Loading
Procedure guide · Reconstructive Plastic Surgery
Facial Trauma ReconstructionFacial trauma reconstruction repairs broken facial bones and the soft tissue over them after an injury. Most fractures are fixed within 1 to 2 weeks, before the bone begins healing in the wrong position, using small plates and screws through hidden incisions. The bite is the reference point that everything else is set against, and correcting a face that has healed crooked is far harder than fixing it early.
Facial trauma reconstruction repairs broken facial bones and the soft tissue over them after an injury. Most of it is urgent rather than elective, which makes it unusual on this site, and the reason is biological: facial bones begin knitting within about 2 weeks, so the window for realigning them precisely is short. A fracture fixed inside that window can usually be restored to its original position. The same fracture treated at 3 months has healed crooked and has to be re-cut, which is harder, less predictable and rarely as good.
That timing pressure is why anyone with a facial injury causing an altered bite, double vision, a flattened cheek or a clearly deviated nose should be assessed promptly rather than waiting to see how it settles. Swelling complicates the picture, since a face swollen immediately after injury cannot be assessed properly and operating into severe swelling makes accurate positioning difficult. Surgeons therefore frequently wait a few days for swelling to subside, which is a deliberate judgement rather than a delay, and imaging in the meantime shows what the swelling hides.
The reference point for most facial fracture surgery is the bite. Where the jaws are involved, the teeth are brought into their correct relationship first and the bones are then fixed to match, because a face that looks symmetrical but cannot chew properly is a failed repair. That is why jaws are sometimes temporarily wired or held with elastics during surgery, and why serious facial trauma care includes a dental assessment. Patients frequently notice a change in their bite before they notice anything about their appearance.
Fixation is with small titanium plates and screws placed through hidden incisions, usually inside the mouth or in natural creases such as the lower eyelid or the hairline. The plates are designed to stay permanently, most people never notice them, and they do not meaningfully affect airport security. They are removed only if they become infected, if they are palpable and uncomfortable in a thin area, or occasionally in children where they could interfere with growth.
Orbital floor fractures deserve separate description. A blow to the eye transmits pressure downward and can blow out the thin floor of the socket, allowing tissue and occasionally muscle to herniate into the sinus below. That causes double vision and, as swelling settles, a sunken eye. Not all need surgery: repair is considered where there is significant double vision, trapped muscle, or enough displacement that the eye will visibly sink. The repair is done through a hidden incision inside the lower eyelid with a thin implant rebuilding the floor.
Numbness is the complication patients most often forget they were warned about. Sensory nerves supplying the cheek, upper lip, lower lip, chin and gums run directly through the commonest fracture lines, so they are frequently stretched or bruised by the injury itself as well as by the repair. It usually improves over 3 to 6 months and a small permanent patch is common. It is a consequence of the injury as much as of the surgery.
One aftercare instruction is worth understanding rather than simply following. After fractures involving the sinuses or the orbital floor, blowing the nose forces air into the tissues around the eye, producing sudden dramatic swelling. It is usually harmless and it is frightening, and it is why patients are told not to blow their nose and to sneeze with their mouth open for a couple of weeks.
The implication for this site is straightforward. Acute facial fractures are treated where the injury happens, because the window is short and assessment needs imaging and frequently a dental opinion. What does travel is secondary correction of a face that healed badly, which is planned surgery rather than emergency care. For that, bringing the original imaging and operation notes matters enormously, because correcting a healed fracture without knowing how it was first treated is considerably harder.
Facial trauma reconstruction begins long before the face is addressed. The immediate priorities in any significant facial injury are the airway, which can be threatened by bleeding or by a displaced jaw, then bleeding itself, then the cervical spine and any head injury. Facial fractures are almost never the thing that endangers life, and they wait until those questions are answered. Understanding this order explains why someone can be in hospital for several days before anyone discusses the shape of their face.
Facial trauma reconstruction is now planned from a CT scan in almost all cases, with fine slices reconstructed into a three-dimensional model. It shows the full pattern of a fracture in a way plain X-rays never did, which matters because facial fractures rarely occur singly: a blow that breaks a cheekbone frequently also breaks the eye socket floor and the wall of the sinus. Planning from the whole pattern rather than the obvious fracture is what prevents a corrected cheekbone sitting on an uncorrected orbit.
Facial trauma reconstruction outcomes depend heavily on the first operation. A fracture fixed accurately within the first 2 weeks generally heals in the right position and needs nothing further. The same fracture fixed poorly, or left, needs the bone re-cut and repositioned months later, which is a bigger operation with a less predictable result. This is why surgeons are firm about timing and why a second opinion, if it is wanted, should be sought within days rather than weeks.
Facial trauma reconstruction carries a psychological weight that is frequently underestimated. Many of these injuries happen in circumstances that are themselves traumatic, including assaults and road collisions, and a proportion of patients develop post-traumatic symptoms that have nothing to do with how the face looks. Specialist units screen for this. Anyone recovering from facial injury who finds themselves avoiding mirrors, avoiding going out or reliving the event should treat that as part of the injury rather than as a separate weakness.
Facial trauma reconstruction rests on the principle of restoring the buttresses, the thicker struts of bone that run vertically and horizontally through the face and carry the forces of chewing. The midface is otherwise a light framework of thin bone around air-filled sinuses, and it is the buttresses that determine facial height, width and projection. Fixing these accurately with small titanium plates is what restores facial shape; the thin bone between them matters much less.
Facial trauma reconstruction outcomes are assessed on 3 things in follow-up: whether the bite meets correctly, whether vision and eye movement are normal, and whether the face is symmetrical. The first 2 are functional and take priority. A bite that is 2 millimetres out is felt constantly and is the most common cause of dissatisfaction after jaw fractures, which is why it is checked at every visit in the early weeks.
Facial trauma reconstruction frequently involves damage to structures other than bone, and these can be missed in the initial assessment. The facial nerve, the parotid duct, the tear duct and the nerves supplying sensation to the cheek and the lip all run through the injured field. A numb lip or cheek after a jaw fracture is common and usually improves over months. Weakness of facial movement or a persistently watering eye needs specific assessment rather than waiting.
Facial trauma reconstruction that has already healed badly is corrected as a secondary procedure, and the results are usually worthwhile even years later. Malunited fractures can be re-cut and repositioned, an enophthalmic eye can be brought forward with an orbital implant, and a deviated nose can be straightened. These are planned operations with the benefit of digital planning and no time pressure, so anyone left with a problem after an injury treated elsewhere is not out of options.
Surgeons look for these points at the consultation.
Facial trauma reconstruction suits people with displaced facial fractures, an altered bite, double vision, a sunken or flattened facial contour, or soft tissue injuries needing repair, assessed with appropriate imaging and treated within the window before the bone heals in the wrong position.
Reasons a good surgeon will ask you to wait or choose something else.
Facial trauma reconstruction is deferred where the patient is unstable from other injuries, where swelling is too great to judge position, in active infection at the operative site, where a head or eye injury takes precedence, and where a minimally displaced fracture will heal well without surgery.
Ask your surgeon which technique they recommend for you and why.
Fracture fragments are exposed through hidden incisions, realigned and held with small titanium plates and screws that usually stay in permanently.
A thin implant is placed to rebuild the floor of the eye socket where it has been blown out, releasing trapped tissue and restoring eye position.
A displaced bone, most often the nose, is pushed back into position without an open incision, usually within the first 2 weeks.
Where a fracture has already healed in the wrong position, the bone is re-cut and repositioned, sometimes with grafts to replace lost volume.
Step by step, from arrival to discharge.
CT scanning shows what swelling hides, with a dental assessment where the jaws are involved and an eye assessment where the orbit is.
Usually within 1 to 2 weeks, frequently after a few days for swelling to settle, since accuracy matters more than speed within that window.
Where the jaws are involved, the teeth are brought into their correct relationship first and the bones fixed to match rather than the reverse.
Fragments exposed through hidden incisions, realigned and held with small titanium plates and screws that usually stay permanently.
A thin implant rebuilds the floor of the eye socket through an incision inside the lower eyelid, releasing trapped tissue and restoring eye position.
Soft diet where the jaw is involved, eye checks after orbital surgery, and review at 3 months once swelling has settled enough to judge contour.
Frequencies follow published guidance; your personal risk depends on your health and the surgeon.
Timing dominates facial trauma reconstruction in a way it does not dominate anything else in this category. Facial bones begin knitting within about 2 weeks, so the window for realigning them precisely is short. A fracture fixed within that window can usually be restored to its original position; the same fracture treated at 3 months has healed crooked and must be re-cut, which is harder, less predictable and rarely as good. Anyone with a facial injury causing an altered bite, double vision, a flattened cheek or a deviated nose should be assessed promptly rather than waiting to see how it settles.
Swelling complicates that timing, because a face swollen immediately after injury cannot be assessed properly and operating into severe swelling makes accurate positioning difficult. Surgeons therefore often wait a few days for swelling to subside, which is a deliberate judgement rather than a delay. Imaging, usually a CT scan, shows what the swelling hides.
The reference point for most facial fracture surgery is the bite. Where the jaws are involved, the teeth are brought into their correct relationship first and the bones are then fixed to match, because a face that looks symmetrical but cannot chew properly is a failure. That is why jaws are sometimes temporarily wired or elastically fixed during surgery, and why a dental assessment is part of serious facial trauma care.
Numbness is the complication patients most often forget they were warned about. Sensory nerves supplying the cheek, upper lip, lower lip, chin and gums run directly through common fracture lines, and numbness after injury and after surgery is very common. It usually improves over 3 to 6 months and can be permanent in a patch. It is an expected consequence of the injury as much as of the repair.
Numbness of the cheek, lip, chin or gum where sensory nerves run through fracture lines. It frequently improves over months and can be permanent.
The bone healing slightly out of position, leaving asymmetry of the cheek, nose or jaw. Correcting it later is considerably harder than positioning it correctly at first.
Teeth not meeting correctly after jaw fracture fixation, which affects chewing and is one of the main reasons the bite is used as the reference during surgery.
Persisting or occasionally worsening after orbital floor repair, caused by muscle scarring or an implant sitting imperfectly.
Plates becoming infected, palpable or uncomfortable, particularly in thin areas, which may require a second operation to remove them.
Infection at a fracture site, more likely where fractures communicate with the mouth or sinuses, and more likely in smokers.
Bleeding behind the eye after orbital surgery raising pressure on the optic nerve. It is rare, it is an emergency, and it is why eye checks follow orbital repair.
The first few days after facial fracture surgery are dominated by swelling, which peaks at around 48 to 72 hours and makes the result impossible to judge. Bruising spreads downward with gravity, frequently into the neck and chest, which alarms people who were not warned. Ice, sleeping propped up and avoiding anything that raises pressure in the head, including bending forward and blowing the nose, all help.
Blowing the nose deserves a specific mention after fractures involving the sinuses or the orbital floor, because it can force air into the tissues around the eye, causing sudden dramatic swelling. It is usually harmless but it is frightening, and the instruction not to blow the nose for a couple of weeks is one worth following precisely.
Where the jaw is involved, diet becomes the main restriction. Soft or liquid food for anywhere between two and 6 weeks depending on the fracture, and meticulous mouth hygiene where incisions were made inside the mouth. Weight loss over that period is common and worth planning for with high-calorie soft foods rather than discovering.
Numbness of the cheek, lip, chin or gums is expected and improves slowly over 3 to 6 months, sometimes leaving a permanent patch. Contact sport waits 6 to 12 weeks depending on the fracture, and returning early risks displacing a healing repair. The contour cannot be honestly judged until swelling has fully resolved at around 3 months.
Days 1-3
1 to 2 nights for most fixations. Swelling peaks at 48 to 72 hours. Eye checks follow orbital surgery. Soft diet where the jaw is involved.
Days 4-14
Soft or liquid diet for 2 to 6 weeks after jaw fractures. Mouth hygiene matters where incisions are inside the mouth. Flying is usually cleared at around 10 days.
Weeks 3-6
Return to desk work at around 2 to 3 weeks. No contact sport for 6 to 12 weeks depending on the fracture. Numbness begins improving.
Months 2-6
Chewing returns to normal. Swelling resolves and asymmetry becomes assessable. Numbness continues improving.
Months 6-12
Bone is fully healed and the contour settled. Any secondary correction or scar revision is considered from this point.
Facial fractures fixed early and accurately usually restore the face very close to its original appearance, with small differences in cheek projection or nasal position noticed mainly by the patient.
The bite is the outcome that matters most where the jaws were involved, and a correctly restored bite is the measure of a successful repair regardless of how the face looks in the first weeks.
Numbness is very common after both the injury and the repair, improves over 3 to 6 months, and frequently leaves a small permanent patch.
Where treatment was delayed and bone healed crooked, secondary correction improves the face substantially but rarely restores the original position fully.
Acute facial trauma is emergency or urgent care and is funded almost everywhere as treatment of injury rather than as cosmetic surgery. It is not something to plan a trip around, because the window for accurate repair is 1 to 2 weeks and assessment needs imaging and frequently a dental opinion.
Secondary correction of a face that healed badly is planned surgery and is priced on this site from verified clinic records. It is harder and less predictable than primary fixation, and it frequently involves re-cutting bone and sometimes grafting, so it costs more than the original repair would have.
The variable that most affects both cost and outcome is information. Bringing the original CT images and operation notes makes secondary correction considerably more predictable. Planning it without them means a surgeon working out what was done before deciding what to do next.
Why quotes for the same procedure differ, so you can compare packages fairly.
Options to weigh before deciding, surgical and non-surgical.
Many minimally displaced facial fractures heal well without surgery, particularly nasal fractures that are not visibly deviated.
Pushing a displaced bone back into position without an incision, possible for simple nasal fractures within the first 2 weeks.
Where the patient is unstable or swelling prevents assessment, accepting later correction rather than operating badly early.
Where a nasal fracture was missed or healed deviated, formal nose surgery after the window has passed.
Addressing facial scarring separately once it has matured at a year, rather than as part of the acute repair.
Ask the same questions at every consultation so you can compare answers.
Usually within 1 to 2 weeks. Facial bones begin knitting within about a fortnight, so the window for realigning them precisely is short, and a fracture fixed inside it can usually be restored to its original position.
Surgeons frequently wait a few days for swelling to settle before operating, which improves accuracy. That is a deliberate judgement rather than a delay, and imaging in the meantime shows what the swelling hides.
Facial trauma reconstruction can correct this, but the bone has to be re-cut and repositioned, sometimes with grafts to replace lost volume. It is considerably harder, less predictable and rarely as good as early fixation.
That is the main argument for prompt assessment after a facial injury. An altered bite, double vision, a flattened cheek or a deviated nose should be looked at rather than left to settle.
Usually not. Titanium plates and screws used on facial fractures are designed to stay permanently and most people never notice them. They do not set off airport scanners in any meaningful way.
They are removed if they become infected, if they are palpable and uncomfortable in a thin area, or occasionally in children where they can interfere with growth. That is a second operation rather than routine.
Sensory nerves supplying the cheek, lips, chin and gums run directly through common facial fracture lines, so they are frequently stretched or bruised by the injury itself as well as by the repair.
It usually improves over 3 to 6 months as the nerve recovers, and a small permanent patch is common. Complete permanent numbness of a large area is less common and usually means the nerve was divided.
A facial fracture of the thin floor of the eye socket, caused by a blow to the eye that transmits pressure downward. Tissue and occasionally muscle can herniate into the sinus below, causing double vision and a sunken eye.
Not all need surgery. Repair is considered where there is significant double vision, trapped muscle, or enough tissue displacement that the eye will sink noticeably as swelling settles.
Because it is the reference everything else is set against. Where the jaws are involved, the teeth are brought into their correct relationship first and the bones fixed to match, since a symmetrical face that cannot chew is a failed repair.
That is why jaws are sometimes temporarily wired or held with elastics during surgery, and why serious facial trauma care includes a dental assessment.
Not for a couple of weeks after facial fractures involving the sinuses or the orbital floor. Blowing forces air into the tissues around the eye, producing sudden dramatic swelling that is usually harmless but alarming.
Sneeze with your mouth open for the same reason. It is one of the few aftercare instructions where the mechanism is worth understanding, because it makes the rule easy to remember.
6 to 12 weeks depending on the fracture, and longer for contact sport. Returning early risks displacing a repair that has not fully knitted.
A custom face guard is worth considering for anyone returning to contact sport after a facial fracture, particularly where the same area has been broken before.
Frequently very close, where facial fractures were fixed early and accurately. Small differences in cheek projection or nasal position are common and often noticed only by the patient.
Where the injury was severe or treatment was delayed, differences can be more noticeable. Swelling makes assessment impossible for the first 3 months, so judgement waits.
No. Many nasal fractures are minimally displaced and heal acceptably without facial surgery. Where the nose is clearly deviated or the airway is blocked, repositioning within the first 2 weeks is usual.
After that window, correction usually means formal rhinoplasty and septal surgery later, which is a bigger operation. Prompt assessment after a nasal injury is therefore worth arranging.
Almost always, as emergency or urgent care. Facial fractures are treated as injuries rather than cosmetic problems and are managed in hospital systems rather than private cosmetic clinics.
Secondary correction of a badly healed fracture is sometimes treated differently and may be assessed on functional grounds. It is worth asking, since these are usually genuinely functional problems.
For acute facial fractures, no. The window for fixing them is 1 to 2 weeks and the assessment needs imaging and often a dental opinion, so treatment happens where the injury happened.
Secondary correction of a face that healed badly is a planned procedure and travels better, though it is harder surgery. Bring the original imaging and operation notes, which change what is possible.
Most within about 2 weeks, while the bone can still be moved back into place. After that, fragments begin to unite where they lie and correction needs the bone to be re-broken.
Some injuries are more urgent: an eye socket fracture trapping a muscle, an open fracture or one obstructing the airway is treated within hours or days. This urgency is why facial trauma is rarely a travel decision.
A facial fracture of the thin floor of the eye socket, in which the contents of the socket drop into the sinus below. It causes double vision looking upwards and a sunken, backset eye.
It is repaired by lifting the tissue back and covering the defect with a thin implant, ideally within 2 weeks. A missed one leaves double vision and a visible difference in eye position that is much harder to correct.
Because the fracture has healed with the jaw slightly out of position, and even a millimetre or two changes how teeth meet. Patients notice this long before they notice any change in facial shape.
It is corrected by cutting the bone and repositioning it, planned with dental models or digital planning and frequently with orthodontic input. This is why bite is checked at every follow-up in the first weeks.
Usually not. Titanium plates used in facial fixation are designed to stay and most cause no trouble. They are removed if they become infected, are palpable in a thin area or cause cold sensitivity, which is most common along the jawline.
Removal is a smaller operation than the original fixation. In children the issue is different: plates can become buried by growing bone, so resorbable plates are frequently used instead.
Not immediately where the facial sinuses or the eye socket are involved, because the pressure change can push air into the tissues. Most surgeons advise waiting 2 to 4 weeks and confirming before booking.
Where an air-filled implant or packing has been used, the wait may be longer. The advice is specific to the injury, so it is a question to ask directly rather than a rule to assume.
NHS2024Regulator
American Society of Plastic Surgeons2024Professional society
National Institute for Health and Care Excellence2023Clinical guideline
Consultation request
Tell us the procedure and destination you are considering. We forward your request to the verified clinic you select.