Q: I am in need of getting jaw surgery and was told that I could get my nose and cheeks done at the same time. They want to do an open rhinoplasty and malar osteotomies as well to get an improved look to my face. My question is can these be done safely all during the same surgery?
A: There are several fundamental issues with this combined surgical plan. The first would be what type of orthognathic surgery? If it is just an isolated lower jaw (mandible osteotomy) procedure, then I see no problem with a combined rhinoplasty as one does not really affect the other. (other than the need to change position of the endotracheal tube for anesthesia) If it is an orthognathic surgery procedure that involves the maxilla (alone or in conjunction with the lower jaw), then more thought need to be put into it. The advisability of those two would depend on what type of nasal deformity one has and what needs to be done to the nose. A maxillary osteotomy changes the skeletal foundation on which the nose sits and detaches the facial muscles which affects the alar base or nostril width. This can make it hard to know with any certainty how the nose will change with rhinoplastic maneuvers. A rhinoplasty procedure, on its own, is fraught with certain variables that can adversely affect the outcome even in the most experienced hands. Adding the underlying changes of maxillary position only adds another variable that may affect the final shape of the nose after its manipulation.
Most of the time, the concept of combining rhinoplasty and orthognathic surgery is an issue of ‘surgical opportunity’. You just want to be sure that the benefit of the opportunity does not over ride the more important objective of a desired result with the least risk of complications.
Lastly, I am unclear as to the need for malar osteotomies vs implants for cheek augmentation. Malar osteotomies tend to be more difficult bony movements that often do not produce as good as a cheek result as the more simple placement of implants. I have put in many a cheek implant with a LeFort 1 osteotomy and have never seen an infection.
Dr. Barry Eppley