Asymmetry
One half of the face is wider, flatter or lower than the other; the cheekbone "collapsed" or protrudes.
CONDITION / FACE
Post-traumatic deformation of the face.
Post-traumatic facial deformity is a change in the shape and function of the face that remains after a car accident, fall or impact, when the fractures did not fuse properly or were not treated. It is corrected in a planned way: the bones are returned to their place, and then the soft tissues are restored.
CONCEPTUAL VISUALIZATION- What it is
- The face changed after the injury, because the bones grew out of place.
- Most often
- After a road accident, assault or fall: cheekbone, orbit, jaws, nose, forehead.
- When corrected
- Planned, after examination and CT scan; first the bones, then the soft tissues.
- Who treats it
- A surgeon who performs reconstructive operations on the bones and tissues of the face.
01 / WHAT IS ITWhat is
What is
post-traumatic deformation.
The bones of the face—cheekbones, orbital walls, jaws, nose, and forehead—hold the eyes, teeth, and soft tissues in place. If, after a fracture, the fragments have fused together with displacement, not only the appearance changes: the eye may become swollen, the teeth may not close properly, the face may become wider or flatter on one side.
This happens for various reasons: the operation was postponed due to injuries that are more life-threatening, the severity of the facial injury was not immediately assessed, the first operation did not completely return the debris to its place, or complications arose.
Facial surgery allows you to correct such changes both months and years after the injury. The general rule is to first return the bones to the correct position and only then work on the soft tissues and scars.
This is general information. The doctor will tell you what will suit you after the examination.
02 / SIGNSHow
How
deformation presents.
The changes depend on which bones were broken. Often a person is concerned not only with appearance, but also with how the eyes and jaws work.
The eye is sunken or lower
The eyeball sits deeper or lower than on the other side. Doctors call it enophthalmos.
Fractures of the orbitDoubling
Double vision, especially when looking up or to the side, because eye movements are limited.
bite
The teeth do not close as before the injury, it is uncomfortable to chew, the mouth does not open completely.
Asymmetry of the face and jawsThe nose and forehead moved
The bridge of the nose became wider, the distance between the corners of the eyes increased, there was a depression on the forehead.
Fractures of the frontal boneSoft tissues
Scarring, skin retraction, lack of volume on the cheek or near the eye.
Scars after facial injuries03 / REASONSWhy bones?
Why bones?
grow incorrectly.
Deformation is not the fault of the patient. Most often, it is related to the circumstances of the injury itself and the first treatment.
Severe injury
According to a meta-analysis of 78 studies, the most frequent cause of facial injuries is road accidents (55.37%), followed by seizures (17.56%) and falls (10.21%).
Other injuries are more important
Half of people with facial fractures (51.04% in a meta-analysis of 26,774 patients) also had a traumatic brain injury. Then the life is saved first, and the face is operated on later.
The fracture was not noticed
The severity of the facial injury was not immediately assessed, and the fracture was not treated or treated inadequately.
The first operation
The wreckage was not completely assembled, or complications arose. The cheekbone is the second most frequently broken facial bone after the nose; its deformations are the result of incomplete alignment, delayed surgery or an untreated fracture.
Fractures of the cheekbones
04 / SEEK MEDICAL ADVICE
When to seek medical advice?
If the injury is long-standing and the bones have already grown together, the deformity usually does not require emergency care — it is a planned situation. If the blow was recent, head trauma is first ruled out: according to the NHS, such signs require 103.
103 immediately if:
- the person has fainted and does not regain consciousness;
- cannot help falling asleep, eyes close by themselves;
- convulsions;
- after the injury, the vision worsened, double vision or hearing worsened;
- a clear watery liquid flows from the nose or ear;
- bleeding from the ear or bruising behind the ear;
- new numbness or weakness in any part of the body;
- impaired speech, gait or balance;
- something stuck in the wound or a dent appeared on the head;
- impact at high speed, such as in a car accident, or falling from a height of more than 1 meter or from 5 steps;
- a bruise around the eye, although there was no blow to the eye;
- behavior has changed: irritability, inattention, indifference to everything;
- after an injury or surgery in the orbit, the eye hurts, it protrudes or the eyelids do not open.
Do not delay:
Immediately to the reception department (do not get behind the wheel) after a fresh head injury, if there was vomiting, dizziness in the head, you briefly lost consciousness or you do not remember the events surrounding the injury, the headache does not go away, you are taking blood-thinning drugs, or the injury occurred while intoxicated. On the same day: if after surgery the temperature on the face rises to 38 °C or higher or pus flows from the wound - to the surgeon on the same day. In the coming days: show a fresh fracture to the surgeon without waiting for the bones to grow: it is then easier to compare them. Planned: if the injury is long-standing, and you are concerned about asymmetry, a sore eye, diplopia, or bite, make an appointment for a consultation.
05 / DIAGNOSTICSAs defined,
As defined,
what to fix
- Conversation and documents
When and how the injury occurred, what operations have already been performed; medical records, old snapshots and photos of the face before the injury, if available.
- Review
The doctor evaluates the position of the eyes and orbits, the width of the cheekbones, bite, bridge of the nose, scars and skin sensitivity.
- CT
Computed tomography shows which bones have fused with displacement and to what extent. A plan cannot be made without it.
- Vision and eye movements
If there is double vision or an inflamed eye, the condition of the eyes is evaluated by an ophthalmologist.
- Planning
For CT, the healthy half of the face is "mirrored" on the damaged one, thus obtaining a model to which the bones must be returned.
06 / TREATMENTHow to fix
How to fix
deformation
Treatment depends on which bones are affected and how long it has been. Small irregularities of the contour are sometimes leveled by simpler interventions, and a significant displacement - only by repositioning the bones. Treatment is often staged.
01
Bones
First, the frame of the face is turned.
- Osteotomy
- Bones that have fused with displacement are dissected, rearranged in the correct position and fixed with plates. This is how they correct, for example, a flattened or displaced cheekbone.
- Contour plastic
- If you need to add just a little volume to the cheekbone or other area, a graft or implant is placed on the bone without moving the bones.
- CT planning
- Virtual planning, intraoperative navigation, and individual implants help to more accurately reconstruct complex areas, including the orbit and cheekbone.
02
orbit
Inflamed eye and diplopia.
- What are they doing?
- The walls of the orbit are restored with their own tissue or an implant to restore the volume and position of the eye.
- The result
- In a systematic review of operations performed more than 30 days after injury, ptosis was corrected in 83–88% of patients, and diplopia resolved in about half (53%).
- Individual implant
- In a review of 23 studies (1,222 patients), after individual implants, persistent sunken eyes remained in 7.3% versus 18.2% with standard implants, and reoperation was required in 5.9% versus 13.7%.
03
Soft tissues
Once the bones are in place.
- Scars and retractions
- Scars are cut out and covered with local fabrics; large defects - in flaps.
- Volume
- Lipofilling — transplantation of own fat — equalizes the lack of volume. How much fat will take root varies greatly from person to person, so sometimes a repeat is needed.
04
What to expect
- Appearance
- In a series of 57 patients after secondary correction, the aesthetic result was assessed as good or excellent in the majority. The most difficult thing to fix is a wide bridge of the nose, a sore eye, and an underbite.
- time
- Results are worse if the deformity is severe, there are many changes, or more than 6-12 months have passed. In a series of 33 patients with multiple fractures who were treated late, 63.64% had a good result, 21.21% had an acceptable result.
- Repeated stages
- In the same series, 21.21% of patients required additional operations on soft tissues: they most often worsened the final appearance.
07 / AT THE VALIKHNOVSKYI INSTITUTE
How
How
we treat it.
Post-traumatic deformations of the face are treated at Dr. Valikhnovskyi's Institute of Surgery in the direction of "New face" - together with fresh fractures, the consequences of injuries and scars. If necessary, the condition of the eyes is monitored by an ophthalmologist.
CLINIC SERVICE
A new face
Form, symmetry, facial expressions and functions after injuries, wounds, burns, removal of tumors and congenital changes.
View service
What we do for this condition
- Osteotomy — bones that have fused with displacement are dissected and rearranged.
- Titanium plates — fix the rearranged debris in a new position.
- Virtual planning and 3D printing — mirror CT modeling of the healthy half of the face and surgical templates for precise cuts.
- Individualized orbital implant — restores the walls of the orbit and the position of the eye.
- Transplants and implants — a cartilage graft, own bone or implant aligns the contour of the cheekbone, orbit, forehead.
- Local and free flaps - close scars and defects of soft tissues.
- Lipofilling — own fat evens out asymmetry after reconstruction.
Rostislav Valikhnovskyi
Plastic surgeon, candidate of medical sciences, founder of Dr. Valikhnovskyi Institute of Surgery.
How treatment works with us
- Photo and CT scan onlineSend a photo of your face now and before the injury, CT images and discharges - the doctor will pre-evaluate the situation.
- ConsultationExamination of the face, eyes and bite; if necessary, a new CT scan and examination by an ophthalmologist.
- PlanWhat and in what sequence to correct, whether templates and an individual implant are needed, how many stages there will be.
- SurgeryRepositioning of bones, restoration of the orbit or contour; soft tissues — at the same or the next stage.
- RecoveryThe swelling subsides, and the scars mature gradually; the doctor assesses how healing is progressing during follow-up examinations.
08 / QUESTIONS AND ANSWERSCommon
Common
questions
Short answers. What is right for you, the doctor will tell you during the consultation.
Is it possible to fix the face if the injury was several years ago?
Yes. Improperly fused bones are dissected and rearranged, and the contour is leveled with grafts or implants. However, old and severe deformations are more difficult to correct than fresh ones.
I already had an operation after the injury. Is it possible to operate again?
Yes, repeated reconstructions are done. The doctor will evaluate the CT scan and what was done during the first surgery and make a new plan.
Will double vision pass after orbital surgery?
Not always. The sunken eye is corrected in most patients, and diplopia, according to a systematic review, has disappeared in about half. Some patients are then helped by surgery on the eye muscles or prismatic glasses.
How many operations will there be?
Depends on the deformation. Bones are often restored first, and soft tissues and scars are repaired in subsequent stages. The doctor will name the number of stages after the CT scan.
Will there be scars?
A trace of the incision always remains. Access to the bones, where possible, is done in hidden places: from the side of the mouth, along the inner surface of the eyelid, behind the hairline.
Why is it so hard on the soul after a facial injury?
It's common: Post-traumatic stress disorder, anxiety and depression are more common after facial trauma. You should tell your doctor about it.
What to bring to the consultation?
CT images (disk or link), statements about previous operations, photo of the face before the injury. If you do not live in Kyiv, you can send them for a preliminary evaluation.
Sources
16 sources · systematic reviews, meta-analyses, patient series, NHS and NICEshowCollapse
- Treatment of Post-traumatic Facial DeformitiesJournal of Maxillofacial and Oral Surgery, 2023doi:10.1007/s12663-023-01892-w ↗
- Secondary Reconstruction of the Zygomaticomaxillary ComplexSeminars in Plastic Surgery, 2020doi:10.1055/s-0040-1721761 ↗
- Applications of Preoperative and Intraoperative Technologies for Complex Primary and Secondary Facial Trauma ReconstructionOtolaryngologic Clinics of North America, 2023doi:10.1016/j.otc.2023.07.002 ↗
- Patient-Specific Implants in Post-traumatic Orbital Reconstruction: A Systematic ReviewJournal of Oral and Maxillofacial Surgery, 2026doi:10.1016/j.joms.2025.10.003 ↗
- Critical appraisal of patient-specific implants for secondary post-traumatic orbital reconstructionInternational Journal of Oral and Maxillofacial Surgery, 2022doi:10.1016/j.ijom.2021.08.027 ↗
- Resolution of Diplopia in Late Repair of Enophthalmos Following Facial TraumaJournal of Craniofacial Surgery, 2018doi:10.1097/SCS.0000000000004430 ↗
- Functional Outcomes of Late Posttraumatic Enophthalmos CorrectionPlastic and Reconstructive Surgery, 2018doi:10.1097/PRS.0000000000004600 ↗
- Late correction of orbital-zygomatic-maxillary fractures combined with orbital wall fracturesJournal of Craniofacial Surgery, 2012doi:10.1097/SCS.0b013e318266f963 ↗
- The secondary correction of post-traumatic craniofacial deformitiesOtolaryngology–Head and Neck Surgery, 2008doi:10.1016/j.otohns.2008.07.031 ↗
- Panfacial fractures: analysis of 33 cases treated lateJournal of Oral and Maxillofacial Surgery, 2007doi:10.1016/j.joms.2007.06.625 ↗
- A systematic review and meta-analysis of oral and maxillofacial traumaThe Journal of Forensic Odonto-Stomatology, 2022pubmed.ncbi.nlm.nih.gov/36623294 ↗
- Traumatic brain injuries and maxillofacial fractures: a systematic review and meta-analysisOral and Maxillofacial Surgery, 2023doi:10.1007/s10006-022-01076-9 ↗
- The psychological sequelae of maxillofacial trauma: a scoping review of the literatureBritish Journal of Oral and Maxillofacial Surgery, 2022doi:10.1016/j.bjoms.2022.09.013 ↗
- Autologous Fat Grafting in Facial Soft Tissue Defects: Application Status, Controversies and FutureAesthetic Plastic Surgery, 2025doi:10.1007/s00266-025-05269-x ↗
- Head injury and concussionNHS, 2025nhs.uk/conditions/head-injury-and-concussion ↗
- Head injury: assessment and early management (NG232)NICE, 2023nice.org.uk/guidance/ng232/chapter/Recommendations ↗
The figures on the page are from these sources.
The face has changed
after an injury?
Submit current and pre-injury facial photos and CT scans. The doctor will tell you what can be corrected and in what sequence.