Would I Be Better With A Custom Midface Implant Or A LeFort Osteotomy?

Q: Dr. Eppley, I’m still torn on which midface surgery I should undergo. 

I can’t tell if I have a recessed or average maxilla, but if that turns out to be the case, will your maxillary implants be able to create a protruding maxilla to the same extent as a lefort II or lefort III procedure? I don’t have an overbite, and according to this test I have an average/slightly receding maxilla.

“1. Make a picture from the side while smiling 

2. then compare the sagittal position of your front teeth compared to the nasion (image a vertical line from the nasion – nasion line) 


if your teeth are at the same lvl with the nasion line your maxilla is average 

if your teeth are beyond the nasion line your maxilla is protruding 

if your teeth are behind the nasion line your maxilla is recessed” 

Thanks a lot for the help,

A:Thank you for your inquiry and detailing your concerns. With an ‘average to slightly receding maxilla’, regardless of how that is determined you are certainly never going to undergo any form of a LeFort osteotomy advancement unless you have a compelling need to bring your lower jaw forward as well. Modified midface osteotomy designs that leave the occlusion alone are poor substitutes for what a custom midfaceimplant can do because of the magnitude of the surgery and the resultant irregular osteotomy lines and bone contours. Bring the midface out in a smooth and contiguous fashion that is predesigned for the aesthetic effect produces superior results. The only thing that a midface implant can not do is change the occlusion but that is what osteotomies are for which is their primary benefit.

Dr. Barry Eppley

Indianapolis, Indiana