Aesthetic orthognathic surgery and rhinoplasty are complementary procedures, which share in common a similar approach for assessment, diagnosis, and stepwise, targeted treatment, based on the existing deformity and cosmetic goals. Orthognathic surgery developed with emphasis on addressing malocclusion and jaw discrepancies, but it was quickly realized that these techniques are powerful tools to dramatically enhance facial appearance. Similarly, rhinoplasty has important functional and reconstructive aspects, but can very positively impact facial cosmetics. For the best, and most aesthetic result, the orthognathic (and adjunctive) procedures must be properly planned and executed.
Establishing the proper occlusion is only the first level in correction, and is necessary, but not sufficient alone in achieving the desired facial appearance. Function and aesthetics are both optimally improved, using orthognathic surgery and rhinoplasty, when performed correctly. This begins with sophisticated recognition and understanding of the imbalances, lack of facial support, and aesthetic compromise that exists at the initial presentation. A comprehensive understanding of what is normal, what is optimal, and what is cosmetic and aesthetic is of utmost importance.
Once the dysmorphology and imbalances are appreciated, a targeted treatment approach is developed to address the concerns, and to improve facial and nasal appearance. An engineering mentality and technical acumen are vital, but the subjective “difference-maker” is the keen artistic eye, appreciation for, and ability to create balance and beauty. This more qualitative and stylistic component cannot be taught, but rather is innate.Appreciation of subtleties, and the ability to modify requisite facial tissues, with anticipation and prediction of biological healing, is critical.
Both orthognathic surgery and rhinoplasty are technically challenging, and often considered among the most difficult operations in maxillofacial and plastic surgery. It is clear that the nasal form, function, and osteocartilaginous vault is intimately related to that of the jaws and maxillofacial skeleton. Aberration and deformity of either the nose or jaws can result in growth disturbances, malposition, and/or secondary sequela of the other. Additionally, change and alteration of one system will almost certainly impact the function and appearance of the other. Sometimes this is in a positive or beneficial manner; in other instances, surgical manipulation of one will negatively influence, or be detrimental, to the other. Occasionally, there is a neutral interchange. It is clear that the ability to manage one or both systems is required for the most optimal outcome.