519

The Facial Soft Tissue Effects of Orthognathic

Surgery
Daljit S. Gill, BDS (Hons), BSc (Hons), MSc, FDS, MOrth, FOrth RCS (Eng), FHEA1,2
Timothy Lloyd, FDS, FRCS3 Charles East, MB, FRCS4
Farhad B. Naini, PhD, BDS, MSc, FDS, MOrth, FOrth RCS (Eng)5

1 Maxillofacial and Dental Department, Great Ormond Street Hospital for
Children NHS Foundation Trust, London, United Kingdom
2 Orthodontics, UCLH Eastman Dental Hospital, London, United Kingdom
3 Oral and Maxillofacial Surgery, UCLH Eastman Dental Hospital,
London, United Kingdom
4 Craniofacial Unit, UCLH NHS Foundation Trust, London, United Kingdom
5 Orthodontics/Maxillofacial, St George’s Hospital and Medical
School, London, United Kingdom
Address for correspondence Daljit S. Gill, BDS (Hons), BSc (Hons),
MSc, FDS, MOrth, FOrth RCS (Eng), FHEA, Maxillofacial and Dental
Department, Great Ormond Street Hospital for Children NHS
Foundation Trust, Great Ormond Street, London WC1N 3JH,
United Kingdom
(e-mail: daljit.gill@nhs.net; farhad.naini@yahoo.co.uk).

Facial Plast Surg 2017;33:519–525.

Abstract Orthognathic surgery is undertaken to correct anteroposterior, vertical, and transverse

Downloaded by: Boston University. Copyrighted material.

Keywords anomalies of the maxilla and mandible. Surgery has significant effects on the overlying
► orthognathic surgery soft tissue envelope. Some of these effects are beneficial while others may be
► maxillary detrimental to facial aesthetics. This review aims to update the reader on what soft
advancement tissue changes occur following orthognathic surgery to the mandible and maxilla. It is
► maxillary impaction important to anticipate the detrimental effects of orthognathic surgery as this will
► mandibular allow the patient to be warned about them before treatment and in some cases,
advancement adjunctive procedures may be planned to limit the unwanted changes.
► mandibular setback
► genioplasty
► soft tissues

The aims of orthognathic surgery are to achieve healthy,
functional, aesthetic, and stable outcomes. Treatment involves
a multidisciplinary approach and the specialties primarily
involved in planning and conducting treatment commonly
include oral and maxillofacial surgery, orthodontics, and the
involvement of a liaison psychiatrist can also be beneficial.
Treatment involving syndromic patients will also often benefit
from the input of a plastic and craniofacial surgeon and ENT
(ear, nose, and throat) surgeon.
It is important to understand the relationship between
the movement of the facial soft tissue envelope and the
underlying skeletal bases during orthognathic surgery, as it is
largely the final soft tissue form and position that determines
the aesthetic outcome of treatment. One can go as far as
saying that so important is the position of the soft tissues
that during orthognathic planning one should consider the
proposed final position of the soft tissues first and then plan
skeletal movements accordingly, albeit taking into consid-
eration the importance of a well-interdigitated dental occlu-
sion. This “aesthetic-centered” approach to treatment
planning has now superseded earlier “occlusion-centered”
approaches even in orthodontic treatment. However, in
orthognathic surgery, it is even more important that “the
teeth are made to fit the face and not vice versa.”1
Orthognathic surgery has both effects on the static and
dynamic soft tissue position(s) but the dynamic relationships,
in particular, has been poorly studied. Some evidence is
available which would suggest that there is no deterioration
of soft tissue movement, due to intraoperative soft tissue
dissection, following orthognathic surgery.2 Concerning the
static soft tissue effects, one must take into consideration the
immediate and longer term soft tissue changes to gain a full

Issue Theme The Evidence Base in 21st Copyright © 2017 by Thieme Medical DOI https://doi.org/
century Facial Plastic Surgery; Guest Publishers, Inc., 333 Seventh Avenue, 10.1055/s-0037-1606334.
Editor, Charles East, MB, FRCS New York, NY 10001, USA. ISSN 0736-6825.
Tel: +1(212) 584-4662.
520 The Facial Soft Tissue Effects of Orthognathic Surgery
understanding of the changes that may be seen following
treatment. The longer term effects are complex and are
influenced by factors, such as relapse, remodeling, and the
aging process. To date, research has only focused on the shorter
term (6–12 months postsurgery) soft tissue changes, and these
will be the focus of this review.
Along with positive changes, certain orthognathic surgi-
cal procedures can also have detrimental effects on the soft
tissues of the face, particularly in the nasal and submental
regions. It is important that these are anticipated and mini-
mized, but also that they are discussed during the planning
and consenting stages of treatment as it is important for
patients to understand the implications of treatment fully.
Also, adjunctive soft tissue procedures may be considered to
help reduce these negative changes, although there is a
paucity of evidence available about the benefits of such
procedures, particularly in the longer term.
Orthognathic surgery can have important effects on the
soft tissues that determine the size and shape of the phar-
yngeal and nasal airway as well as effects on the soft tissue
facial drape. These effects may be positive or negative,
depending on the type of surgery, and should also be
considered during the planning stages. A discussion on these
changes is outside the scope of this article.
Research into the soft tissue effects of orthognathic surgery
has largely been hampered by a past lack of tools for evaluating
changes in all three dimensions, small sample sizes, variation
in surgical technique, and the involvement of many different
surgeons within any given series. These drawbacks can be
tackled with the use of three-dimensional imaging techniques,
such as stereophotogrammetry, laser scanning, and cone beam
computed tomography, and improved research study designs
to reduce confounding variables.
Before continuing, it is essential that the reader appreci-
ates that there is tremendous individual variation in the soft
tissue response to orthognathic surgery. Therefore, it is
impossible to predict the exact changes that may occur within
any given individual.3 This article will describe the mean
changes, but it is important to remember that a large
standard deviation may be associated with these means.
Surgical prediction software (e.g., Dolphin) utilizes algo-
rithms, which may be based upon linear or nonlinear move-
ment models, with average changes, and therefore cannot
give precise predictions for any given individual. Another
limitation of prediction software is that most packages only
provide an idea of the changes typically seen in one dimen-
sion—the profile view.
The possible reasons for the individual variation in soft
tissue response are complex, not fully understood, and may
include factors such as:
1. Variation in the thickness of the facial soft tissues between
individuals. Thicker soft tissues tend to respond less to
underlying skeletal movements compared with thinner
tissues.4
2. Variation in muscular tone between individuals. Where
there is greater muscular tone, there may be a closer
relationship between hard and soft tissue movements. It
Facial Plastic Surgery Vol. 33 No. 5/2017
Gill et al.
is well established that with aging the tissues become
thinner, and there is a loss of muscle tone.5 It is plausible
that the soft tissue responses to orthognathic surgery are
less in older (>40 years) compared with younger
individuals.
3. Anatomical variations in the position and size of muscular
attachments. The soft tissue responses at sites of muscular
attachment are probably greater than at sites of
nonattachment.6
4. The size of the skeletal movement. It is accepted that there
is a nonlinear relationship between the size of the hard
and soft tissue movement. Larger skeletal changes may
not induce proportionally larger changes within the soft
tissues.
5. The surgical technique employed. The amount of soft
tissue dissection, the position of the osteotomy cuts
(e.g., subspinal Le Fort I), V-Y closure of the upper lip,
the alar cinch suture, and method of fixation are some
factors that may influence the soft tissue responses.
Downloaded by: Boston University. Copyrighted material.
The Immediate Response to Orthognathic
Surgery
The immediate soft tissue response to orthognathic surgery
is largely determined by the magnitude of the inflammatory
response to surgical injury. This has been prospectively
investigated in several studies7–9 using three-dimensional
facial scanning before and after surgery, including both
bimaxillary and single jaw procedures. ►Fig. 1 shows data
collected in one study9 and outlines the reduction of facial
swelling. It can be seen that it takes on average 3 weeks for
the swelling to reduce by 50%, 3 months for it to reduce by
80%, and even after 6 months, 10 to 15% resolution needs to
occur during the following 6 months. Studies have also found
some other interesting trends:7,8
1. There is large individual variation in the immediate
(<6 months) soft tissue edema (swelling).
2. Peak swelling typically occurs approximately 48 hours
after surgery.
3. The swelling may be asymmetrical. Patients and their care
givers should be reassured that this is normal; otherwise,
it can become a matter of concern in the postoperative
period.
Fig. 1 Facial swelling reduction following orthognathic surgery.9
 The Facial Soft Tissue Effects of Orthognathic Surgery
4. There is a vertical gradient in the reduction of swelling
with the resolution being quicker in the maxillary region
compared with the mandibular region, possibly owing to
the effects of gravity on the tissue fluids.
5. Resolution of swelling is also not symmetrical with one
side often settling quicker than the other.
From the results of these studies, it is clear that the final
soft tissue response, ignoring longer term soft tissue changes
due to skeletal relapse, cannot be evaluated until at least
6 months, and ideally 12 months, following surgery. It is
important that patients are informed of this during the
consenting stages of treatment and that any fine
tuning, secondary, adjunctive surgical procedures, for exam-
ple, rhinoplasty, are ideally planned following this period.
Research evaluating facial changes following surgery should
also ideally follow up patients for a minimum of 12 months
following surgery.
Soft Tissue Changes with Maxillary Surgery
The Le Fort I Osteotomy
The Le Fort I osteotomy can be used to reposition the maxilla
anteriorly, posteriorly to a small degree, superiorly, infer-
iorly, and transversely. Maxillary advancement, and bimax-
illary (maxillomandibular) advancement has important
effects on the soft tissues of the airway that can result in
an improvement of the symptoms of obstructive sleep
apnea.10
The major facial soft tissue effects are seen within the
nasolabial region although three-dimensional studies have
also documented changes in the paranasal soft tissues.6
Vertical repositioning of the maxilla also has an
important secondary effect on the position of the mandible,
due to autorotation, which is a clockwise or counterclock-
wise rotation of the mandible about the hinge axis following
vertical maxillary repositioning. The major effects of Le Fort I
surgery is on the following structures:
• Nose (nasolabial angle, alar bases, nasal tip, supratip
depression, and dorsal hump)
• Upper lip
• Paranasal regions
• Mandibular autorotation
In almost all cases, a Le Fort I osteotomy results in
widening of the alar bases.11 The significant factor contri-
buting to these changes is the soft tissue dissection rather
than the skeletal movements themselves. Periosteal eleva-
tion will sever important muscular attachments (zygomati-
cus major, levator labii superioris, levator labii superioris
alaeque nasi, nasalis, and dilator nasi) leading to muscular
retraction, alar flaring and shortening, and flattening and
thinning of the upper lip.12,13 As a guideline the alar base
width (insertion of the alar onto the cheek) should ideally
equal the intercanthal distance in Caucasians. The alar base is
wider in African Americans, and further widening must often
be undertaken with great care. The alar cinch suture, first
described by Millard (1980),14 has been proposed as a
Gill et al. 521
method to control alar flaring at the time of surgery. How-
ever, some controversy remains as to the effectiveness of this
procedure.15 One randomized controlled trial found that the
classically described alar cinch suture had a clinically insig-
nificant effect in controlling alar base flaring.15 A more
recent systematic review has suggested that modified
version of the classic alar cinch, such as reinsertion and
transseptal techniques, may be more efficient at controlling
alar base flaring but more randomized controlled trials are
required.16 There is some evidence to suggest that an extra-
oral alar base cinch suture is more efficient in maintaining
alar base width, at least in the short-term (<9 months after
surgery), compared with the classically described intraoral
nasal suture.17 Other techniques that may help to control alar
base flaring and maybe worth researching include:
• Pyriform remodeling to reduce the compressive forces at
the base
• The subspinal Le Fort I osteotomy
Maxillary Advancement
Downloaded by: Boston University. Copyrighted material.
Maxillary advancement is most commonly undertaken for
the management of maxillary retrognathia, in class III mal-
occlusion correction, and occasionally for the correction of
bimaxillary retrusion. There is variability in the reported
hard-to-soft tissue movement ratios within the literature,18
and ►Table 1 summarizes some of the reported changes.
The Le Fort I advancement leads to alar base widening, and
there is an elevation and widening of the nasal tip, resulting
in an increase in the supratip depression, and a lowering of
the columella (►Fig. 2). In patients with an already upwardly
inclined nasal columella, elevation of the nasal tip can
increase nostril exposure,24 which may be detrimental to
facial aesthetics. If the nasal dorsum is concave in shape,
nasal tip elevation can lead to an accentuation of this
convexity. Conversely, if there is a nasal dorsal hump before
surgery, elevation of the nasal tip may improve the nasal
appearance. There is no evidence at present that a subspinal
osteotomy is superior to a conventional Le Fort I osteotomy
in minimizing changes at the nasal tip.25
Table 1 Range of reported ratios for soft tissue to hard tissue
movements in Le Fort I maxillary advancement surgery
Measurement Ratio
Maxillary incisor to upper lip 57%19
(stomion superius)
86%20
70%21
82%21
69%22
Alar base widening 9%23
Elevation and advancement 34%19
of nasal tip
29–34%6
35%21
Paranasal area 74–79%6
Facial Plastic Surgery Vol. 33 No. 5/2017
522 The Facial Soft Tissue Effects of Orthognathic Surgery Gill et al.

those with a degree of malar deficiency. There is some

evidence to suggest that a Le Fort I advancement may help
to reduce small amounts of lower scleral show by affecting
the soft tissues at the infraorbital rim.28

Maxillary Superior Repositioning (Impaction)

Maxillary impaction is most commonly undertaken for the
treatment of vertical maxillary excess, to reduce the lower
anterior facial height, close an anterior open bite (posterior
maxillary impaction) and reduce incisor or gingival display
(anterior impaction). It is challenging to study the effects of
maxillary impaction alone because there is also often a
planned anteroposterior movement of the maxilla.
With maxillary impaction, similar changes occur to those
with maxillary advancements, such as the widening of the
alar bases, elevation and widening of the nasal tip and
deepening of the supratip nasal depression (►Fig. 3).
Also, secondary to the effects of soft tissue dissection, there
may be thinning, shortening, and flattening of the upper lip,
which can lead to a reduction in vermillion exposure. As a

Downloaded by: Boston University. Copyrighted material.

more anterior portion of the maxillary incisor crown comes
to lie against the upper lip with impaction, the degree to

Fig. 2 Before and after maxillary advancement. (A) Preoperative and

(B) postoperative, there is an increase in nasal width and nares display.
(C) Preoperative and (D) postoperative, note the reduction in naso-
labial angle, elevation in nasal tip, and the increase in supratip
depression.

Changes to the upper lip include advancement, which may

increase the nasolabial angle if subnasale advances more
than labrale superius, and shortening due to periosteal
dissection. As the nasolabial angle is determined by both
the inclination of the upper lip and the columella, the overall
change in this angle is dependent upon the change in its
individual components which increases the variability of the
response.1,16 There is some evidence to suggest that V-Y
closure of the upper lip may help to reduce shortening of the
upper lip and increase vermillion show.26
Soncul and Bamber (2004),6 in a study using three-
dimensional surface scans, found that the upper lip at sub-
nasale (80%) followed the skeletal movements more closely
than the upper lip at stomion superius (70%) and the upper
lip in the supracommissural region (45%). This suggests that
there is a vertical and a horizontal gradient in the movement
of the upper lip with the biggest changes occurring at
subnasale, which is a major area of muscle attachment.
The horizontal gradient in the movement of the upper lip
may be explained because areas of muscle attachment
(incisive and mental slips of orbicularis oris) also occur in
the midline, which may also help to explain why the soft
tissues follow the hard tissues more closely in these regions.
Advancement of the paranasal soft tissue region appears
to follow the advancement of the hard tissue closely.6 There Fig. 3 Before and after Le Fort I maxillary impaction. (A) Preoperative
frontal view, (B) postoperative frontal view, (C) preoperative profile
is evidence to suggest that the soft tissue effects of a high-
view, and (D) postoperative profile change. Note the increase in nasal
level Le Fort I osteotomy extend further laterally within the width, increase in supratip depression. The reduction in facial height,
face, compared with a conventional Le Fort I osteotomy, to due to mandibular autorotation, also makes the face look rounder and
include the zygomatic region,27 which may be of benefit to reduces mentalis strain to achieve lip competence.

Facial Plastic Surgery Vol. 33 No. 5/2017

 The Facial Soft Tissue Effects of Orthognathic Surgery
which flattening of the upper lip occurs will depend on the
pretreatment inclination of the maxillary incisors. Where
they are proclined, the lip support may increase and when
they are more average in inclination the increase in support
may be minimal. More research is required to clarify if the
V-Y closure method helps to maintain upper lip height
following orthognathic surgery.18
Maxillary impaction will also result in anticlockwise (or
forward) autorotation of the mandible, which will reduce the
lower anterior facial height and move the chin point further
forward. This not only increases the prominence of the chin
point, relative to the forehead but also increases the promi-
nence relative to the lower lip. This occurs because the lower
lip is positioned closer to the center of rotation of the
mandible and moves forward less than pogonion.
Maxillary Inferior Repositioning
The maxilla may be inferiorly repositioned when there is a
vertical maxillary deficiency, leading to reduced maxillary
incisor display and a reduction in the lower anterior facial
height. Inferior maxillary repositioning can also help to
reduce the prominence of the chin point by causing clock-
wise (or backward) autorotation of the mandible.
The inferior maxillary movement may lead to drooping of
the nasal tip, alar base, and columella. Care has to be taken
that drooping of the nasal tip does not lead to a “parrot beak”
deformity.11 The upper lip may flatten and thin with the
downward movement of the maxilla. This effect is accentu-
ated as a posterior portion of the maxillary incisor crown
repositions against the upper lip. The degree of the latter
effect will depend again on the inclination of the maxillary
incisors. Finally, setting down the maxilla will cause auto-
rotation of the mandible with a resultant increase in lower
anterior facial height and posterior movement of the chin
point relative to the forehead and lower lip.
Maxillary Expansion
Maxillary expansion is undertaken for the management of
transverse deficiency of the maxilla. Surgical techniques
include surgically assisted rapid palatal expansion and the
segmental maxillary osteotomy. Reported soft tissue
changes following surgical expansion are summarized
below:26
1. Increased interalar width 0.4:1
2. Increased Cheilion–Cheilion distance 0.26:1
3. Increased cheek width 0.32:1
4. Retraction of the upper lip 0.88:1
Maxillary Setback
The maxillary setback is a rarely undertaken procedure, and
there is no research to document its soft tissue effects.
Maxillary setback, at the Le Fort I level, can be undertaken
to a small degree for the management of maxillary protru-
sion during class II correction. The effects of a setback may
include a reduction of the nasal tip and upper lip support.
This may lead to a reduction of the supratip depression and
an increase in the nasolabial angle. There may be widening of
the alar bases due to soft tissue dissection.
Gill et al. 523
Soft Tissue Changes with Mandibular
Surgery
Bilateral Sagittal Split Osteotomy
The main indications for the bilateral sagittal split osteotomy
(BSSO) are for the correction of mandibular retrognathism,
prognathism, and asymmetry. A recent systematic review on
the profile changes after BSSO advancement concluded that
there was poor evidence on the short- and long-term effects
of advancement.29 Studies tend to have small sample sizes,
no power calculation, and a mixture of surgical procedures
performed on the study subjects.
Mandibular Advancement
With mandibular advancement alone, one can expect a down-
ward and forward repositioning of soft tissue pogonion with a
resultant reduction in facial convexity, increase in the lower
anterior facial height, and increase in throat length (►Fig. 4).
The increase in lower anterior facial height will be influenced
by the maxillary occlusal plane inclination, with a steeper
Downloaded by: Boston University. Copyrighted material.
plane resulting in a greater increase in lower facial height. The
reported short-term (<2 years) and long-term (>2 years)
ratios with rigid fixation are summarized in ►Table 2.29
The figures in ►Table 2 suggest that a vertical gradient in
effects exists with the greater proportional changes occur-
ring at soft tissue pogonion with reducing changes as one
moves up to the upper lip. In the short-term, the upper lip can
be affected by edema and the upper lip may also follow the
lower lip movement to some degree. Longer term changes to
the upper lip may be related to relapse and the aging process
with gradual thinning and inferior movement of labrale
superius.30 The changes at soft tissue pogonion may be
more predictable as there is the close attachment of the
facial muscles onto this bony region.
With mandibular advancement, one may also expect a
reduction in facial convexity, an increase in submental length,
reduction in any submental soft tissue sag, and a reduction of
the lower lip-chin-submental plane angle. There may also be
an uncurling effect on the lower lip, particularly if the
Fig. 4 (A) Before and (B) after mandibular advancement. Note the
reduction in facial convexity, increase in face height, and increase in
throat length.
Facial Plastic Surgery Vol. 33 No. 5/2017
524 The Facial Soft Tissue Effects of Orthognathic Surgery Gill et al.

Table 2 Range of ratios for soft tissue to hard tissue movements

for mandibular advancement, without genioplasty, with rigid
internal fixation29

Short-term Long-term
(<2 y) ratios (>2 y) ratios
Upper lip to incisor inferior 2 to 29% 10 to 67%
Lower lip to incisor inferior 35–108% 31–60%
Mentolabial fold to B-point 88–111% 86–111%
Soft tissue pogonion to 90–124% 102–127%
hard tissue pogonion

Table 3 Range of ratios for soft tissue to hard tissue movements

for mandibular setback, without genioplasty, with rigid internal
Fig. 5 (A) Before and (B) after advancement genioplasty. Note the
fixation32
reduction in facial convexity.

Short-term Long-term
(<2 y) ratios (>2 y) ratios
ment. Submental-cervical surgical procedures may be re-
Soft tissue pogonion 94% to 128% 94% (after 3 y)

Downloaded by: Boston University. Copyrighted material.

to hard tissue quired as adjunctive procedures. For example, submental
pogonion liposuction may be used to attempt to reduce these negative
changes. However, no clinical trials have evaluated the effec-
Mentolabial fold 106–108% 106% (after 3 y)
to B-Point tiveness of this procedure.

Labrale inferius to 73–90% 100% (after 3 y)

incision inferius
Labrale superius to 1% to 23% 35% (after 3 y)
hard tissue pogonion
preoperative lower facial height was reduced.31 Although
mandibular advancement did not affect absolute nasal dimen-
sions, advancement of the chin point may reduce the relative
prominence of the nose in relation to the forehead and chin
point, and help to improve overall facial balance.
Mandibular Setback
The reported short-term (<2 years) and long-term (>2 years)
soft tissue ratios for mandibular setback are summarized
in ►Table 3.32
The figures in ►Table 3 suggest a vertical gradient in effects
occurring, with the greatest proportional changes happening
at soft tissue pogonion, and with reducing changes as one
moves up to the upper lip. The upper lip may move forward
slightly in several cases, possibly because the lower lip does not
trap it following the mandibular setback. Again, the changes at
soft tissue pogonion may be more predictable as there is a
close attachment of the musculature onto this region.
With the mandibular setback, one may also expect a
reduction in facial concavity, a reduction in submental length,
increase in submental soft tissue sag, and an increase of the
lower lip-chin-submental plane angle. Although mandibular
setback does not affect absolute nasal dimensions, setting back
the chin point may increase the relative prominence of the
nose in comparison to the forehead and chin point. Particular
attention should be paid to the effects of mandibular setback
on submental aesthetics during the planning stages of treat-
Genioplasty
Genioplasty is a versatile surgical procedure that allows
sagittal, vertical, and transverse changes to be made to
the chin without affecting the dental occlusion. It can be
undertaken in isolation or in combination with other more
extensive mandibular procedures.
With advancement genioplasty the reported ratio of hard-
to-soft tissue changes range from 1: 0.6 to 1:1.33–39 Effects
also include an increase in the submental length, a reduction
in submental soft tissue sag, a decrease in the lower lip-chin-
submental plane angle, deepening of the labiomental fold, a
reduction in facial convexity and a reduction in relative nasal
prominence (►Fig. 5). Because genioplasty involves dissec-
tion of the mentalis muscle, which is important in elevating
the lower lip, there may be an increase in lower incisor
exposure following surgery.40
There are fewer reported studies on the soft tissue effects
of setback genioplasty, and sample sizes tend to be smaller.
The opposite changes may be expected with setback genio-
plasty and a recent study suggested a soft tissue:hard tissue
movement ratio of 1:1 at menton, 0.7:1 at pogonion, and
0.9:1 at B-point.41 Effects also may include a decrease in the
submental length, a possible increase in submental soft
tissue sag, an increase in the lower lip-chin-submental plane
angle, a reduction of the mentolabial fold, an increase in soft
tissue thickness,41 an increase in facial convexity, and a
relative increase in perceived nasal prominence.
Recommended Reading
Naini FB, Gill DS. Orthognathic Surgery: Principles, Planning and
Practice. New York, NY: John Wiley & Sons Ltd; 2017

Facial Plastic Surgery Vol. 33 No. 5/2017

 The Facial Soft Tissue Effects of Orthognathic Surgery
References
1 Naini FB, Cobourne MT, McDonald F, Wertheim D. The aesthetic
impact of upper lip inclination in orthodontics and orthognathic
surgery. Eur J Orthod 2015;37(01):81–86
2 Nooreyazdan M, Trotman CA, Faraway JJ. Modeling facial move-
ment: II. A dynamic analysis of differences caused by orthognathic
surgery. J Oral Maxillofac Surg 2004;62(11):1380–1386
3 Kaipatur NR, Flores-Mir C. Accuracy of computer programs in
predicting orthognathic surgery soft tissue response. J Oral Max-
illofac Surg 2009;67(04):751–759
4 Mobarak KA, Espeland L, Krogstad O, Lyberg T. Soft tissue profile
changes following mandibular advancement surgery: predict-
ability and long-term outcome. Am J Orthod Dentofacial Orthop
2001;119(04):353–367
5 Zoumalan RA, Larrabee WF Jr. Anatomic considerations in the
aging face. Facial Plast Surg 2011;27(01):16–22
6 Soncul M, Bamber MA. Evaluation of facial soft tissue changes
with optical surface scan after surgical correction of Class III
deformities. J Oral Maxillofac Surg 2004;62(11):1331–1340
7 Kau CH, Cronin AJ, Richmond S. A three-dimensional evaluation of
postoperative swelling following orthognathic surgery at 6
months. Plast Reconstr Surg 2007;119(07):2192–2199
8 Day CJ, Robert T. Three-dimensional assessment of the facial soft
tissue changes that occur postoperatively in orthognathic pa-
tients. World J Orthod 2006;7(01):15–26
9 van der Vlis M, Dentino KM, Vervloet B, Padwa BL. Postoperative
swelling after orthognathic surgery: a prospective volumetric
analysis. J Oral Maxillofac Surg 2014;72(11):2241–2247
10 Holty JE, Guilleminault C. Maxillomandibular advancement for
the treatment of obstructive sleep apnea: a systematic review and
meta-analysis. Sleep Med Rev 2010;14(05):287–297
11 Schendel SA, Carlotti AE Jr. Nasal considerations in orthognathic
surgery. Am J Orthod Dentofacial Orthop 1991;100(03):197–208
12 Altman JI, Oeltjen JC. Nasal deformities associated with orthog-
nathic surgery: analysis, prevention, and correction. J Craniofac
Surg 2007;18(04):734–739
13 O’Ryan F, Schendel SA Jr. Nasolabial esthetics and maxillary
surgery. In: Bell WH, ed. Modern Practice in Orthognathic and
Reconstructive Surgery. St. Louis, MO: W.B. Saunders; 1992
14 Millard DR Jr. The alar cinch in the flat, flaring nose. Plast Reconstr
Surg 1980;65(05):669–672
15 Howley C, Ali N, Lee R, Cox S. Use of the alar base cinch suture in Le
Fort I osteotomy: is it effective? Br J Oral Maxillofac Surg 2011;49
(02):127–130
16 Liu X, Zhu S, Hu J. Modified versus classic alar base sutures after
LeFort I osteotomy: a systematic review. Oral Surg Oral Med Oral
Pathol Oral Radiol 2014;117(01):37–44
17 Ritto FG, Medeiros PJ, de Moraes M, Ribeiro DPB. Comparative
analysis of two different alar base sutures after Le Fort I osteot-
omy: randomized double-blind controlled trial. Oral Surg Oral
Med Oral Pathol Oral Radiol Endod 2011;111(02):181–189
18 Khamashta-Ledezma L, Naini FB. Systematic review of changes in
maxillary incisor exposure and upper lip position with Le Fort I
type osteotomies with or without cinch sutures and/or VY
closures. Int J Oral Maxillofac Surg 2014;43(01):46–61
19 McCollum AGH, Dancaster JT, Evans WG, Becker PJ. Sagittal soft-
tissue changes related to the surgical corrections of maxillary-
deficient class III malocclusions. Semin Orthod 2009;15(03):
172–184
20 Conley RS, Boyd SB. Facial soft tissue changes following max-
illomandibular advancement for treatment of obstructive sleep
apnea. J Oral Maxillofac Surg 2007;65(07):1332–1340
21 Lin SS, Kerr WJ. Soft and hard tissue changes in Class III patients
treated by bimaxillary surgery. Eur J Orthod 1998;20(01):
25–33
Gill et al. 525
22 Jensen AC, Sinclair PM, Wolford LM. Soft tissue changes associated
with double jaw surgery. Am J Orthod Dentofacial Orthop 1992;
101(03):266–275
23 Betts NJ, Vig KW, Vig P, Spalding P, Fonseca RJ. Changes in the nasal
and labial soft tissues after surgical repositioning of the maxilla.
Int J Adult Orthodon Orthognath Surg 1993;8(01):7–23
24 Dann JJ III, Fonseca RJ, Bell WH. Soft tissue changes associated
with total maxillary advancement: a preliminary study. J Oral
Surg 1976;34(01):19–23
25 Mommaerts MY, Lippens F, Abeloos JV, Neyt LF. Nasal profile
changes after maxillary impaction and advancement surgery.
J Oral Maxillofac Surg 2000;58(05):470–475, discussion 475–476
26 San Miguel Moragas J, Van Cauteren W, Mommaerts MY.
A systematic review on soft-to-hard tissue ratios in orthognathic
surgery part I: maxillary repositioning osteotomy. J Craniomax-
illofac Surg 2014;42(07):1341–1351
27 Kim YI, Park SB, Son WS, Hwang DS. Midfacial soft-tissue changes
after advancement of maxilla with Le Fort I osteotomy and mandib-
ular setback surgery: comparison of conventional and high Le Fort I
osteotomies by superimposition of cone-beam computed tomogra-
phy volumes. J Oral Maxillofac Surg 2011;69(06):e225–e233
28 Soydan SS, Bayram B, Sar C, Uckan S. Change in inferior sclera
exposure following Le Fort I osteotomy in patients with midfacial
retrognathia. J Oral Maxillofac Surg 2014;72(01):166.e1–166.e5
Downloaded by: Boston University. Copyrighted material.
29 Joss CU, Joss-Vassalli IM, Kiliaridis S, Kuijpers-Jagtman AM. Soft
tissue profile changes after bilateral sagittal split osteotomy for
mandibular advancement: a systematic review. J Oral Maxillofac
Surg 2010;68(06):1260–1269
30 Behrents RG. Growth in the aging craniofacial skeleton. In:
McNamara JA, ed. Monograph 17, Craniofacial Growth Series.
Ann Arbor, MI: University of Michigan; 1985
31 Maal TJJ, de Koning MJJ, Plooij JM, et al. One year postoperative
hard and soft tissue volumetric changes after a BSSO mandibular
advancement. Int J Oral Maxillofac Surg 2012;41(09):1137–1145
32 Joss CU, Joss-Vassalli IM, Bergé SJ, Kuijpers-Jagtman AM. Soft
tissue profile changes after bilateral sagittal split osteotomy for
mandibular setback: a systematic review. J Oral Maxillofac Surg
2010;68(11):2792–2801
33 McDonnell JP, McNeill RW, West RA. Advancement genioplasty: a
retrospective cephalometric analysis of osseous and soft tissue
changes. J Oral Surg 1977;35(08):640–647
34 Park HS, Ellis E III, Fonseca RJ, Reynolds ST, Mayo KH. A retro-
spective study of advancement genioplasty. Oral Surg Oral Med
Oral Pathol 1989;67(05):481–489
35 Davis WH, Davis CL, Daly BW, Taylor C III. Long-term bony and soft
tissue stability following advancement genioplasty. J Oral Max-
illofac Surg 1988;46(09):731–735
36 Nishioka GJ, Mason M, Van Sickels JE. Neurosensory disturbance
associated with the anterior mandibular horizontal osteotomy.
J Oral Maxillofac Surg 1988;46(02):107–110
37 Polido WD, de Clairefont Regis L, Bell WH. Bone resorption,
stability, and soft-tissue changes following large chin advance-
ments. J Oral Maxillofac Surg 1991;49(03):251–256
38 Talebzadeh N, Pogrel MA. Long-term hard and soft tissue relapse
rate after genioplasty. Oral Surg Oral Med Oral Pathol Oral Radiol
Endod 2001;91(02):153–156
39 Reddy PS, Kashyap B, Hallur N, Sikkerimath BC. Advancement
genioplasty–cephalometric analysis of osseous and soft tissue
changes. J Maxillofac Oral Surg 2011;10(04):288–295
40 Soydan SS, Cubuk S, Pektas ZO, Uckan S. The extent of chin ptosis
and lower incisor exposure changes following the osseous genio-
plasties. J Craniofac Surg 2013;24(05):e445–e458
41 Park JY, Kim MJ, Hwang SJ. Soft tissue profile changes after setback
genioplasty in orthognathic surgery patients. J Craniomaxillofac
Surg 2013;41(07):657–664
Facial Plastic Surgery Vol. 33 No. 5/2017