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  1. 1. Enhancing Facial Harmony ORTHOGNATHIC SURGERY COMBINED WITH FACIAL PLASTIC PROCEDURES Samuel Benarroch Mahfoda MD, DDS, OMS Assistant Professor Oral & Maxillofacial Surgery Residency Program Woodhull Medical Center. New York Hospital Magallanes de Catia. Caracas
  2. 2. ORTHOGNATHIC AND ESTHETIC PROCEDURES Create improvement while maintaining a natural appearance
  3. 3. Purpose Determine the type of cosmetic surgery procedures most frequently performed to enhance the result of orthognathic surgery
  4. 4. DESIGN <ul><li>Multicenter </li></ul><ul><li>Retrospective study </li></ul><ul><li>Conducted from 1996 to 2005 </li></ul>
  5. 5. PATIENT DISTRIBUTION SEX AND AGE 100 1.252 TOTAL 71.4 894 FEMALE 28.6 358 MALE % NUMBER SEX 100 1.252 TOTAL 1.6 20 > 35 4.4 55 30 – 34 18.3 229 25 – 29 70.6 879 20 – 24 5.2 63 15 – 19 % NUMBER AGE
  6. 6. PATIENT DISTRIBUTION DENTOFACIAL DEFORMITY 1.252 TOTAL 304 BIMAXILAR III 438 MANDIBLE II 510 MAXILLA I NUMBER DEFORMITY GROUP
  7. 7. SURGICAL TECHNIQUES <ul><li>Maxilla </li></ul><ul><ul><li>Lefort I </li></ul></ul><ul><ul><li>High Lefort I </li></ul></ul><ul><ul><li>Segmental </li></ul></ul><ul><ul><li>RPE </li></ul></ul><ul><ul><li>Facial implants </li></ul></ul><ul><li>Mandible </li></ul><ul><ul><li>BSS </li></ul></ul><ul><ul><li>VOR </li></ul></ul><ul><ul><li>Distraction osteogenesis </li></ul></ul><ul><ul><li>Segmental </li></ul></ul>
  8. 8. <ul><li>MA, F, 21. Feb. 1996 </li></ul><ul><li>PROBLEM LIST </li></ul><ul><ul><li>Nasal deformity </li></ul></ul><ul><ul><li>Facial asymmetry </li></ul></ul><ul><ul><li>Mandibular deviation </li></ul></ul><ul><ul><li>Thinner upper lip </li></ul></ul><ul><li>SURGICAL PLAN </li></ul><ul><ul><li>Closed basic rhinoplasty </li></ul></ul><ul><ul><li>Mandibular osteotomy </li></ul></ul><ul><ul><li>Upper Lip plasty </li></ul></ul>
  9. 18. <ul><li>CH, F, 23. Feb. 1997 </li></ul><ul><li>PROBLEM LIST </li></ul><ul><ul><li>Nasal deformity </li></ul></ul><ul><ul><li>Full inframalar contours </li></ul></ul><ul><ul><li>V.M.E. </li></ul></ul><ul><ul><li>Drooping lower lip </li></ul></ul><ul><ul><li>AP Chin deficiency </li></ul></ul><ul><ul><li>Neck lipomatosis </li></ul></ul><ul><li>SURGICAL PLAN 2 Phases </li></ul><ul><ul><li>Rhinoseptoplasty </li></ul></ul><ul><ul><li>Buccal fat pad removal </li></ul></ul><ul><ul><li>Maxillary impaction </li></ul></ul><ul><ul><li>Lower Lip plasty </li></ul></ul><ul><ul><li>Chin advancement </li></ul></ul><ul><ul><li>Neck liposuction </li></ul></ul>
  10. 67. <ul><li>MM, F, 20. April,1999 </li></ul><ul><li>PROBLEM LIST </li></ul><ul><ul><li>Nasal deformity </li></ul></ul><ul><ul><li>Full inframalar contours </li></ul></ul><ul><ul><li>Gumming smile </li></ul></ul><ul><ul><li>Small and round face </li></ul></ul><ul><ul><li>AP mandible deficiency </li></ul></ul><ul><ul><li>AP and vertical chin deficiency </li></ul></ul><ul><ul><li>Drooping lower lip </li></ul></ul><ul><ul><li>SURGICAL PLAN 3 PHASES </li></ul></ul><ul><ul><li>Intraoral mandible distraction osteogenesis </li></ul></ul><ul><ul><li>Rhinoplasty </li></ul></ul><ul><ul><li>Maxillary Anterior gingivoplasty </li></ul></ul><ul><ul><li>Buccal fatpad removal </li></ul></ul><ul><ul><li>Lower lip plasty </li></ul></ul><ul><ul><li>Vertical augmentation and advancement of the chin </li></ul></ul>
  11. 76. <ul><li>LR, F, 21. July, 2000 </li></ul><ul><li>PROBLEM LIST </li></ul><ul><ul><li>Ocular surface disease </li></ul></ul><ul><ul><li>Nasal deformity </li></ul></ul><ul><ul><li>Lower third vertical augmentation </li></ul></ul><ul><ul><li>Upper and lower lip deformity </li></ul></ul><ul><ul><li>Maxillary transverse collapse </li></ul></ul><ul><ul><li>AP chin deficiency </li></ul></ul><ul><ul><li>Vertical chin augmentation </li></ul></ul><ul><li>SURGICAL PLAN 2 PHASES </li></ul><ul><ul><li>Maxillary assisted expansion </li></ul></ul><ul><ul><li>Maxillary posterior impaction </li></ul></ul><ul><ul><li>Mandible BSS </li></ul></ul><ul><ul><li>Lip pasties </li></ul></ul><ul><ul><li>Vertical reduction of the chin </li></ul></ul><ul><ul><li>AP chin advancement </li></ul></ul>
  12. 85. RESULTS Group I 0.9 Malar augmentation 8.1 Submental liposuction 13.6 Buccal fat pad removal 16.4 Lip-plasty 5.6 Blepharoplasty 26.4 Rhinoplasty 57.3 Genioplasty % PROCEDURE
  13. 86. RESULTS Group II 5.7 Malar augmentation 2.3 Submental liposuction 17 Buccal fat pad removal 19.1 Lip-plasties 3.4 Blepharoplasty 54.5 Rhinoplasty 60.2 Genioplasty % PROCEDURE
  14. 87. RESULTS Group III 0 Malar augmentation 5.5 Submental liposuction 22.2 Buccal fat pad removal 24.1 Lip-plasty 3.7 Blepharoplasty 29.6 Rhinoplasty 53.7 Genioplasty % PROCEDURE
  15. 88. OVERALL RESULTS 2.4 Malar augmentation 5.1 Submental liposuction 13.1 Buccal fat pad removal 20.6 Lip-plasty 4.4 Blepharoplasty 36.9 Rhinoplasty 57.5 Genioplasty % PROCEDURE
  16. 89. DISCUSSION <ul><li>There is great variability (sex, race) and subjectivity (eye of the beholder) in appreciation of facial beauty </li></ul><ul><li>The advantages of combined procedures include a single recovery period, reduced surgery costs, and faster patient gratification </li></ul><ul><li>The results of this retrospective review does not indicate that the combination of cosmetic surgical procedures increases morbidity </li></ul>
  17. 90. DISCUSSION <ul><li>The correction of the dominant negative traits , is it enough? </li></ul><ul><li>When should we stop? </li></ul>
  18. 91. CONCLUSION Facial harmony will not appear as “beautiful” unless the combination of different facial procedures Orthognathic + Cosmetic + Esthetics Guidance
  19. 92. <ul><li>ESTETHIC </li></ul><ul><li>Patient's needs Surgeon's satisfaction </li></ul>
  20. 93. Thank you for your kind attention Enhancing Facial Harmony ORTHOGNATHIC SURGERY COMBINED WITH FACIAL PLASTIC PROCEDURES Samuel Benarroch Mahfoda MD, DDS Oral & Maxillofacial Surgery

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