Orthognathic Surgical Refinements to Correct Discrepancies in Patients Having Undergone Camouflage Facial Contouring Surgeries

In modern society, facial attractiveness is well appreciated, therefore many cosmetic surgeries are popular to make ovoid, elliptical and tiny face. For this purpose, facial contouring surgery is the most frequently used surgical modality. Unfortunately, these operations are sometimes carried out by inadequate diagnosis supported by patient’s desires seeking the minimally invasive surgery. This study was designed to explore the patients group who had orthognathic surgeries after facial contouring surgeries in depth by evaluating the perception of their facial appearance and clinical features in an attempt to identify the characteristics of these patients group, and to suggest more reliable and efficacious strategy for dentofacial esthetics.

This clinical study included 29 patients who had orthognathic treatments after facial contouring surgeries. Initially, these patents had at least one of the following surgeries - mandibular angle/body reduction, zygoma reduction or genioplasty. We evaluated characteristics of each group through clinical and radiographic examination. These patients were divided into three groups according to primary concern of their facial appearance and clinical diagnosis. Group I had problems in facial height and profile(n=16); Group II had problems in occlusion(n=9); Group III had problems in facial symmetry(n=4). The most common problems were long faces, protrusive lips and mandibular prognathism. We evaluated characteristics of each group through clinical and radiographic examination including 3-dimensional CT and cephalometric analysis before and after orthognathic treatments. This study was reviewed by the ethical committee of clinical investigation of Jukjeon dental hospital, college of dentistry, Dankook university(IRB approval No. DKDH-clinical-001).           

These three groups of patients underwent orthognathic surgeries including LeFort I osteotomy for the maxilla, and bilateral sagittal split osteotomy and genioplasty for the mandible. The dentofacial esthetics and occlusion improved much through these treatments after initial facial contouring surgery. The results of this study suggest that orthognathic treatment should be selected as initial treatment modality for the deformities of facial height and profile, occlusion and facial symmetry.

Occasionally, not a few camouflage facial contouring surgeries end upon insufficient resolution and result in dissatisfaction of surgeons and patients, which necessitate orthognathic surgical refinements to correct discrepancies. These corrective surgeries are often difficult to do, so additional skills and time are accompanied by the increased costs and high chances of postoperative complications. Conclusively, we can get the best results by minimum numbers of surgeries through the precise and comprehensive diagnosis of the dentofaciclal deformities.

Key References :

1.Arnett GW, Gunson MJ. Esthetic treatment planning for orthognathic surgery. Journal of clinical orthodontics 2010;44(3):196-200.

2.Johnston C, Hunt O, Burden D, Stevenson M, Hepper P. Self-perception of dentofacial attractiveness among patients requiring orthognathic surgery. The Angle orthodontist. 2010;80(2):361-6.