THE SURGICAL ART OF FACIAL MAKEOVER

SHOWCASE

Maurice Y. Mommaerts

Key words Procedures Problem list orthodontic classification

13 Class III, crossbite, crowding TPD, pterygoid dysjunction Occlusal considerations Class III, crowding, crossbite

17 Narrow upper jaw TPD, OBA Occlusal considerations Class III, crowding

19 Narrow jaws TPD, TMD Small apical bases, upper and lower

23 Mandibular autorotation Maxillary impaction, chin advancement Gummy smile, lip incompetence Class II, open bite

29 Gummy smile, mandibular autorotationMaxillary impaction, mandibular autorotation

Gummy smile Class II, laterognathia

35 Open biteLe Fort I in 3 parts, in step, without extractions

Open bite Anterior open bite

41 Autorotation mandible Le Fort I, chin osteotomy

45 Open bite, Class III Maxilla in 2 parts, chin osteotomy Anterior open bite Class III, anterior open bite

49 Class III TPD, maxillary advancement Occlusal considerations Class III

53 Class III Upper jaw advancement Class III

57 Class IIIMaxillary advancement and chin advancement, HA onlays paranasally

Occlusal considerations Class III

61 Class III, macrogeniaUpper jaw advancement, chin height reduction

Occlusal and facial considerations Class III

65 Class III, laterognathiaMaxillary advancement, unilateral set-back mandible

Problematic gingiva, demo of clinical examination

Class III, laterognathia

71 Deep bite, prominent chinMandibular advancement and negative rotation

Class II, deep bite

75 Class II, deep bite, prominent chin BSSO negative rotation Occlusal considerations Class II, deep bite, prominent chin

79Class II, very deep bite, prominent chin, Sunday posture

Mandibular negative rotation Deep bite and need for dental restoration Class II, deep bite

83 Class II, small chin, hypotonic lip Deep antegonial notch Class II, short face

87 Class II, deep biteMandibular negative (counterclockwise) rotation

Occlusal considerations Class II, deep bite

91 Class II, long faceMandibular advancement, chin advancement and impaction

Class II, high chin

97 Class II, prominent chinMandibular advancement, maxillary posterior impaction, bimaxillary negative rotation

Mandibular hypoplasia with prominent chin Class II, prominent chin

103 Long face, facial makeoverMaxillary impaction, mandibular advancement, chin reduction, bilateral malar valgization, rhinoplasty

Unhappy with face Long face

107 Class II, lip incompetenceUpper jaw impaction, mandibular autorotation, chin advancement and impaction

Lip incompetence, occlusal considerations Class II, long face

113 Gummy smile, lip incompetenceUpper jaw impaction, lower jaw advancement, chin impaction and advancement

Lip incompetence, occlusal considerationsClass II, long face, lip incompetence, gummy smile

117 Class II, prominent chin Bimaxillary negative rotationOcclusal considerations, fearful of too strong a chin, wishing to reduce mentolabial fold depth

Class II, deep bite, prominent chin

INDEX

Key words Procedures Problem list orthodontic classification

125 Open bite, lip incompetence

Maxillary impaction in 2 parts with transverse osteotomy, malar valgization osteotomy, mandibular leveling osteotomy (unilateral advancement right, chin reduction in height and advancement, chin narrowing)

Open bite, lip incompetence, gummy smile Class I

129 Class II, deep bite, prominent chin Bimaxillary negative rotation Class II, prominent chin, deep bite

135Class II, lower face deficiency after 4 premolar extractions

Bimaxillary advancement Class II, 4 bicuspid extractions

141 Laterognathia, Class IIIUpper jaw advancement, lower jaw rotation/set-back

Deteriorating bite and profile Laterognathia, Class III

149 Class II, long face, lip incompetence Trimax surgery Class II, long face

153Late mandibular growth, with compensation of occlusal plane of the maxilla

Trimax surgery Unable to chew Class III, with late mandibular growth

157 Class III, midface deficiencyMaxillary advancement, bilateral zygoma valgization osteotomy, infraorbital augmentation with HydroSet

Profile and smile Class III, midface hypoplasia

165 Class III, midface deficiencyBimaxillary negative rotation, zygoma valgization osteotomy, infraorbital hydroxyapatite only

Prognathic face Class III, midface deficiency

169 Class IIIUpper jaw advancement, mandibular set-back, chin advancement

Prognathic profile, occlusal considerations Class III

175 Dish-face deformity, OSAS Bimaxillary advancement Dished-in face, deep bite, OSAS Class II, deep bite, midface deficiency

177 Class III Mandibular set-back, chin advancement Class III

185 Class II, deep bite profile, prominent chin Bimaxillary negative rotation Chin deficiency with deep mentolabial fold Class II, deep bite

189 Bimaxillary dentoalveolar protrusionBimaxillary set-back, chin advancement, masseter muscle reductions

Wish to occidentalize Bimaxillary dentoalveolar protrusion

193 Class III, macrogenia, open bite Trimax, rotation, chin undercorrected Facial and occlusal considerations Class III, long face, open bite

199 Class II, long face, lip incompetenceUpper jaw impaction, lower jaw advancement, chin impaction and advancement

Occlusal considerations, gummy smile Class II, long face

203Class II, long face, lip incompetence, anterior open bite

Trimax surgery Facial and occlusal considerations Class II, anterior open bite, long face

209 Class II, long faceTPD, mandibular advancement, maxillary impaction, chin advancement

Class II, long face

215 Bipro, chin deficiency, Class IIUpper jaw set-back, mandibular set-back, chin advancement

Wish to occidentalize Class II, long face, bipro

219 Class III, open biteUpper jaw in 2 parts, closure of open bite, chin refinement

Open bite, facial considerations Open bite, long face

223 Class II, open bite Trimax and rhinoplasty Class II, open bite

229 Class II, prominent chin, flat horizontal plane Bimaxillary negative (clockwise) rotation Occlusal and facial considerations Class II, prominent chin

233 Class III, wide upper jaw in dorsal regionMandibular setback, maxillary narrowing dorsally (2 parts)

Excess of submental soft tissue after mandibular set-back

Class III

237 Facial asymmetryMaxillary leveling, lower jaw advancement, chin advancement and impaction, rhinoplasty

Unhappy with facial features Class II, long face

243 Class II, prominent chinBimaxillary negative rotation, well prepared with front teeth proclined

Occlusal considerations Class II, prominent chin

Key words Procedures Problem list orthodontic classification

247 Bimaxillary negative rotation Bimaxillary osteotomy Occlusal and facial considerations Class II, prominent chin

251 Long face, Class II

Upper jaw impaction, lower jaw advancement, chin impaction and advancement, bilateral zygomatic valgization osteotomies, microlipofilling

Facial and occlusal considerations Class II, long face

257 Class II, long face TrimaxOcclusal considerations, lip incomptence, mentalis habit

Class II, long face

261Class III, frontal open bite, mandibular asymmetry

Unilateral mandibular set-back, maxillary advancement and impaction to close frontal open bite

Class III, laterognathia, frontal open bite

265 Hemimanidbular hyperplasiaMaxillary leveling, mandibuloplasty, chin symmetrizing

Facial considerations Hemimandibular hyperplasia

269 Laterognathia, Class IIIMaxillary impaction, lower jaw set-back, after negative Tc scan of condyles

Asymmetrical gummy smile, occlusal cant Class III, laterognathia

275 Chin hypoplasia, compensating orthodontiaChin osteotomy, advancement, impaction, narrowing, jaw line straightening

Weak chin

279 Chin deficiency Chin advancement, jumping bone flap Chin deficiency, mentalis habit, no jaw line Class II, orthodontically compensated

281 Zygomatic valgization osteotomyBilateral zygomatic valgization osteotomy, genioplasty, rhinoplasty, lip augmentation …

Wish to increase malar projection

283 Class III, midface deficiencyMaxillary advancement, zygomatic valgization osteotomy

Occlusal and profile considerations Class III

287 Nasal deformity after primary rhinoplasty

291Dished-in face after orthodontic compensation for Class II malocclusion

Trimax with negative rotation, full rhinoplasty

Dished-in lower face after premolar extractions and compensating orthodontics for Class II

Class I after orthodontic decompensation, then reversed orthodontics

295 Nasal defects Hyaluronic acid injections

297 Nasal deformity RhinoplastyDissatisfied with shape of nose and function

299Mandibular deficiency, lip incompetence, gummy smile

Mandibular advancement, nasal frame osteotomy, drop of upper lip

Lip incompetence, gummy smile Class II

303 Narrow lower jawCircumferential mandibular onlay with hydroxyapatite/fibrin glue mixture

Narrow lower mandible, with face disappearing into neck

305 Aging face, jowling Facelift, microliposuction jowls

309 Aging faceFacelift, forehead lift, upper blepharoplasty, hyaluronic acid filler in nasolabial sulci

311 Aging face Upper blepharoplasties, facelift

315 Aging neck Neck lift

319 Forehead feminization, secondary rhinoplasty

Reconstruction of anterior wall of frontal sinus, trimming of lateral supraorbital rims, calcium phosphate smoothing, secondary rhinoplasty

Masculine forehead and nose, transgender transformation

323 Forehead descent Knize brow lift, upper blepharoplasty Tired look

325 Aging foreheadKnize forehead lift and upper blepharoplasty

Tired look

327 Aging foreheadKnize forehead lift and upper blepharoplasty

Tired look

329 Baggy upper eyelids Bipolar lipolysis in upper blepharoplasty Asymmetrical eyelid ptosis

331Baggy eyelid lower right, scars after dog bite, epicanthal fold

Transconjuctival lower blepharoplasty, medial canthoplasty

Baggy eyelid lower right (lymphedema), visible scar and fold at corners of the eyes

333 Bat ears, nasal kyphosis, sad-looking eyesPinnaplasty, rhinoplasty, upper blepharoplasty, lateral canthoplasty

Bat ears, nasal shape, tired eyes

Key words Procedures Problem list orthodontic classification

335 Upper blepharoplasty Upper blepharoplasty Fullness upper eyelids

337Rhinoplasty, blepharoplasty — transconjunctival

Rhinoplasty, transconjunctival blepharoplasy

Tired lower eyelids, unaesthetic nose

341 Full upper eyelids, mole Upper blepharoplasty, excision mole

343 Baggy eyelids, upper and lower Upper and lower blepharoplasty Baggy eyelids

345 Baggy upper eyelids Upper blepharoplasty, conservative

347 Upper eyelids Upper blepharoplasty

349 Baggy eyelid Upper blepharoplasty

351 Baggy eyelids Upper blepharoplasty

355 Earlobe reduction Earlobe reduction Long earlobes None

357 Class II, bat ears

Mandibular advancement, chin advancement, hydroxylapatite and Aquamid in mentolabial fold, set-back pinnaplasty

Weak chin, bat ears, deep lip/chin fold Class II, chin hypoplasia

363 Bat ears, plagiocephaly Pinnaplasty, bilateral Bat ears

365 Class II, long face, prominent earsTPD, lower jaw and chin osteotomy, pinnaplasty

Weak lower face, bat ears Class II, long face

371 Unilateral bat ear Pinnaplasty, only antihelix

373 Long face, Class II, premature agingMaxillary impaction, mandibular advancement, chin impaction, submental liposuction

Lip incompetence, premature aging Class II, long face

377 Laterognathia, submental liposuctionMandibular rotation, chin advancement, submental liposuction

Laterognathia, submental lipodystrophia Class II, laterognathia

381 Class II, long face, submental ptosisMandibular advancement, maxillary impaction, chin advancement and impaction, submental liposuction

Weak chin, heavy neck, occlusal considerations

Class II, long face

385 Baggy lower eyelids, with wrinklesTransconjunctival blepharoplasty and microfat grafting

Baggy eyelids with wrinkles

387Microlipofilling lower face, dermopigmentation upper brows

Gaunt face Facial considerations

389 Aging faceFacelift, microlipofilling and hyaluronic acid filler

393 Deep nasolabial sulci Hyaluronic acid filler in nasolabial sulci Deep nasolabial folds

395 Dark circles around the eyes Hyaluronic acid fillerHeavy smoker, requests nonsurgical solution

397Nonsurgical compensation of Class II malocclusion, compensating orthodontics

NoneUnhappy with result regarding inclination of teeth, lip incompetence, profile

Class II, long face

THE SURGICAL ART OF FACIAL MAKEOVER

SHOWCASE

Transpalatal Distraction TPD

KEY WORDS PROCEDURES PROBLEM LIST ORTHODONTIC CLASSIFICATION

Class III, CrossbIte, CrowdIng | tPd, PterygoId dysjunCtIon | oCClusal ConsIderatIons | Class III, CrowdIng, CrossbIte

| 13Class III, CrossbIte, CrowdIng

Class I I I , CrossbIte, CrowdIng

Surgery at age 15 yearsEndo TPD for crowding and Class III, with pterygoid dysjunction

14 | Class III, CrossbIte, CrowdIng

| 15Class III, CrossbIte, CrowdIng

Orthodontist: Anne-Mie Schurmans

KEY WORDS PROCEDURES PROBLEM LIST ORTHODONTIC CLASSIFICATION

Class II, deep bIte, promInent ChIn | bsso neGatIVe rotatIon | oCClUsal ConsIderatIons | Class II, deep bIte, promInent ChIn

| 75Class II, deep bIte, promInent ChIn

Class I I , deep bIte, promInent ChIn

Surgery at age 20 yearsBSSO advancement, right 6 mm, left 4.5 mm, negative rotation (clockwise) out of increased overbiteMidlines clinically and radiographically inconsistent Range of deviations applies only in occlusion

76 | Class II, deep bIte, promInent ChIn

| 77

Orthodontist: Evelyn Asselman

Class II, deep bIte, promInent ChIn

1 day postoperatively

KEY WORDS PROCEDURES ORTHODONTIC CLASSIFICATION Class II, lower faCe defICIenCy after 4 premolar extraCtIons | BImaxIllary advanCement | Class II, 4 BICuspId extraCtIons

| 135Class II, lower faCe defICIenCy after 4 premolar extraCtIons

Class I I , lower faCe defICIenCy after 4 premolar extraCtIons

Surgery at age 24 yearsUpper jaw advancement of 5 mmLower jaw advancement of 8 mmCalcium phosphate cement in cortical gap of BSSO to prevent antegonial notchingClass II occlusion treated first by 4 bicuspid extractions and orthodontic therapy Dished-in midface, deficient lower face, and residual Class II occlusion prompted selection of bimaxillary advancement

136 | Class II, lower faCe defICIenCy after 4 premolar extraCtIons

| 137

Orthodontist: Marianne De Loecker

Class II, lower faCe defICIenCy after 4 premolar extraCtIons

138 |

After bimaxillary advancement

1 day postoperatively with absence of 4 bicuspids 1 day postoperative OPGHydroSet reconstruction of cortical defect

BImaxIllary advanCement

| 139

Lower facial defi ciency depicted in virtual 3D

BImaxIllary advanCement

KEY WORDS PROCEDURES PROBLEM LIST Class III, maCrogenIa, open bIte | trImax, rotatIon, ChIn underCorreCted | FaCIal and oCClusal ConsIderatIons | ORTHODONTIC CLASSIFICATION Class III, long FaCe, open bIte

| 193Class III, maCrogenIa, open bIte

Class I I I , maCrogenIa, open bIte

Surgery at age 23 yearsUpper jaw advancement 6 mm, anterior impaction 3 mm, posterior impaction 6 mmLower jaw set-back 10 mm bilaterallyGenioplasty reduction 5 mm, advancement 5 mmMalar valgization osteotomy, bilaterally 4 mm

194 | Class III, maCrogenIa, open bIte

| 195

Orthodontist: Katrien Mesotten

Class III, maCrogenIa, open bIte

196 | trImax, rotatIon, ChIn underCorreCted

| 197Class III, maCrogenIa, open bIte

Simulations: complete correction and incomplete, as requested by the patient’s mother

KEY WORDS PROCEDURES Upper eyelids | Upper blepharoplasty

| 347Upper eyelids

Upper eyelids

Surgery at age 51 yearsUpper eyelid correction, 1.5 cm skin heightFat coagulationResult after 3 months

KEY WORDS PROCEDURES Long face, cLass II, premature agIng | maxILLary ImpactIon, mandIbuLar advancement, chIn ImpactIon, submentaL LIposuctIon | PROBLEM LIST ORTHODONTIC CLASSIFICATION LIp Incompetence, premature agIng | cLass II, Long face

| 373Long face, cLass II, premature agIng

Long face, cLass I I , premature agIng

Maxillary impaction posterior 7 mm, anterior 6 mm, left 4 mm, anterior 3 mm, levelingMandibular advancementChin 4 mm intrusionSubmental liposuction

374 | Long face, cLass II, premature agIng

| 375

Orthodontist: An Roels

Long face, cLass II, premature agIng