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Aesthetic Enhancements Through Secondary Surgery After Orthognathic
Treatment of Malocclusion
Boymuradov Shukhrat Abdujalilovich
DSc, Professor, Tashkent Medical Academy, Republic of Uzbekistan, Tashkent, Uzbekistan
Khasanov Adkham Ibrokhimovich
DSc, Professor, Tashkent State Dental Institute, Republic of Uzbekistan, Tashkent, Uzbekistan
Yusupov Shokhrukh Shukhratovich
PhD, Associate professor, Tashkent Medical Academy, Republic of Uzbekistan, Tashkent, Uzbekistan
Rakhmanov Shakhzod Alimovich
Clinical Resident, Tashkent Medical Academy, Republic of Uzbekistan, Tashkent, Uzbekistan
Madraimova Khonzoda
Master student, Tashkent Medical Academy, Republic of Uzbekistan, Tashkent, Uzbekistan
A R T I C L E I N f
О
Article history:
Submission Date: 15 March 2025
Accepted Date: 11 April 2025
Published Date: 13 May 2025
VOLUME:
Vol.05 Issue05
Page No. 5-10
DOI: -
https://doi.org/10.37547/medical-
fmspj-05-05-02
A B S T R A C T
Orthognathic surgery significantly improves facial aesthetics and
functional occlusion; however, secondary procedures are often required
for optimal aesthetic results. This study analyzes the role of
complementary surgical interventions, primarily genioplasty, in enhancing
chin and jawline contours after orthognathic surgery. Patients with
skeletal Class II malocclusion frequently present with retrognathia or
microgenia, necessitating chin augmentation through osteotomy and
fixation. For Class II patients with excessive submental fat, liposuction and
platysmaplasty refine the cervicomental angle. Additional procedures,
such as cheek lifting, temporal lifting, and SMAS lifting, address facial
sagging and deep nasolabial folds. Rhinoplasty is indicated in cases where
nasal tip ptosis or dorsal hump formation occurs postoperatively. Patients
with periorbital aging signs undergo blepharoplasty or forehead lifting to
enhance facial harmony. In cases of thin bone structure or underdeveloped
soft tissues, custom 3D implants made from PEEK, hydroxyapatite, or
porous polyethylene are used to define the jawline and zygomatic region.
This study evaluates aesthetic outcomes among 87 patients, highlighting
the importance of individualized secondary surgeries for superior facial
aesthetics.
Frontline Medical Sciences and Pharmaceutical
Journal
ISSN: 2752-6712
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Keywords:
Orthognathic surgery, skeletal malocclusion, patient motivation, maxillofacial surgery,
genioplasty, secondary surgery, facial aesthetics, skeletal malocclusion, rhinoplasty, blepharoplasty,
jawline contouring, 3D implants, facial harmony.
INTRODUCTION
Orthognathic
surgery
corrects
skeletal
discrepancies in patients with malocclusion,
improving both function and facial appearance.
However, in many cases, achieving an optimal
aesthetic result requires additional surgical
interventions. This paper discusses secondary
aesthetic procedures commonly performed after
orthognathic surgery, with a primary focus on
genioplasty, rhinoplasty, liposuction, and facial
lifting techniques. These procedures help refine
facial proportions, enhance the jawline, and
improve overall harmony, addressing patient
concerns related to facial profile and aging signs.
The study also explores the use of patient-specific
implants for skeletal augmentation in cases where
traditional osteotomy techniques are insufficient.
METHODS
Study Design. This study is based on a
retrospective analysis of 87 patients who
underwent orthognathic surgery followed by
secondary aesthetic procedures between 2023 and
2025. Patients were selected based on the
necessity for additional surgical interventions to
enhance facial aesthetics after achieving stable
occlusion through orthognathic correction.
Patient Selection Criteria. Patients included in this
study met the following criteria:
-
Diagnosed with skeletal Class II or Class III
malocclusion requiring orthognathic surgery.
-
Underwent secondary aesthetic surgery
within 6
–
12 months post-orthognathic surgery.
-
Demonstrated functional occlusion stability
before secondary surgery.
-
Expressed
dissatisfaction
with
chin
projection, jawline definition, midface contour, or
nasal appearance post-orthognathic correction.
Surgical Interventions. The secondary procedures
were categorized based on patient needs:
1. Genioplasty (Chin Augmentation/Reduction)
- Performed on 78 out of 87 patients (89.7%).
-Sliding osteotomy of the chin (symphysis
osteotomy) with advancement or setback, fixation
with titanium plates.
-Used for patients with retrognathia, microgenia,
or excessive chin projection.
2. Rhinoplasty
-Performed on 6 patients (6.9%).
-Indicated for nasal tip ptosis or dorsal hump
formation following orthognathic surgery.
-Techniques included nasal tip refinement,
septoplasty, and dorsal augmentation.
3. Facial Implants (3D Custom Implants for Jaw and
Cheeks)
-Used in 3 patients (3.4%).
-Materials:
PEEK
(polyetheretherketone),
hydroxyapatite, porous polyethylene.
-Augmentation of the chin, mandibular angles, and
zygomatic region for facial contouring.
4. Facial Liposuction & Platysmaplasty
-Liposuction performed on 12 patients (13.8%).
-Indicated for Class II patients with excessive
submental fat.
-Platysmaplasty combined with liposuction in 6
cases to improve the cervicomental angle.
5. Cheek Lift (Midface Lifting Procedures)
-Performed on 15 patients (17.2%).
-Included cheek lifting, temporal lifting, and SMAS
lifting.
-Indicated for patients with ptotic cheeks, deep
nasolabial folds, and excessive skin laxity.
6. Blepharoplasty & Forehead Lifting
-Upper blepharoplasty: 18 patients (20.7%).
-Lower blepharoplasty: 15 patients (17.2%).
-Forehead lifting (temporal or full forehead lift): 6
patients (6.9%).
-Indicated for periorbital aging, excess upper
eyelid skin, and brow ptosis.
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Fig.2 :
Data Collection & Analysis.
-
Preoperative and postoperative 3D imaging
(Dolphin Imaging software) was used to assess
skeletal and soft tissue changes.
-
Patient satisfaction was evaluated through
surveys at 6 months and 1 year post-surgery.
-
Statistical analysis was conducted to compare
aesthetic
outcomes
and
patient-reported
satisfaction scores.
RESULTS
Patient Demographics
-Total number of patients: 87
-Male: 38 (43.7%)
-Female: 49 (56.3%)
-Age range: 18
–
42 years (Mean: 26.4 years)
-Primary diagnosis:
*Class II skeletal malocclusion: 46 patients
(52.9%)
*Class III skeletal malocclusion: 32 patients
(36.8%)
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Fig. 1:
Aesthetic and Functional Outcomes.
-
Genioplasty outcomes:
*92.3% of patients reported improved chin
aesthetics and facial balance.
*7.7% noted mild dissatisfaction due to residual
asymmetry or minor soft tissue irregularities.
- Rhinoplasty outcomes:
*83.3% of patients noted improved nasal
aesthetics and breathing function.
*16.7% required minor revision procedures.
- Facial liposuction & platysmaplasty outcomes:
*95% reported an enhanced jawline contour.
*5% had mild residual submental fullness
requiring additional contouring.
- Cheek lift & blepharoplasty outcomes:
*90% of patients observed significant facial
rejuvenation.
*10%
had
transient
swelling
or
mild
dissatisfaction with results.
Patient Satisfaction.
-Overall, 93.1% of patients were satisfied with
their final aesthetic results after secondary
procedures.
-5.7% of patients required minor revisions for
optimal contouring.
-1.1% of patients expressed dissatisfaction, mainly
due to minor asymmetries or unmet expectations.
Complications.
-Minor
complications
(resolved
without
reoperation): 8 cases (9.2%)
*Temporary swelling and bruising: 5 patients
*Mild sensory disturbances: 3 patients
-Major complications (requiring revision): 2 cases
(2.3%)
*Chin asymmetry after genioplasty: 1 patient
*Residual nasal asymmetry after rhinoplasty: 1
patient
DISCUSSION
The integration of secondary aesthetic procedures
following orthognathic surgery plays a crucial role
in achieving optimal facial harmony and patient
satisfaction. The results of this study demonstrate
that procedures such as genioplasty, rhinoplasty,
blepharoplasty, facial liposuction, and midface
lifting
significantly
enhance
post-surgical
outcomes, particularly in patients with skeletal
Class II and III malocclusions.
Genioplasty as the Most Common Secondary
Procedure. Genioplasty was performed in 89.7% of
patients, primarily to correct retrognathia and
microgenia, which are common in Class II skeletal
patterns. Studies have shown that mandibular
advancement alone may not always provide the
desired aesthetic balance, necessitating additional
chin augmentation or repositioning to enhance the
lower third of the face. The high satisfaction rate
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(92.3%) among genioplasty patients indicates that
this procedure effectively improves facial
proportion and harmony.
Rhinoplasty and Facial Profile Refinement.
Rhinoplasty was performed in 6.9% of patients,
particularly in those with nasal tip ptosis or dorsal
humps, which became more prominent after
skeletal realignment. These findings align with
previous research suggesting that nasal aesthetics
can be significantly affected by orthognathic
movements, especially maxillary advancement.
The 83.3% satisfaction rate suggests that
rhinoplasty
is
a
valuable
complementary
procedure for select patients.
Facial Contouring Procedures. Liposuction and
platysmaplasty were used to refine jawline
definition in 13.8% and 6.9% of patients,
respectively. These procedures were particularly
beneficial for Class II patients with excess
submental fat. Similarly, custom implants for the
chin and jaw angles were used in select cases
where bony deficiencies remained after surgery.
The high patient satisfaction (95%) confirms the
importance of addressing soft tissue dynamics
alongside skeletal corrections.
Midface and Periorbital Rejuvenation. Patients
with significant midface sagging or deep nasolabial
folds benefited from cheek lifting (17.2%) and
blepharoplasty (upper: 20.7%, lower: 17.2%).
These procedures were crucial in aging patients or
those with soft tissue ptosis. Our findings support
existing literature emphasizing the need for soft
tissue repositioning after maxillary surgery,
particularly in cases of significant vertical or
anteroposterior movements.
Psychological and Functional Considerations. The
psychological
impact
of
these
secondary
procedures cannot be overlooked. Many patients
undergo orthognathic surgery primarily for
aesthetic reasons, and the ability to refine their
post-surgical appearance enhances self-confidence
and social interactions. Additionally, functional
benefits such as improved nasal breathing,
reduced strain on facial muscles, and enhanced
chewing efficiency further contribute to the overall
quality of life.
Complication Rate and Revision Needs. The overall
complication rate (9.2% minor, 2.3% major) aligns
with reported literature on aesthetic surgery
complications. The need for minor revisions
(5.7%) underscores the importance of meticulous
planning and patient counseling regarding realistic
expectations and possible refinements.
Clinical Implications and Future Research. This
study
reinforces
the
necessity
of
a
multidisciplinary approach involving maxillofacial
surgeons, plastic surgeons, and orthodontists to
optimize treatment outcomes. Future research
should focus on long-term patient satisfaction, the
effect of secondary procedures on aging, and the
role
of
computer-assisted
planning
for
personalized surgical approaches.
CONCLUSION
This study highlights the importance of secondary
aesthetic procedures in achieving optimal results
following orthognathic surgery. Among the most
common procedures:
- Genioplasty (89.7%) was the most frequently
performed, significantly improving chin projection
and lower facial aesthetics.
-Rhinoplasty (6.9%) effectively enhanced nasal
aesthetics and breathing function, particularly in
patients with nasal tip ptosis or dorsal humps.
-Facial liposuction and platysmaplasty refined
jawline contours and improved neck aesthetics,
particularly in Class II skeletal patterns.
-Blepharoplasty and midface lifting addressed age-
related facial sagging, restoring a youthful
appearance.
The high satisfaction rates (93.1%) and low
complication rates (9.2% minor, 2.3% major)
emphasize the effectiveness and safety of these
secondary interventions. The findings underscore
the necessity of a patient-specific approach,
ensuring that both skeletal and soft tissue
components are addressed for optimal functional
and aesthetic outcomes.
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