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Enhancing Facial HarmonyEnhancing Facial HarmonyORTHOGNATHIC SURGERY COMBINED WITH ORTHOGNATHIC SURGERY COMBINED WITH
FACIAL PLASTIC PROCEDURESFACIAL PLASTIC PROCEDURES
Samuel Benarroch Mahfoda Samuel Benarroch Mahfoda MD, DDS, OMSMD, DDS, OMS
Assistant ProfessorAssistant Professor
Oral & Maxillofacial Surgery Residency ProgramOral & Maxillofacial Surgery Residency Program
Woodhull Medical Center. New YorkWoodhull Medical Center. New York
Hospital Magallanes de Catia. CaracasHospital Magallanes de Catia. Caracas
ORTHOGNATHIC AND ORTHOGNATHIC AND ESTHETICESTHETIC PROCEDURES PROCEDURES
Create improvement while maintaining a natural appearance
PurposePurpose
Determine the type of cosmetic surgery Determine the type of cosmetic surgery procedures most frequently performed to procedures most frequently performed to enhance the result of orthognathic surgeryenhance the result of orthognathic surgery
DESIGN DESIGN
• Multicenter Multicenter
• Retrospective study Retrospective study
• Conducted from 1996 to 2005 Conducted from 1996 to 2005
PATIENT DISTRIBUTION
SEX AND AGE SEX AND AGE
SEX NUMBER %
MALE 358 28.6
FEMALE 894 71.4
TOTAL 1.252 100
dd
AGE NUMBER %
15 – 19 63 5.2
20 – 24 879 70.6
25 – 29 229 18.3
30 – 34 55 4.4
> 35 20 1.6
TOTAL 1.252 100
PATIENT DISTRIBUTIONDENTOFACIAL DEFORMITYDENTOFACIAL DEFORMITY
GROUP DEFORMITY NUMBER
I MAXILLA 510
II MANDIBLE 438
III BIMAXILAR 304
TOTAL 1.252
SURGICAL TECHNIQUESSURGICAL TECHNIQUES
• Maxilla Maxilla – Lefort ILefort I– High Lefort IHigh Lefort I– Segmental Segmental – RPERPE– Facial implantsFacial implants
• Mandible Mandible – BSSBSS– VORVOR– Distraction osteogenesisDistraction osteogenesis– Segmental Segmental
MA, F, 21. Feb. 1996MA, F, 21. Feb. 1996
• PROBLEM LISTPROBLEM LIST– Nasal deformityNasal deformity– Facial asymmetryFacial asymmetry– Mandibular deviationMandibular deviation– Thinner upper lip Thinner upper lip
• SURGICAL PLAN SURGICAL PLAN – Closed basic rhinoplastyClosed basic rhinoplasty– Mandibular osteotomyMandibular osteotomy– Upper Lip plastyUpper Lip plasty
CH, F, 23. Feb. 1997CH, F, 23. Feb. 1997
• PROBLEM LISTPROBLEM LIST– Nasal deformityNasal deformity– Full inframalar contoursFull inframalar contours– V.M.E.V.M.E.– Drooping lower lip Drooping lower lip – AP Chin deficiencyAP Chin deficiency– Neck lipomatosisNeck lipomatosis
• SURGICAL PLAN SURGICAL PLAN 2 Phases2 Phases– Rhinoseptoplasty Rhinoseptoplasty – Buccal fat pad removal Buccal fat pad removal – Maxillary impactionMaxillary impaction– Lower Lip plastyLower Lip plasty– Chin advancementChin advancement– Neck liposuctionNeck liposuction
MM, F, 20. April,1999MM, F, 20. April,1999
PROBLEM LISTPROBLEM LIST– Nasal deformityNasal deformity– Full inframalar contoursFull inframalar contours– Gumming smileGumming smile– Small and round face Small and round face – AP mandible deficiencyAP mandible deficiency– AP and vertical chin deficiencyAP and vertical chin deficiency– Drooping lower lip Drooping lower lip SURGICAL PLAN 3 PHASESSURGICAL PLAN 3 PHASES– Intraoral mandible distraction Intraoral mandible distraction
osteogenesisosteogenesis– RhinoplastyRhinoplasty– Maxillary Anterior Maxillary Anterior
gingivoplasty gingivoplasty – Buccal fatpad removalBuccal fatpad removal– Lower lip plastyLower lip plasty– Vertical augmentation and Vertical augmentation and
advancement of the chin advancement of the chin
LR, F, 21. July, 2000LR, F, 21. July, 2000
• PROBLEM LISTPROBLEM LIST– Ocular surface diseaseOcular surface disease– Nasal deformityNasal deformity– Lower third vertical augmentationLower third vertical augmentation– Upper and lower lip deformityUpper and lower lip deformity– Maxillary transverse collapseMaxillary transverse collapse– AP chin deficiencyAP chin deficiency– Vertical chin augmentationVertical chin augmentation
• SURGICAL PLAN 2 PHASESSURGICAL PLAN 2 PHASES– Maxillary assisted expansionMaxillary assisted expansion– Maxillary posterior impactionMaxillary posterior impaction– Mandible BSSMandible BSS– Lip pastiesLip pasties– Vertical reduction of the chinVertical reduction of the chin– AP chin advancement AP chin advancement
RESULTSRESULTSGroup I
PROCEDURE %
Genioplasty 57.3
Rhinoplasty 26.4
Blepharoplasty 5.6
Lip-plasty 16.4
Buccal fat pad removal
13.6
Submental liposuction
8.1
Malar augmentation 0.9
RESULTSRESULTS
Group IIPROCEDURE %
Genioplasty 60.2
Rhinoplasty 54.5
Blepharoplasty 3.4
Lip-plasties 19.1
Buccal fat pad removal
17
Submental liposuction
2.3
Malar augmentation 5.7
RESULTSRESULTS
Group IIIPROCEDURE %
Genioplasty 53.7
Rhinoplasty 29.6
Blepharoplasty 3.7
Lip-plasty 24.1
Buccal fat pad removal
22.2
Submental liposuction
5.5
Malar augmentation 0
OVERALL RESULTSOVERALL RESULTS
PROCEDURE %
Genioplasty 57.5
Rhinoplasty 36.9
Blepharoplasty 4.4
Lip-plasty 20.6
Buccal fat pad removal
13.1
Submental liposuction
5.1
Malar augmentation
2.4
DISCUSSION DISCUSSION
• There is great variability (sex, race) and There is great variability (sex, race) and subjectivity (eye of the beholder) in appreciation subjectivity (eye of the beholder) in appreciation of facial beauty of facial beauty
• The advantages of combined procedures include The advantages of combined procedures include a single recovery period, reduced surgery costs, a single recovery period, reduced surgery costs, and faster patient gratificationand faster patient gratification
• The results of this retrospective review does not The results of this retrospective review does not indicate that the combination of cosmetic indicate that the combination of cosmetic surgical procedures increases morbiditysurgical procedures increases morbidity
DISCUSSION DISCUSSION
• The correction of the The correction of the dominant negative traits, is it enough?
• When should we stop?
CONCLUSIONCONCLUSIONFacial harmony will not appear as Facial harmony will not appear as
“beautiful” unless the combination of “beautiful” unless the combination of different facial procedures different facial procedures
Orthognathic + Cosmetic + Orthognathic + Cosmetic + Esthetics GuidanceEsthetics Guidance
ESTETHICESTETHIC
Patient's needs Surgeon's satisfaction
Thank you for your kind attentionThank you for your kind attention
Enhancing Facial HarmonyEnhancing Facial Harmony
ORTHOGNATHIC SURGERY COMBINED WITH FACIAL PLASTIC PROCEDURESORTHOGNATHIC SURGERY COMBINED WITH FACIAL PLASTIC PROCEDURES
Samuel Benarroch Mahfoda MD, DDSOral & Maxillofacial SurgeryOral & Maxillofacial Surgery