Can A LeFort I With A Custom Midface Implant Achieve A Similar Effect As A LeFort II Osteotomy?

Q: Dr. Eppley, I am a young man who is due to undergo bimaxillary advancement for health reasons. The planned procedure involves a Le Fort 1 osteotomy. I have researched this topic in depth, so I am aware the different Le Fort osteotomies and their aesthetic implications. I have learned that I not only have a recessive lower maxilla, but my entire nasal region (both upper and lower) is recessive. I understand that this is the area moved foward with a Le Fort 2 osteotomy. I now have to make a choice between going forward with the Le Fort 1 osteotomy, or scrapping my plans and finding a surgeon who would perform the full Le Fort 2 osteotomy. The key aspect that will inform my decision is whether it is possible to (almost) achieve the results of a Le Fort 2 osteotomy with a combination of a Le Fort 1 osteotomy and a customized implant (or more than one of them). I envisage the customized implant to move forward the entire circumference of the piriform aperture in addition to the nasal bone and the frontal process of the maxilla. If this is possible, I would come to you for this implant after undergoing bimax. What do you think about this?

A: It is important to remember that facial bone surgery is not always as it appears in a diagram. LeFort II and III osteotomies look great on a diagram but executing them and accepting the tradeoffs and their more limited aesthetic effects is a different matter. The more assured result is a LeFort I, which is a very predictable operation, followed by addressing the remaining superior aesthetic midface needs secondarily with custom implants.

Dr. Barry Eppley

Indianapolis, Indiana