Aesthetic Adjuncts with Orthognathic Surgery

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Key points

  • Traditional orthognathic surgery aligns the patient’s bony jaws into a desired, more appropriate position but may leave other cosmetic issues unaddressed.

  • Soft tissue deformities may be treated concomitantly with orthognathic surgery, including soft tissue augmentation (fillers), reduction (liposuction), hard tissue augmentation, cosmetic lip procedures, and rhinoplasty.

  • Some cosmetic adjunctive procedures may be performed at a later date after soft tissue edema from orthognathic surgery has

Initial evaluation

Patients should be directed to provide both written and verbal rationales for their desire to seek orthognathic and/or cosmetic surgery. A thorough history of previous trauma and cosmetic or orthognathic surgery should be documented. Medical history and the appropriate consults need to be established before any procedures are performed.

Facial Adipose

The facial/neck adipose tissue is present in superficial and deep planes. The face represents approximately 80% of adipose tissue with the neck assuming the remaining 20%. Superficial fat is a continuous layer intertwined in a dense weblike network of fascia extending from superficial fascia to dermis, making up more than half of the facial fat. The deep fat (44%) is contained in loosely supported fascia and is divided into discreet fat pads.13

Retaining Ligaments of the Face

The true and false ligaments represent the soft

Treatment planning

Treatment planning adjunctive cosmetic procedures to occur simultaneously or perioperatively with orthognathic surgery should take into account predictable soft tissue changes that occur with skeletal realignment.

Treatment planning rhinoplasty

Addressing a nasal deformity, whether functional or cosmetic, deserves particular attention. The central position of the nose relative to the face creates a situation in which even minor asymmetries or deformities of 1 mm or less are readily apparent.

Mandibular osteotomies show minimal change to the nasal structures; however, advancing or retruding the mandible increases or decreases the prominence of the chin, respectively. The perception of a more or less prominent chin creates the illusion

Long Lip/Inadequate Incisal Display

Maxillary movements are largely dictated by the desired amount of tooth display at repose. Excess or inadequate incisal display may be secondary to vertical skeletal deformities in the maxilla or the soft tissue length of the upper lip. If a patient presents with a long upper lip, obtaining the optimal incisal display may cause the maxilla to be placed more inferiorly than is ideal, which can create more patient morbidity because a bone graft may be required to support an inherently less stable

Tear Trough

Placement of the filler is in the nasojugal folds and in areas of fat atrophy just below the inferior orbital rim. Augmentation is in the submuscular plane above the periosteum, often in the SOOF pad, to prevent visible clumping or nodule formation.27 Once injected, the area is gently massaged. Results are immediate (Fig. 4).

  • Malar region: dermal and subdermal planes. Higher G′ injectables provide results that rival solid implantable devices.

  • Nasolabial folds: dermal and subdermal planes.

Discussion

Orthognathic surgery involves understanding of both hard and soft tissue anatomy and the soft tissue changes associated with skeletal movements. The skeletal and soft tissue changes associated with aging are also factors in finalizing the treatment plan. Despite soft tissue changes that can be manipulated with orthognathic surgery, deformities in the soft and hard tissues may persist that require adjunctive procedures.

The malar, submalar, and chin regions can be addressed with implants and

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References (35)

Cited by (16)

  • Adjunctive Aesthetic Procedures in Orthognathic Surgery

    2023, Oral and Maxillofacial Surgery Clinics of North America
    Citation Excerpt :

    Some aesthetic volumizing procedures can help with enhancing the volume further in different aesthetic regions of the face (eg, by fat grafting and malar augmentation), whereas those procedures aimed at removing redundant tissue can also create a more youthful appearance (eg, lip lift, blepharoplasty, and liposuction). Aesthetic procedures are categorized as: (1) procedures that enhance the results of orthognathic surgery, and can be performed concomitantly; (2) procedures performed secondarily after a soft tissue edema has resolved and healing is complete; (3) procedures that can address undesired aesthetic changes that have occurred after orthognathic surgery; and (4) procedures that are performed to camouflage certain aspects in patients not desiring optimal orthognathic surgery.1 In this article, we discuss different facial aesthetic procedures that are combined with orthognathic surgery, to the patient’s benefit, to help them become the most beautiful version of themselves.

  • Surgery first in cosmetically driven orthognathic surgery

    2022, Seminars in Orthodontics
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    This is done in an asynchronous manner based on the esthetic results observed after surgery. Medpor® (Stryker, Kalamazoo, MI) which is a high density, porous polyethylene implant is the most common type of chin implant.10 Fig. 8 shows a patient that had undergone orthognathic surgery with a modified surgery first approach (1 month of orthodontic appliances to increase the overjet prior to the surgery) with genioplasty.

  • Nasal spine implant to correct nasal asymetry and to enable nose correction accompanying orthognathic surgery

    2022, Journal of Stomatology, Oral and Maxillofacial Surgery
    Citation Excerpt :

    This can lead a nasal tip or septal deviation, or even a nostril asymmetry. Anesthetic results can be very difficult to assess during orthognathic surgery due to soft tissue edema [7]. Because of this, some surgeons choose to have a rhinoplasty on a second surgical procedure.

  • Use of non-surgical aesthetic refinement after orthognathic surgery: Case studies

    2022, Journal of Taibah University Medical Sciences
    Citation Excerpt :

    In these cases, the patient, especially males, can fill in the region or install a facial implant to make the jaw more square with well-defined angles and edges that add youthfulness and masculinity to the face. The anteroposterior projection and the lip contour can also be improved during the postoperative period.13 Even certain manoeuvres performed in the postoperative period are aimed at better anteroposterior projection of the lips, such as the VY suture, resulting in a lip projection considered adequate by many patients.

  • Three-dimensional acquisition technologies for facial soft tissues – Applications and prospects in orthognathic surgery

    2020, Journal of Stomatology, Oral and Maxillofacial Surgery
    Citation Excerpt :

    Surgical simulation allows soft tissue changes to be anticipated from those of the bone base to either exploit them for esthetic benefit, or on the contrary limit their effects right from the preoperative planning stage. In cases of unfavorable bone movements, complementary corrective measures for soft tissues (VY closure, alar base reduction or rhinoplasty, autologous fat graft…) can be planned in advance to improve esthetic results [26]. Early software package used predefined ratios to simulate soft tissue displacements based on bone movements.

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Disclosures: None.

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