Maxilla is the medical term for the cheekbone and hypoplasia is a developmental anomaly in which the cheekbone on one or both sides does not develop normally. This used to be corrected through a surgical procedure. These days, we can do it without surgical intervention. Recently, we had a patient, an American national who was

ageing gracefully until her facial asymmetry and the resultant laugh lines on her face started impacting her life. She was suffering from maxillary hypoplasia. Her face (cheekbone area) was asymmetrical from birth and the right side of her face was not in line with the left part. As the patient aged, the asymmetry became even more marked and this resulted in her smile becoming more crooked and the laugh lines on the right side of her face became a very deep furrow.
As she aged however, the defect became much more pronounced as ageing led to the fat on the cheek descending and increasing the defect. This is seen in many patients with maxillary hypoplasia. Usually this can be treated with orthognatic surgery in which the cheekbone is cut apart and bought forward to symmetrise it with the other side and then refixed with plates and screws. This is of course, major surgery and would mean that the patient would not be able to chew for a couple of weeks. Also, the swelling on her face would prevent her from flying for at least a month or more.

Cure without Surgery

Now, maxillary hypoplasia can be
rectified with a non-surgical procedure to restore the symmetry of the face. This technique uses the latest injectable filler, Juvederm Voluma.
Orthognatic surgery is major one in which the bones of the face are cut and then reunited with screws and plates, in the correct position, so that the face becomes symmetrical again. The healing time post orthognatic surgery can sometimes vary from three to six months after the procedure.
The patient did not want surgery for mild maxillary hypoplasia. We used the filler material and injected it in between two cheek muscle layers in the patient’s right cheek and filled up the volume to give the retruded maxillary bone on the right side enough volume, so that the face looked almost symmetrical. The moment this was done, the patient’s laugh lines on the right side completely disappeared.

Precautions after
Treatment

This procedure lasts about half an hour. With a thick filler like the one we used, one needs to be in the right position and the filler needs to be injected between the muscle layers with precision. If the filler is injected even one millimeter off from where it should be, the face will just look lumpy and worse than before! This procedure is also very delicate, since the concerned facial plane is full of nerves which control facial animation and movement. In such a scenario, the slightest slip can lead to the death of a crucial structure in the face, since the needle is much thicker than normal needles used on the face.
Before the procedure is done, the patient has to undergo a CT scan. Today, technology in India has changed so much all these breakthrough procedures possible.

(Dr Shome is a consultant facial plastic surgeon and head of the Institute of Aesthetic Surgery at Apollo Hospitals, Hyderabad)