Oro-Facial Plastic Surgery

 

699. Oro-Facial Plastic Surgery
Oro-facial plastic surgery is not simply about reshaping the lips—it’s a comprehensive approach that considers the harmony of the lower face structure and the overall facial proportions when correcting issues around the mouth.

For subtle correction of protruding lips, TADs (Temporary Anchorage Devices) can be fixed to the alveolar bone to precisely move teeth in the desired direction—allowing retraction of front teeth even without extractions. In more pronounced cases, anterior segmental osteotomy (ASO) may be performed, instead of or in addition to orthodontics.

For open bites, orthodontics alone is often insufficient, and orthognathic (jaw) surgery may be necessary. In severe cases, triple jaw surgery (maxilla, mandible, and ASO) is needed to achieve proper alignment.

When there is facial asymmetry due to one-sided mouth corner elevation, orthognathic surgery helps align the upper and lower jaws. In mandibular prognathism (prominent lower lip or chin), correction may involve mandibular setback or rotation jaw surgery (rotational orthognathics). For receding chins with protrusive upper lips, options include orthodontic retraction of the upper teeth, chin advancement surgery, or counterclockwise jaw rotation, which can also improve sleep apnea by advancing the airway space.

When the gums are overly exposed while smiling, and the midface is long enough to show the upper teeth even at rest, severe cases may require maxillary impaction (upper jaw elevation) via jaw surgery. Milder cases can be treated with botulinum toxin injections targeting the elevator muscles of the upper lip and depressor muscles of the nasal tip.

For retruded mouths, the angle of the upper teeth may be corrected with orthodontics, but if the maxilla is recessed, maxillary advancement through jaw rotation surgery is required to correct midface depression.

Factors such as:
– Whether the mouth is protruding or sunken,
– Whether the lip corners are symmetrical,
– The relationship between upper and lower teeth,
– The presence of overbite, underbite, or misalignment,
– Whether the dental axis is tilted—
all determine the right treatment plan. This may include orthodontics, TADs, ASO, orthognathic surgery, or even triple jaw surgery.

These decisions are made after analyzing medical facial photos, dental models, and 3D facial CT scans.

Oro-facial surgery is not just about changing the shape of the lips—it’s about correcting the relationship between the upper (maxilla) and lower (mandible) facial structures.

[Oro-facial surgery is about analyzing and correcting both mouth-related and mid-lower facial issues together.]
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