jaws. It makes it possible to correct both the anteroposterior and vertical positions of both jaws.

It is the most powerful tool for changing facial proportions.

Osteotomy with Genioplasty

Adding chin correction to jaw osteotomy allows the lower third of the face to be adjusted more precisely.

Often, even a small genioplasty significantly improves the overall result.

Midface Correction

In cases of underdevelopment or asymmetry of the cheekbones, osteotomy of the zygomatic complex with repositioning may be performed, or contour plastic surgery may be used with autografts or custom implants.

The choice of method depends on the nature and severity of the deformity.

Distraction Osteogenesis

In cases of significant bone deficiency, for example in hemifacial microsomia, one-stage movement is limited by the capacity of the soft tissues.

In these cases, distraction osteogenesis is used. This is gradual bone lengthening with a distractor that the patient activates independently every day.

The method makes it possible to achieve movements that are not possible with standard osteotomy.

Treatment Stages

Correction of pronounced disproportions is usually a multi-stage process. The first stage may be aimed at correcting functional disorders, such as normalizing the bite or improving breathing, while later stages focus on improving the aesthetic result.

Each stage is planned with the entire treatment plan in mind, so that every intervention contributes to the overall result.

When orthognathic surgery is combined with orthodontic treatment, the full plan is discussed jointly by the surgeon and orthodontist during the initial consultation.

Rehabilitation

Rehabilitation timelines depend on the scope of surgery. After bimaxillary osteotomy with genioplasty, hospitalization usually lasts 5–7 days, a soft diet is required for 6–8 weeks, and return to work usually takes 2–4 weeks.

The final result forms within 6–12 months.

Contraindications

Contraindications include incomplete growth of the facial skeleton, except in cases with functional indications, severe systemic diseases in the stage of decompensation, uncorrectable blood clotting disorders, and active infectious processes.

The full list of contraindications is determined individually by the surgeon.

Frequently Asked Questions

How Is Correction of Disproportions Different from a Standard Orthognathic Operation?

A standard orthognathic operation primarily normalizes the bite. In facial disproportions, the task is broader: harmonization of the entire face.

This requires more detailed planning, often non-standard surgical decisions, and consideration of the patient’s aesthetic wishes.

Can Surgery Help with Facial Asymmetry?

In skeletal asymmetry, yes. If asymmetry is caused by a difference in the position or size of the bones, surgical correction can significantly improve symmetry.

In soft tissue asymmetry, soft tissue correction is additionally planned. A precise answer is possible only after CT imaging and an in-person examination.

Is Orthodontic Treatment Needed If Only Aesthetic Disproportions Are Being Corrected?

If the bite is normal and the goal is only aesthetic correction, for example correction of the chin or midface without changing the bite, orthodontic treatment may not be required.

This is decided during the consultation.

What Does the Virtual Planning Process Look Like?

Based on CT data, a three-dimensional model of the skull is created. On this model, the surgeon “performs” the operation virtually: moves the bones and sees the predicted changes in the facial soft tissues.

The result of this modeling is discussed with the patient and serves as the basis for manufacturing surgical guides.

Book a Consultation

Book a consultation. The surgeon will assess facial proportions, explain the correction options, and create an individual plan.