I am 30 years old, seeking functional/cosmetic rhinoplasty & fat transfer to balance asymmetry caused by combo of fat atrophy that got worse over period of 3-5 years that became even more noticeable after orthognathic surgery on both upper and lower jaws.
**picture attached, I refer to left as YOUR left not mine.
1.) I've been suffering from TMJ issues for over 8 years and sought various forms of dental treatment that may or may not have had anything to do with significant volume loss in my face. I personally did not start to notice the volume loss until age 27 when I began orthodontic treatment & had my wisdom teeth removed in preparation for the jaw surgery (I had no actual problems with my wisdom teeth) . Some doctors have said it resembles mild Parry-Rombarg syndrome, but there is no way to confirm this. They only reference this syndrome because they have no way of knowing why I experienced such extreme volume loss in my 20s over a quick period of 3 years.
The fat loss is on both sides, but not symmetric. It is extreme in the buccal area on the left side, making that cheek appear extremely prominent. And both temples are extremely sunken in. I have always had a long oval face, but now it is extremely long and narrow due to the buccal area diminishing so much.
Along with the fat loss on the left side, I experienced facial drooping of my eyebrow, nose, and lip, possibly due to no loss of structural foundation to help keep it up? I'm not sure.
2.) My jaw surgery was done almost 1 year ago. My upper jaw was moved upward and lower jaw forward. This means a cut was made in the mandible to move it forward. Because I had such extreme volume loss on the left side, the cut made there can now be seen in addition to the deflated look of the cheek. And it is a very drastic cut. I basically have a huge, sharp, very noticeable dent in my jawline.
It looks like a chunk of my face was removed, or deflated, on the left side, also making my face look lopsided. Basically the entire masseter region has no fat over it.
The right side's dent (where the cut was made) can be seen only slightly, however the area still looks gaunt.
3.) The upper jaw movement affected the position of my nose, now making it very hard to breathe. I already had my deviated septum fixed previously, but now am being told I need to have it done again as it is crooked yet again. I also can't breathe out of my nose.
**In the picture, it may appear that I am slightly turned, but that is an illusion due to my face being lopsided. I am actually looking and sitting straight on. I apologize that the dent cannot be seen in these pictures and the bright lighting is somewhat masking the deflated look.
1.) Can fat grafting help me when my volume loss is a result of trauma rather than typical aging?
2.) Can fat grafting smooth my jawline with the noticeable dent without a facelift?
3.) During my jaw surgery, small plates and screws were placed in my face. Does this complicate anything in terms of injecting?
4.) Where would you personally inject fat to achieve balance in a case such as mine? I have read that you tend to inject fat around the entire face rather than spot filling. The surgeon I have been seeing says he would mainly attempt to fill out the deflated area, jawline, and temples, but no where else. What is your opinion of that strategy?
5.) Do you recommend waiting to get the rhinoplasty before or after the fat transfer? Is it okay to do it at the same time? Any benefits to waiting or it doesn't matter?
6.) I live in San Francisco, CA. I am very scared and overwhelmed over how to fix my situation. I have read horror stories about being overfilled, about asymmetric fat resorption, fat forming lumps or "roping" around the eyes and cheek area, etc. Considering my past trauma, am I to expect asymmetric resorption? How does technique avoid this, or at least attempt to avoid it?
It would be too hard for me to commute to Dallas to see you, but I was hoping you could possibly guide me in finding a trustworthy surgeon to perform the fat transfer. Even better if you have recommendations of actual doctors.