Restoring Facial Balance Using a Creative, Cost-Effective Approach—How a Customized Unilateral Wing Osteotomy Corrected Mandibular Asymmetry

Background: Facial asymmetry affecting the mandibular contour may significantly impact facial harmony even in patients with stable occlusion. Although orthognathic surgery remains the standard for skeletal correction, it carries substantial morbidity. In selected cases, contour-focused approaches can achieve meaningful esthetic improvement with reduced surgical burden. Objective: To describe the virtual surgical planning (VSP) workflow and clinical outcome of a unilateral Wing osteotomy for mandibular contour asymmetry. Case presentation: A 24-year-old woman presented with left-sided mandibular contour deficiency and facial asymmetry, despite stable Class I occlusion and preserved function. VSP with contralateral mirroring guided the design of the osteotomy and fabrication of a stereolithographic model and patient-specific cutting guide. Surgery was performed through a tunnelized mandibular approach using a 702 bur and reciprocating saw. Fixation was achieved with pre-bent 2.0 plates adapted to the 3D model, and Bio-Oss Collagen was interposed within the osteotomy gap. Occlusion and mental nerve function were preserved. Results: Postoperatively, the patient demonstrated improved facial symmetry, uneventful healing, preserved long-term neurosensory function, and high esthetic satisfaction. Conclusions: Unilateral Wing osteotomy guided by VSP and patient-specific instrumentation is a predictable, minimally invasive alternative to bimaxillary orthognathic surgery with genioplasty in selected patients presenting contour-focused asymmetry and stable occlusion. This case highlights a rare, underreported application of the technique.