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