Management Plan for Progressive Hemifacial Asymmetry with Decreased Cheek Bulk

Classification and Analysis

• The patient's presentation falls into category (f) of facial asymmetries: "More pronounced facial asymmetry sometimes associated with cheek flattening and slanting of the whole midface to one side" 1, 2
• Systematic analysis should divide the face into horizontal thirds (upper, middle, and lower) to better conceptualize the deformity and plan appropriate interventions 3, 2
• Assessment should include evaluation of facial width differences, orbital level differences, rotation displacement of upper jaw/piriform aperture, and alar base position 1

Management Approach

• Obtain 3D-CT maxillofacial scan to accurately assess the skeletal discrepancies and soft tissue deficiency 4
• If skeletal discrepancy is identified, orthognathic surgery such as LeFort I osteotomy may be required to correct maxillary asymmetry 4

Potential Pitfalls and Caveats

• Patients with facial asymmetry often have complex three-dimensional discrepancies that require careful surgical planning 4
• Camouflaging techniques alone may be insufficient for progressive cases, and structural correction is often necessary 5