Your Questions

Q: Dr. Eppley,I am interested in a LeFort osteotomy. My bite relationship is significantly off, though, and I’m still wearing braces.  I’d suspect my upper jaw exceeds my lower jaw by at least 7-10 mms.  My orthodontist is under the impression that my bite relationship is fine, but I think that either extractions or upper jaw surgery would be necessary to shove my upper jaw back and even out my profile view.  I think the jaw surgery might be a better bet than a chin implant, in this case, since i like my lower jaw position but not my upper jaw position.  Do you perform upper jaw surgeries?  Could you show me an image of what an upper jaw surgery might look like, in terms of shoving my jawline back?

A: I have performed many maxillary (LeFort osteotomy) upper jaw surgeries. You can not really push your upper jaw back more than 1 to 2mms. It may go significantly up (impaction) or forward but it can not be moved any significant amount back as a total jaw unit. You may have the first premolars removed and have the pr maxilla (bone that contains the front 6 teeth) moved back by orthodontics or even by a premaxillary osteotomy but whether that is a reasonable thing to debased on your tooth relationships and facial profile is a questions for your orthodontist and their participation in integral in this process.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am in the process of correcting my jaw. I have had SARPE for my first phase. My main concern for the second phase of the surgery is to correct my flat under eye region. I would like implants to corrects this region of my face. I have a negative vector, flat upper cheeks, however I have moderate submalar projection. I have been told that my cheeks will fill out and the cheek fat of the submalar region will be pushed upward creating a fuller cheek effect, which I am seeking. I was also told, if I am still unsatisfied with my cheeks, it’s best to wait a year after orthognathic surgery to augment my cheeks. I have been reading that these procedures can be done at the same time and that orthognathic Lefort I osteotomy will not provide the same results as cheek implants/augmentation. I keep reading mixed reviews, Please help.

A: Let me answer your two questions directly and unequivocally.

1) A LeFort osteotomy, no matter how it is done, will not create a cheek augmentation effect. Based on where the bone cuts are and the how the bone is moved, this is simply not possible. Anyone that would suggest otherwise does not understand cheek augmentation.

2) Cheek implants can be done at the same time as a LeFort osteotomy. I have done it many times without any problems. It is as good combined procedure for the right patient. Just because someone had not done it before or is unwilling to do it does not mean it can not be done.

I hope this is helpful,

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I write to you to inquire if Lefort 1 osteotomy can be done for cosmetic purposes ( for instance: if a person considers herself to have a long mid face). I know my question is vain and somewhat selfish, but it is something that really bothers me about my appearance. Thank you for your time.

A: While a low level maxillary osteotomy (LeFort I) is usually done for some functional benefits (improved occlusion), it can also be performed for a pure cosmetic benefit. The usual reason that is done is in the patient with a long midface and a gummy smile. This is known as LeFort I impaction or vertical maxillary shortening. This is almost the only incidence where a LeFort osteotomy can be performed without having to cut (move) the lower jaw as well. Depending upon how much vertical movement is being done, the lower jaw (mandible) may autorotate enough so that orthodontic tooth movement/alignment before and/or after surgery may not be needed. Because of this potential issue, it is imperative to have an orthodontic consultation prior to considering this surgery.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have a short midface and we had previously discussed using cheek, paranasal and premaxillary implants to give me more midface projection for an improved facial look.  At your suggestion, I also visited an orthodontist who advised me to have a Lefort 1 procedure because there is an issue with my tongue not having enough room in my mouth and is constantly sore from rubbing on my teeth at the right side. He says implants would not help this but a LeFort advancement would. What are your views?

A: There is no question that the best functional treatment for maxillary retrusion is a LeFort (maxillary) advancement. This is the complete opposite of a cosmetic camouflage approach using multiple facial implants. These two approaches are diametric methods for treating midfacial retrusion. The key decision about a maxillary osteotomy approach at your age is whether you are committed for the necessary presurgical and postsurgical orthodontics required and that the amount of maxillary advancement that would be obtained is a minimum of 5mms, preferably 7mms. Any amount of maxillary forward movement less than 5mms would not be worth that amount of effort. It may also be possible that you would need a mandibular osteotomy setback as well to get the necessary forward movement of the maxilla. These are issues that would be known in advance through comprehensive orthognathic surgical treatment planning. Even with maxillary advancement you will still benefit by simultaneously performed cheek implants as the maxillary osteotomy moves the dental and nasal base bone but not the cheek bone.

Dr. Barry Eppley

Indianapolis, Indiana