Would I Benefit By A Maxillary Advancement?

Q: Dr. Eppley, The maxillary advancement is the original reason why I consulted with you. My plastic surgeon in Beverly Hills told me he’s the go-to guy for this and it’s what I need. Does he believe I would benefit from it? I do not mind putting off cheeks/midface augmentation until this decision is made. 

A: The key questions about the potential benefits of a maxillary advancement are based on the following insights:

1) The two lower midfacial areas in which a LeFort I advancement would benefit, provided the forward movement is significant is: a) increased upper lip projection and 2) increased paranasal/premaxillary (nasal base) projection. Any midfacial area north of the osteotomy line would have no benefit and, in the long run, would end up more deficient as they are ‘left behind’. That is not an issue in you as you already recognize these upper midfacial areas would need to be augmented.

2) Whether a maxillary advancement would be worth it depends on whether its movement would be significant. (more than 1 or 2mms) That is a determination that ultimately needs an orthodontic evaluation to provide an absolute definitive determinatio as the position of the upper teeth relative to the lower teeth needs to have orthodontic tooth movement done in preparation for the surgery. (dental decompensations removed) This would worsen your current bite relationship which is typical for orthognathic surgery as this would then allow for maximal maxillary bone advancement. I can only estimate such a potential maxlllary movement which I would guess is not more than 3 or 4mms at best….seems like a lot of effort for q very modest lower midface augmentation effect…unless your bite and lower lip position is a major aesthetic issue for you.

Dr. Barry Eppley

Indianapolis, Indiana