What Is The Order For Orthognathic Surgery, Custom Facial Implants And Facelift Surgery?
Q: Dr. Eppley, I want to get custom implants and contouring to fix asymmetry in my face, mostly my jaws and orbitals, as well as add depth to the back of my head.
I’m also interested in more, but worry about how much you could do in one procedure. “More” being a facelift that includes my lips and brows and neck.
Lastly I understand you do orthognathic surgery. Could you perform maxillomandibular distraction osteogenesis? If so I want that procedure more than anything. I choose distraction over advancement because its results are more controllable, will help with my sleep apnea (undiagnosed but suspected), and will help advance my palate to better support my lips and help reduce marionette lines.
A:Thank you for your inquiry and sending your picture. You have described three types of facial procedures (orthognathic surgery (1), onlay bone augmentation with custom facial implants (2) and soft tissue rejuvenation surgery (3)) which involve different levels of tissues and which can not or should not be performed together as each one impacts the other one. These three ‘layers’ have to be done separately for a variety of reasons. If layer 1 (orthognathic surgery) is important then it absolutely has to be done first. Layers 2 and 3, however, can probably be done together.
Distraction osteogenesis of the maxilla and mandible is not a practical procedure in adults. Unless the movements are 10mms forward it is not going to help much with sleep apnea and it would also cause great aesthetic distortion of your face. But regardless of what method is used you have to have solid preoperative studies that prove that OSA exists and is obstructive in nature before ever doing any surgery for it.
You have to decide whether layer 1 surgery needs to be done before proceeding on to layers 2 and 3.
Dr. Barry Eppley