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THE SURGICAL ART OF FACIAL MAKEOVER
THE SURGICAL ART OF FACIAL MAKEOVER SHOWCASE Maurice Y. Mommaerts INDEX 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 23 Mandibular autorotation Maxillary impaction, chin advancement Gummy smile, lip incompetence Class II, open bite 29 Gummy smile, mandibular autorotation Maxillary impaction, mandibular autorotation Gummy smile Class II, laterognathia 35 Open bite Le 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 57 Class III Maxillary advancement and chin advancement, HA onlays paranasally Occlusal considerations Class III 61 Class III, macrogenia Upper jaw advancement, chin height reduction Occlusal and facial considerations Class III 65 Class III, laterognathia Maxillary advancement, unilateral set-back mandible Problematic gingiva, demo of clinical examination Class III, laterognathia 71 Deep bite, prominent chin Mandibular advancement and negative rotation 75 Class II, deep bite, prominent chin BSSO negative rotation Occlusal considerations Class II, deep bite, prominent chin 79 Class 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 bite Mandibular negative (counterclockwise) rotation Occlusal considerations Class II, deep bite 91 Class II, long face Mandibular advancement, chin advancement and impaction 97 Class II, prominent chin 103 Long face, facial makeover 107 Class II, lip incompetence 113 Gummy smile, lip incompetence 117 Class II, prominent chin Mandibular advancement, maxillary posterior impaction, bimaxillary negative rotation Maxillary impaction, mandibular advancement, chin reduction, bilateral malar valgization, rhinoplasty Upper jaw impaction, mandibular autorotation, chin advancement and impaction Upper jaw impaction, lower jaw advancement, chin impaction and advancement Bimaxillary negative rotation Small apical bases, upper and lower Class III Class II, deep bite Class II, high chin Mandibular hypoplasia with prominent chin Class II, prominent chin Unhappy with face Long face Lip incompetence, occlusal considerations Class II, long face Lip incompetence, occlusal considerations Class II, long face, lip incompetence, gummy smile Occlusal considerations, fearful of too strong a chin, wishing to reduce mentolabial fold depth Class II, deep bite, prominent chin 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) 129 Class II, deep bite, prominent chin Bimaxillary negative rotation Class II, prominent chin, deep bite 135 Class II, lower face deficiency after 4 premolar extractions Bimaxillary advancement Class II, 4 bicuspid extractions 141 Laterognathia, Class III Upper jaw advancement, lower jaw rotation/set-back 149 Class II, long face, lip incompetence Trimax surgery 153 Late mandibular growth, with compensation of occlusal plane of the maxilla Trimax surgery 157 Class III, midface deficiency 165 Class III, midface deficiency 169 Class III 175 Open bite, lip incompetence, gummy smile Deteriorating bite and profile Class I Laterognathia, Class III Class II, long face Unable to chew Class III, with late mandibular growth Profile and smile Class III, midface hypoplasia Prognathic face Class III, midface deficiency Upper jaw advancement, mandibular set-back, chin advancement Prognathic profile, occlusal considerations Class III 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 185 Class II, deep bite profile, prominent chin Bimaxillary negative rotation Chin deficiency with deep mentolabial fold Class II, deep bite 189 Bimaxillary dentoalveolar protrusion Bimaxillary 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 incompetence Upper jaw impaction, lower jaw advancement, chin impaction and advancement Occlusal considerations, gummy smile Class II, long face 203 Class 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 face TPD, mandibular advancement, maxillary impaction, chin advancement 215 Bipro, chin deficiency, Class II Upper jaw set-back, mandibular set-back, chin advancement Wish to occidentalize Class II, long face, bipro 219 Class III, open bite Upper 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 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 region Mandibular setback, maxillary narrowing dorsally (2 parts) Excess of submental soft tissue after mandibular set-back Class III 237 Facial asymmetry Maxillary leveling, lower jaw advancement, chin advancement and impaction, rhinoplasty Unhappy with facial features Class II, long face 243 Class II, prominent chin Bimaxillary negative rotation, well prepared with front teeth proclined Occlusal considerations Class II, prominent chin Maxillary advancement, bilateral zygoma valgization osteotomy, infraorbital augmentation with HydroSet Bimaxillary negative rotation, zygoma valgization osteotomy, infraorbital hydroxyapatite only Class III Class II, long face Class II, open bite Key words 247 Procedures Problem list orthodontic classification 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 Trimax Occlusal considerations, lip incomptence, mentalis habit Class II, long face 261 Class III, frontal open bite, mandibular asymmetry Unilateral mandibular set-back, maxillary advancement and impaction to close frontal open bite 265 Hemimanidbular hyperplasia Maxillary leveling, mandibuloplasty, chin symmetrizing Facial considerations Hemimandibular hyperplasia 269 Laterognathia, Class III Maxillary impaction, lower jaw set-back, after negative Tc scan of condyles Asymmetrical gummy smile, occlusal cant Class III, laterognathia 275 Chin hypoplasia, compensating orthodontia Chin osteotomy, advancement, impaction, narrowing, jaw line straightening Weak chin 279 Chin deficiency Chin advancement, jumping bone flap Chin deficiency, mentalis habit, no jaw line 281 Zygomatic valgization osteotomy Bilateral zygomatic valgization osteotomy, genioplasty, rhinoplasty, lip augmentation … Wish to increase malar projection 283 Class III, midface deficiency Maxillary advancement, zygomatic valgization osteotomy Occlusal and profile considerations Class III 287 Nasal deformity after primary rhinoplasty 291 Dished-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 Rhinoplasty Dissatisfied with shape of nose and function 299 Mandibular deficiency, lip incompetence, gummy smile Mandibular advancement, nasal frame osteotomy, drop of upper lip Lip incompetence, gummy smile 303 Narrow lower jaw Circumferential mandibular onlay with hydroxyapatite/fibrin glue mixture Narrow lower mandible, with face disappearing into neck 305 Aging face, jowling Facelift, microliposuction jowls 309 Aging face Facelift, 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 forehead Knize forehead lift and upper blepharoplasty Tired look 327 Aging forehead Knize forehead lift and upper blepharoplasty Tired look 329 Baggy upper eyelids Bipolar lipolysis in upper blepharoplasty Asymmetrical eyelid ptosis 331 Baggy 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 eyes Pinnaplasty, rhinoplasty, upper blepharoplasty, lateral canthoplasty Bat ears, nasal shape, tired eyes Class III, laterognathia, frontal open bite Class II, orthodontically compensated Class II Key words Procedures Problem list orthodontic classification 335 Upper blepharoplasty Upper blepharoplasty Fullness upper eyelids 337 Rhinoplasty, 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 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 ears TPD, 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 aging Maxillary impaction, mandibular advancement, chin impaction, submental liposuction Lip incompetence, premature aging Class II, long face 377 Laterognathia, submental liposuction Mandibular rotation, chin advancement, submental liposuction Laterognathia, submental lipodystrophia Class II, laterognathia 381 Class II, long face, submental ptosis Mandibular advancement, maxillary impaction, chin advancement and impaction, submental liposuction Weak chin, heavy neck, occlusal considerations Class II, long face 385 Baggy lower eyelids, with wrinkles Transconjunctival blepharoplasty and microfat grafting Baggy eyelids with wrinkles 387 Microlipofilling lower face, dermopigmentation upper brows Gaunt face Facial considerations 389 Aging face Facelift, 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 filler Heavy smoker, requests nonsurgical solution 397 Nonsurgical compensation of Class II malocclusion, compensating orthodontics None Unhappy with result regarding inclination of teeth, lip incompetence, profile Baggy eyelids Class II, long face THE SURGICAL ART OF FACIAL MAKEOVER SHOWCASE K EY WORDS P ROCEDURES P ROBLEM LIST O RTHODONTIC CLASSIFICATION Class III, CrossbIte, CrowdIng | tPd, PterygoId dysjunCtIon | oCClusal ConsIderatIons | Class III, CrowdIng, CrossbIte Transpalatal Distraction TPD Class III, CrossbIte, CrowdIng | 13 C l a s s III, C rossb Ite, C rowd In g Surgery at age 15 years Endo TPD for crowding and Class III, with pterygoid dysjunction 14 | Class III, CrossbIte, CrowdIng Class III, CrossbIte, CrowdIng | 15 Orthodontist: Anne-Mie Schurmans K EY WORDS P ROCEDURES P ROBLEM LIST O RTHODONTIC CLASSIFICATION Class II, deep bIte, promInent ChIn | bsso neGatIVe rotatIon | oCClUsal ConsIderatIons | Class II, deep bIte, promInent ChIn Class II, deep bIte, promInent ChIn | 75 C l a s s II, deep bI te, pro mIn en t ChI n Surgery at age 20 years BSSO advancement, right 6 mm, left 4.5 mm, negative rotation (clockwise) out of increased overbite Midlines clinically and radiographically inconsistent Range of deviations applies only in occlusion 76 | Class II, deep bIte, promInent ChIn Class II, deep bIte, promInent ChIn | 77 1 day postoperatively Orthodontist: Evelyn Asselman KEY WORDS PROCEDURES ORTHODONTIC CLASSIFICATION Class II, lower faCe defICIenCy after 4 premolar extraCtIons | BImaxIllary advanCement | Class II, 4 BICuspId extraCtIons Class II, lower faCe defICIenCy after 4 premolar extraCtIons | 135 C l a s s II, l ow er faC e d efIC IenCy af ter 4 premolar extraCtI ons Surgery at age 24 years Upper jaw advancement of 5 mm Lower jaw advancement of 8 mm Calcium phosphate cement in cortical gap of BSSO to prevent antegonial notching Class 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 Class II, lower faCe defICIenCy after 4 premolar extraCtIons | 137 Orthodontist: Marianne De Loecker 138 | BImaxIllary advanCement 1 day postoperatively with absence of 4 bicuspids 1 day postoperative OPG HydroSet reconstruction of cortical defect After bimaxillary advancement BImaxIllary advanCement | 139 Lower facial deficiency depicted in virtual 3D 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 Class III, maCrogenIa, open bIte | 193 C l a s s III, m aC rog enIa , o pen bIt e Surgery at age 23 years Upper jaw advancement 6 mm, anterior impaction 3 mm, posterior impaction 6 mm Lower jaw set-back 10 mm bilaterally Genioplasty reduction 5 mm, advancement 5 mm Malar valgization osteotomy, bilaterally 4 mm 194 | Class III, maCrogenIa, open bIte Class III, maCrogenIa, open bIte | 195 Orthodontist: Katrien Mesotten 196 | trImax, rotatIon, ChIn underCorreCted Class III, maCrogenIa, open bIte | 197 Simulations: complete correction and incomplete, as requested by the patient’s mother KEY WORDS PROCEDURES Upper eyelids | Upper blepharoplasty Upper eyelids | 347 U p p er ey e lid s Surgery at age 51 years Upper eyelid correction, 1.5 cm skin height Fat coagulation Result after 3 months KEY WORDS PROCEDURES PROBLEM LIST ORTHODONTIC CLASSIFICATION Long face, cLass II, premature agIng | maxILLary ImpactIon, mandIbuLar advancement, chIn ImpactIon, submentaL LIposuctIon | LIp Incompetence, premature agIng | cLass II, Long face Long face, cLass II, premature agIng | 373 L on g fac e, c L a s s II, pr ematu re ag Ing Maxillary impaction posterior 7 mm, anterior 6 mm, left 4 mm, anterior 3 mm, leveling Mandibular advancement Chin 4 mm intrusion Submental liposuction 374 | Long face, cLass II, premature agIng Long face, cLass II, premature agIng | 375 Orthodontist: An Roels