A midface deficiency can put a damper on anyone’s facial aesthetics, but what exactly is a midface deficiency, and how can it be treated?
Midface deficiencies refer to an underdeveloped or set back maxilla, which can cause cosmetic and medical issues. The causes can be hereditary or stem from habits. The cause and severity of the recessed maxilla will determine the treatment.
Midface deficiency refers to when the midface/maxilla is recessed. Recession refers to a cavity or space, and a recessed maxilla means that the maxilla is underdeveloped or set back.
The maxilla bone is the upper jaw, but it also includes the lower half of the eye sockets and the cheeks. The maxilla recession often causes several cosmetic issues, such as flat cheekbones, a low hyoid bone, and a “bug-eyed” look.
It is also common for people with midface deficiencies to look like they have an overly prominent jaw if their mandibles grew normally. Their normal-sized lower jaw would look very large in contrast to their underdeveloped upper jaw.
Other than cosmetic issues, it can also cause many medical problems. A midface deficiency can lead to breathing obstructions because a midface deficiency often comes with a narrow palate, which is the roof of the mouth but the base of the nasal cavity. An underdeveloped maxilla does not leave enough room for sinus tissues and easy nose breathing. This decreases the passage of air, making a person breathe through their mouth instead of their nose.
Another example is that recessed maxillas often lead to dental issues like misaligned bites. For example, you would likely have an underbite or crossbite if your mandible grew normally while your maxilla is underdeveloped.
Recessed/Deficient Maxilla vs. Down-Swung Maxilla
A recessed or deficient maxilla and a down-swung maxilla are used interchangeably but refer to different things.
A recessed maxilla, or a maxillary deficiency, refers to a maxilla that did not grow enough relative to the rest of the face. Its outward appearance is retruded from a side profile:
A downswung maxilla is a maxilla that developed normally but became downswung due to craniofacial dystrophy. A downswung mandible also accompanies it.
In general, the medical community does refer to the normal craniofacial dystrophy that happens with age as “a recessed maxilla.” A true recessed maxilla is one that did not grow to its full size. However, the maxilla does, in fact, retrude in a downward and backward direction with craniofacial dystrophy, so the terms are often used interchangeably.
Symptoms of a Midface Deficiency
Maxillary recession often leads to visible facial symptoms, which include:
- Flat cheekbones
- Malocclusion (misaligned teeth)
- Thin upper lip
- Prominent-looking nose
- Pronounced lower lip
- Bug-like eyes
Since midface deficiencies often cause malocclusions, some symptoms a person can experience include:
- Mouth breathing
- Teeth grinding
- Sleep apnea
- Excessive wear of the tooth enamel
- Discomfort when you chew
- Frequently biting the tongue or cheek
Causes of Midface Deficiency
A recessed maxilla can be a sign of an underlying condition. However, it could also be mild and may not accompany different medical issues.
A person can have a midface deficiency because of a single cause, but it is also possible for them to have it because of a mixture of causes. Some causes of a recessed maxilla include:
Childlike habits can often lead to an underdeveloped maxilla. For instance, years of thumb sucking as a child can make you have a down-swung maxilla.
The action makes the muscles around the mouth forces the upper jaw to become narrow. It makes the palate have a V-like shape rather than a horseshoe one. Additionally, it can make your cheeks cave in.
Mouth breathing is another habit that can cause a down-swung maxilla. There will be a lack of support to your palate from your tongue when your jaw hangs open, making you have sunken cheekbones.
Additionally, years of thumb sucking can make a person breathe through their mouth. Their narrow palates make it difficult for them to breathe through their noses, so they may opt to breathe orally instead.
In some cases, a recessed midface can be from your genetics. While bad habits like thumb sucking and mouth breathing can take a toll on your face, genetics still play a major role in your general face shape.
One study that looks at twins and their facial shapes concluded that around 75% of facial shape variance depends on their genetics (Richmond et al., 2018). For instance, a parent would likely have a recessed maxilla if you have a midface deficiency.
Some people may carry a gene that makes them predisposed to getting a more severely recessed maxilla. For instance, maxillofacial dysostosis is a rare genetic disorder that causes an underdeveloped maxilla, speech abnormalities, etc.
Some syndromes can also cause improper maxilla growth, such as Angelman syndrome and fetal alcohol syndrome.
Facial trauma is another potential cause of an underdeveloped maxilla. Facial trauma when you are young can affect your development, leading to a weaker midface.
Does a Recessed Maxilla Cause Health Risks?
There may not be health risks for people who have mildly recessed maxillas. However, moderate to severely recessed upper jaws can lead to obstructed breathing, speech issues, difficulty eating (from malocclusions), etc.
Treatment for Midface Deficiency
Treatment for a recessed midface greatly varies on what caused it. Here is a quick look at what can treat midface deficiencies.
If you have a mild maxilla recession that does not affect your health, you can opt for a simple cosmetic fix. Dermal fillers are an excellent and non-invasive way to add volume to your midface.
Most natural fillers are made of materials like hyaluronic acid, which naturally dissolve in your body. You can see the effects of your filler for about 6-15 months.
There are semi-permanent and permanent fillers also available. The semi-permanent ones can last for several years. However, you will have to get surgery to remove permanent fillers if you do not want them anymore.
Orthodontic headgear is a device that people wear outside of their mouths to correct bite and jaw irregularities, including a recessed maxilla. It is more common for children to wear headgear because their teeth and jaws are still developing.
Most people wear reverse-pull facemasks to correct underdeveloped upper jaws. The device usually works because it has elastic bands connected to braces. Most people will need to wear this for at least 12 hours a day.
MSE stands for Maxillary Skeletal Expander. It is a device that expands your palate over time.
There are different kinds of expanders. Some surgeons can simply fit an expander between your palate. However, adults may need to get theirs surgically inserted because their maxillas are harder.
Each device usually comes with a small key. The patient will use the key to slightly turn the expander once a day to make the device larger and further expand your palate.
Most people only need several months to expand their palates. However, they may still need to wear the expander for several more months to maintain their new jaw size. It gives your palate time to create a new bone between your palate to avoid relapsing.
While MSE may not directly fix your recessed maxilla, it could fix problems that your maxilla caused. An MSE expands your palate, which could help realign your teeth and help you breathe better by opening your airways.
Surgery for Midface Recession
More severe cases of recessed maxillas will likely require surgery. Some people may opt for surgery even if they are not that severe for cosmetic purposes.
For more mild or moderate cases that simply need a cosmetic procedure, then you can get implants. Implants can add more volume to your midface, enhancing your overall facial appearance.
In some cases, a surgeon may perform recessed maxillary surgery to correct facial recession. Orthognathic surgery can help treat jaw irregularities by pulling it forward or backward, and it could also make it wider. In the case of facial recession, pulling the upper jaw forward and widening it is common.
Generally, most procedures for a recessed upper jaw will involve cutting the jawbone and realigning them into the proper position. A surgeon may use rubber bands, wires, screws, or bone plates to keep the jawbone in the new position.
The exact technique a surgeon will use will depend on your case. For instance, a Le Fort I osteotomy cuts high in the cheekbone area can help enhance the cheekbones.
Another technique that can fix maxilla hypoplasia is an anterior maxillary distraction, which can also treat cleft lips and palates (Srivastava et al., 2015).
Can These Surgeries Correct a Down-Swung Maxilla?
These surgeries normally address recessed maxillas. For instance, LeFort surgery is normally done to correct a recessed maxilla.
However, it can be trickier to correct a down-swung maxilla that would come from thumb sucking, mouth breathing, etc. Your options may be more limited, but some people see great progress when trying techniques like mewing (see below).
Depending on your age and how “down-swung” the face and maxilla is, you could potentially correct a down-swung maxilla with devices like MSE.
Can Mewing Fix Midface Deficiencies?
As stated earlier, bad habits like mouth breathing and thumb sucking can cause recessed maxillas. Many parts of mewing involve doing the exact opposite of those habits, but would that correct a midface deficiency?
In many cases, mewing can correct a recessed midface. Mewing focuses on putting consistent pressure on your palate, which your palate would have lacked if you breathe through your mouth.
Most people can get more prominent cheekbones when they mew consistently. The pressure on your palate from your tongue will move your midface up and forward. It could also enhance your eyes since moving the midface up will add more support to your eyes.
The results will depend on your consistency and age. Most children can see results within months, whereas teenagers can see results after 1-2 years. Adults can still see results, but they may only see obvious results after 2-4 years.
However, mewing is more than simply resting your tongue flat on your palate all day. There are a lot more details that you need to know about to effectively mew.
Click here to learn how to mew properly.
Is It Possible to Fix a Midface Deficiency as an Adult?
Adults often feel like they lack options compared to children. But most people can fix their midface deficiency, even as adults.
Most children can opt for MSE, headgear, etc. While those options are still available for adults, they may take longer or need surgery to wear the device (for instance, surgically assisted maxillary expanders).
Adults will likely need to get surgery to get quicker and more significant changes in their midfaces. As stated earlier, adults can still mew to enhance their overall face, but the results will take a while to be noticeable.
Is There a Way to Prevent Upper Jaw Recession?
You can try ways to prevent furthering your recessed maxilla if it is mild. If you are young or have a child and want to prevent maxilla recession, you could also try these methods.
While mewing can counteract the results of a recessed face, you can also try mewing to enhance your face before it gets to that point. You tend to see quicker results when you do this because you are only enhancing your face, not correcting and enhancing it.
Children often see the most visible and quick results from mewing. If you can teach a child how to properly mew, it can become second nature to them fast. They can carry that habit into their adulthood without overthinking it.
While mewing helps you breathe through your nose, it would be good to remember to breathe nasally as much as possible. You should always use your nose to breathe whether you decide to mew or not.
If you are used to mouth breathing, focus on keeping your lips sealed and your teeth close to each other (but do not let them touch). Keep your head and neck straight, then inhale and exhale slowly through your nose. It may take some time to get used to, but eventually, it will become normal for you.