Featured Case 09/20: COSMETIC JAW SURGERY

Patient:

Chad

The problem:

• Chad is a 30-year-old who had concerns about his facial appearance.
• In particular, he was not fond of his relatively short and “square” facial shape.
• He wanted to have a more attractive smile but wasn't certain what it took to fulfill that desire.

Patient History:

• Chad sought numerous consultations for orthodontics (braces), jaw reconstructive surgery, and facial plastic surgery.
• After seeing multiple specialists, he narrowed his search down to 2 orthodontists and 2 Oral & Maxillofacial Surgeons.
• He had no perceptible issues with his bite or chewing ability.
• The other orthodontist and Oral & Maxillofacial team recommended he have braces and lower jaw advancement surgery.
• After numerous consultations, Chad felt comfortable with our recommendations to address his cosmetic request.

Pertinent Information:

• Chad demonstrated what has been described as a Brachyfacial (short vertical and square shape) presentation.
• His lower face (below the nose to the chin) was shorter than the midface (between the brows to under the nose).
• He showed very little upper teeth when smiling, making him seem aged.
• His teeth and bite appeared very acceptable and stable.
• Computer simulations were performed to give Chad a sense of facial proportions.

• Since his teeth and bite were stable, only minor orthodontic fine-tuning was necessary.
• He needed skeletal and soft tissue solutions to his cosmetic problem.

Procedures:

• Cheiloplasty or lip lift contouring was performed.
• Reconstructive augmentation of his upper jaw was performed to increase vertical length and show the appropriate amount of his upper teeth.
• The upper jaw surgery is known as a Le Forte I osteotomy.
• Reconstructive augmentation of his chin was also performed to increase the vertical dimension.
• This approach to the chin is called a genioplasty via Mandible (lower jaw) inferior border osteotomy.
• All cosmetic jaw surgery was performed inside the mouth so no visible scarring would occur on his face.
• Soft tissue filler was placed to soften the deep fold under his lower lip.
• All procedures were performed as an outpatient in our AAAHC-accredited surgery center.
• He was discharged on the morning of surgery to the comfort of his home.

Treatment Course:

• Chad had a very uneventful recovery.
• He experienced typical facial swelling for about one week.
• He was instructed to stay on a soft diet and avoid strenuous activity for 2 weeks.
• He completed orthodontic fine-tuning (braces) within 2 months of his surgical procedure.

Commentary:

• Facial cosmetics is a function of tissue harmony, proportions, and perception.
• Understanding all components of facial anatomy and aesthetics is paramount to achieving acceptable results.
• Addressing the facial bones along with soft tissues is important to determine the true nature and solution to the condition.
• It is sometimes stated that “there is usually one correct diagnosis but numerous ways in which to approach it.”
• Comprehensively trained Oral & Maxillofacial surgeons have unique expertise in treating all aspects of the face.
• A comprehensive approach to, and surgical skill set of the entire face, is integral to our core competence at Inland Institute.
• We are overjoyed to see how pleased Chad felt about his results and overall experience in our practice.