THE SURGICAL ART OF FACIAL MAKEOVER

Transcription

1 THE SURGICAL ART OF FACIAL MAKEOVER SHOWCASE Maurice Y. Mommaerts

2 INDEX Key words Procedures Problem list orthodontic classification 13 Class III, crossbite, crowding TPD, pterygoid dysjunction Occlusal considerations Class III, crowding, crossbite 17 Narrow upper jaw TPD, OBA Occlusal considerations Class III, crowding 19 Narrow jaws TPD, TMD Small apical bases, upper and lower 23 Mandibular autorotation Maxillary impaction, chin advancement Gummy smile, lip incompetence Class II, open bite 29 Gummy smile, mandibular autorotation Maxillary impaction, mandibular autorotation Gummy smile Class II, laterognathia 35 Open bite Le Fort I in 3 parts, in step, without extractions Open bite Anterior open bite 41 Autorotation mandible Le Fort I, chin osteotomy 45 Open bite, Class III Maxilla in 2 parts, chin osteotomy Anterior open bite Class III, anterior open bite 49 Class III TPD, maxillary advancement Occlusal considerations Class III 53 Class III Upper jaw advancement Class III 57 Class III Maxillary advancement and chin advancement, HA onlays paranasally Occlusal considerations Class III 61 Class III, macrogenia Upper jaw advancement, chin height reduction Occlusal and facial considerations Class III 65 Class III, laterognathia Maxillary advancement, unilateral set-back mandible Problematic gingiva, demo of clinical examination Class III, laterognathia 71 Deep bite, prominent chin Mandibular advancement and negative rotation Class II, deep bite 75 Class II, deep bite, prominent chin BSSO negative rotation Occlusal considerations Class II, deep bite, prominent chin 79 Class II, very deep bite, prominent chin, Sunday posture Mandibular negative rotation Deep bite and need for dental restoration Class II, deep bite 83 Class II, small chin, hypotonic lip Deep antegonial notch Class II, short face 87 Class II, deep bite 91 Class II, long face 97 Class II, prominent chin 103 Long face, facial makeover 107 Class II, lip incompetence 113 Gummy smile, lip incompetence Mandibular negative (counterclockwise) rotation Mandibular advancement, chin advancement and impaction Mandibular advancement, maxillary posterior impaction, bimaxillary negative rotation Maxillary impaction, mandibular advancement, chin reduction, bilateral malar valgization, rhinoplasty Upper jaw impaction, mandibular autorotation, chin advancement and impaction Upper jaw impaction, lower jaw advancement, chin impaction and advancement 117 Class II, prominent chin Bimaxillary negative rotation Occlusal considerations Mandibular hypoplasia with prominent chin Unhappy with face Lip incompetence, occlusal considerations Lip incompetence, occlusal considerations Occlusal considerations, fearful of too strong a chin, wishing to reduce mentolabial fold depth Class II, deep bite Class II, high chin Class II, prominent chin Long face Class II, long face Class II, long face, lip incompetence, gummy smile Class II, deep bite, prominent chin

3 Key words Procedures Problem list orthodontic classification 125 Open bite, lip incompetence Maxillary impaction in 2 parts with transverse osteotomy, malar valgization osteotomy, mandibular leveling osteotomy (unilateral advancement right, chin reduction in height and advancement, chin narrowing) Open bite, lip incompetence, gummy smile Class I 129 Class II, deep bite, prominent chin Bimaxillary negative rotation Class II, prominent chin, deep bite 135 Class II, lower face deficiency after 4 premolar extractions Bimaxillary advancement Class II, 4 bicuspid extractions 141 Laterognathia, Class III Upper jaw advancement, lower jaw rotation/set-back Deteriorating bite and profile Laterognathia, Class III 149 Class II, long face, lip incompetence Trimax surgery Class II, long face 153 Late mandibular growth, with compensation of occlusal plane of the maxilla 157 Class III, midface deficiency 165 Class III, midface deficiency 169 Class III Trimax surgery Unable to chew Class III, with late mandibular growth Maxillary advancement, bilateral zygoma valgization osteotomy, infraorbital augmentation with HydroSet Bimaxillary negative rotation, zygoma valgization osteotomy, infraorbital hydroxyapatite only Upper jaw advancement, mandibular set-back, chin advancement Profile and smile Prognathic face Prognathic profile, occlusal considerations Class III, midface hypoplasia Class III, midface deficiency Class III 175 Dish-face deformity, OSAS Bimaxillary advancement Dished-in face, deep bite, OSAS Class II, deep bite, midface deficiency 177 Class III Mandibular set-back, chin advancement Class III 185 Class II, deep bite profile, prominent chin Bimaxillary negative rotation Chin deficiency with deep mentolabial fold Class II, deep bite 189 Bimaxillary dentoalveolar protrusion Bimaxillary set-back, chin advancement, masseter muscle reductions Wish to occidentalize Bimaxillary dentoalveolar protrusion 193 Class III, macrogenia, open bite Trimax, rotation, chin undercorrected Facial and occlusal considerations Class III, long face, open bite 199 Class II, long face, lip incompetence 203 Class II, long face, lip incompetence, anterior open bite 209 Class II, long face 215 Bipro, chin deficiency, Class II 219 Class III, open bite Upper jaw impaction, lower jaw advancement, chin impaction and advancement Occlusal considerations, gummy smile Class II, long face Trimax surgery Facial and occlusal considerations Class II, anterior open bite, long face TPD, mandibular advancement, maxillary impaction, chin advancement Upper jaw set-back, mandibular set-back, chin advancement Upper jaw in 2 parts, closure of open bite, chin refinement Wish to occidentalize Open bite, facial considerations Class II, long face Class II, long face, bipro Open bite, long face 223 Class II, open bite Trimax and rhinoplasty Class II, open bite 229 Class II, prominent chin, flat horizontal plane Bimaxillary negative (clockwise) rotation Occlusal and facial considerations Class II, prominent chin 233 Class III, wide upper jaw in dorsal region Mandibular setback, maxillary narrowing dorsally (2 parts) Excess of submental soft tissue after mandibular set-back Class III 237 Facial asymmetry Maxillary leveling, lower jaw advancement, chin advancement and impaction, rhinoplasty Unhappy with facial features Class II, long face 243 Class II, prominent chin Bimaxillary negative rotation, well prepared with front teeth proclined Occlusal considerations Class II, prominent chin

4 Key words Procedures Problem list orthodontic classification 247 Bimaxillary negative rotation Bimaxillary osteotomy Occlusal and facial considerations Class II, prominent chin 251 Long face, Class II 257 Class II, long face Trimax 261 Class III, frontal open bite, mandibular asymmetry 265 Hemimanidbular hyperplasia 269 Laterognathia, Class III 275 Chin hypoplasia, compensating orthodontia Upper jaw impaction, lower jaw advancement, chin impaction and advancement, bilateral zygomatic valgization osteotomies, microlipofilling Unilateral mandibular set-back, maxillary advancement and impaction to close frontal open bite Maxillary leveling, mandibuloplasty, chin symmetrizing Maxillary impaction, lower jaw set-back, after negative Tc scan of condyles Chin osteotomy, advancement, impaction, narrowing, jaw line straightening Facial and occlusal considerations Occlusal considerations, lip incomptence, mentalis habit Facial considerations Asymmetrical gummy smile, occlusal cant Weak chin Class II, long face Class II, long face Class III, laterognathia, frontal open bite Hemimandibular hyperplasia Class III, laterognathia 279 Chin deficiency Chin advancement, jumping bone flap Chin deficiency, mentalis habit, no jaw line Class II, orthodontically compensated 281 Zygomatic valgization osteotomy Bilateral zygomatic valgization osteotomy, genioplasty, rhinoplasty, lip augmentation Wish to increase malar projection 283 Class III, midface deficiency Maxillary advancement, zygomatic valgization osteotomy Occlusal and profile considerations Class III 287 Nasal deformity after primary rhinoplasty 291 Dished-in face after orthodontic compensation for Class II malocclusion Trimax with negative rotation, full rhinoplasty Dished-in lower face after premolar extractions and compensating orthodontics for Class II Class I after orthodontic decompensation, then reversed orthodontics 295 Nasal defects Hyaluronic acid injections 297 Nasal deformity Rhinoplasty 299 Mandibular deficiency, lip incompetence, gummy smile 303 Narrow lower jaw Mandibular advancement, nasal frame osteotomy, drop of upper lip Circumferential mandibular onlay with hydroxyapatite/fibrin glue mixture 305 Aging face, jowling Facelift, microliposuction jowls Dissatisfied with shape of nose and function Lip incompetence, gummy smile Narrow lower mandible, with face disappearing into neck Class II 309 Aging face Facelift, forehead lift, upper blepharoplasty, hyaluronic acid filler in nasolabial sulci 311 Aging face Upper blepharoplasties, facelift 315 Aging neck Neck lift 319 Forehead feminization, secondary rhinoplasty Reconstruction of anterior wall of frontal sinus, trimming of lateral supraorbital rims, calcium phosphate smoothing, secondary rhinoplasty Masculine forehead and nose, transgender transformation 323 Forehead descent Knize brow lift, upper blepharoplasty Tired look 325 Aging forehead 327 Aging forehead Knize forehead lift and upper blepharoplasty Knize forehead lift and upper blepharoplasty Tired look Tired look 329 Baggy upper eyelids Bipolar lipolysis in upper blepharoplasty Asymmetrical eyelid ptosis 331 Baggy eyelid lower right, scars after dog bite, epicanthal fold 333 Bat ears, nasal kyphosis, sad-looking eyes Transconjuctival lower blepharoplasty, medial canthoplasty Pinnaplasty, rhinoplasty, upper blepharoplasty, lateral canthoplasty Baggy eyelid lower right (lymphedema), visible scar and fold at corners of the eyes Bat ears, nasal shape, tired eyes

5 Key words Procedures Problem list orthodontic classification 335 Upper blepharoplasty Upper blepharoplasty Fullness upper eyelids 337 Rhinoplasty, blepharoplasty transconjunctival Rhinoplasty, transconjunctival blepharoplasy Tired lower eyelids, unaesthetic nose 341 Full upper eyelids, mole Upper blepharoplasty, excision mole 343 Baggy eyelids, upper and lower Upper and lower blepharoplasty Baggy eyelids 345 Baggy upper eyelids Upper blepharoplasty, conservative 347 Upper eyelids Upper blepharoplasty 349 Baggy eyelid Upper blepharoplasty 351 Baggy eyelids Upper blepharoplasty 355 Earlobe reduction Earlobe reduction Long earlobes None 357 Class II, bat ears Mandibular advancement, chin advancement, hydroxylapatite and Aquamid in mentolabial fold, set-back pinnaplasty Weak chin, bat ears, deep lip/chin fold Class II, chin hypoplasia 363 Bat ears, plagiocephaly Pinnaplasty, bilateral Bat ears 365 Class II, long face, prominent ears TPD, lower jaw and chin osteotomy, pinnaplasty Weak lower face, bat ears Class II, long face 371 Unilateral bat ear Pinnaplasty, only antihelix 373 Long face, Class II, premature aging 377 Laterognathia, submental liposuction 381 Class II, long face, submental ptosis 385 Baggy lower eyelids, with wrinkles 387 Microlipofilling lower face, dermopigmentation upper brows 389 Aging face Maxillary impaction, mandibular advancement, chin impaction, submental liposuction Mandibular rotation, chin advancement, submental liposuction Mandibular advancement, maxillary impaction, chin advancement and impaction, submental liposuction Transconjunctival blepharoplasty and microfat grafting Lip incompetence, premature aging Laterognathia, submental lipodystrophia Weak chin, heavy neck, occlusal considerations Baggy eyelids with wrinkles Gaunt face Facial considerations Facelift, microlipofilling and hyaluronic acid filler Class II, long face Class II, laterognathia Class II, long face 393 Deep nasolabial sulci Hyaluronic acid filler in nasolabial sulci Deep nasolabial folds 395 Dark circles around the eyes Hyaluronic acid filler 397 Nonsurgical compensation of Class II malocclusion, compensating orthodontics None Heavy smoker, requests nonsurgical solution Unhappy with result regarding inclination of teeth, lip incompetence, profile Class II, long face

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7 THE SURGICAL ART OF FACIAL MAKEOVER SHOWCASE

8 KEY WORDS PROCEDURES PROBLEM LIST ORTHODONTIC CLASSIFICATION Class III, CrossbIte, CrowdIng tpd, PterygoId dysjunction occlusal ConsIderatIons Class III, CrowdIng, CrossbIte Transpalatal Distraction TPD

9 Class III, CrossbIte, CrowdIng 13 Class III, CrossbIte, CrowdIng Surgery at age 15 years Endo TPD for crowding and Class III, with pterygoid dysjunction

10 14 Class III, CrossbIte, CrowdIng

11 Orthodontist: Anne-Mie Schurmans Class III, CrossbIte, CrowdIng 15

12 KEY WORDS PROCEDURES PROBLEM LIST ORTHODONTIC CLASSIFICATION Class II, deep bite, prominent ChIn bsso negative rotation occlusal ConsIderatIons Class II, deep bite, prominent ChIn

13 Class II, deep bite, prominent ChIn 75 Class II, deep bite, prominent ChIn Surgery at age 20 years BSSO advancement, right 6 mm, left 4.5 mm, negative rotation (clockwise) out of increased overbite Midlines clinically and radiographically inconsistent Range of deviations applies only in occlusion

14 76 Class II, deep bite, prominent ChIn

15 Class II, deep bite, prominent ChIn 77 1 day postoperatively Orthodontist: Evelyn Asselman

16 KEY WORDS PROCEDURES ORTHODONTIC CLASSIFICATION Class II, lower face deficiency after 4 premolar extractions BImaxIllary advancement Class II, 4 BICuspId extractions

17 Class II, lower face deficiency after 4 premolar extractions 135 Class II, lower face deficiency after 4 premolar extractions Surgery at age 24 years Upper jaw advancement of 5 mm Lower jaw advancement of 8 mm Calcium phosphate cement in cortical gap of BSSO to prevent antegonial notching Class II occlusion treated first by 4 bicuspid extractions and orthodontic therapy Dished-in midface, deficient lower face, and residual Class II occlusion prompted selection of bimaxillary advancement

18 136 Class II, lower face deficiency after 4 premolar extractions

19 Class II, lower face deficiency after 4 premolar extractions 137 Orthodontist: Marianne De Loecker

20 138 BImaxIllary advancement 1 day postoperatively with absence of 4 bicuspids 1 day postoperative OPG HydroSet reconstruction of cortical defect After bimaxillary advancement

21 BImaxIllary advancement 139 Lower facial deficiency depicted in virtual 3D

22 KEY WORDS PROCEDURES PROBLEM LIST Class III, macrogenia, open bite trimax, rotation, ChIn undercorrected FaCIal and occlusal ConsIderatIons ORTHODONTIC CLASSIFICATION Class III, long FaCe, open bite

23 Class III, macrogenia, open bite 193 Class III, macrogenia, open bite Surgery at age 23 years Upper jaw advancement 6 mm, anterior impaction 3 mm, posterior impaction 6 mm Lower jaw set-back 10 mm bilaterally Genioplasty reduction 5 mm, advancement 5 mm Malar valgization osteotomy, bilaterally 4 mm

24 194 Class III, macrogenia, open bite

25 Class III, macrogenia, open bite 195 Orthodontist: Katrien Mesotten

26 196 trimax, rotation, ChIn undercorrected

27 Simulations: complete correction and incomplete, as requested by the patient s mother Class III, macrogenia, open bite 197

28 KEY WORDS PROCEDURES Upper eyelids Upper blepharoplasty

29 Upper eyelids 347 Upper eyelids Surgery at age 51 years Upper eyelid correction, 1.5 cm skin height Fat coagulation Result after 3 months

30 KEY WORDS PROCEDURES Long face, class II, premature aging maxillary ImpactIon, mandibular advancement, chin ImpactIon, submental LIposuctIon PROBLEM LIST ORTHODONTIC CLASSIFICATION LIp Incompetence, premature aging class II, Long face

31 Long face, class II, premature aging 373 Long face, class II, premature aging Maxillary impaction posterior 7 mm, anterior 6 mm, left 4 mm, anterior 3 mm, leveling Mandibular advancement Chin 4 mm intrusion Submental liposuction

32 374 Long face, class II, premature aging

33 Long face, class II, premature aging 375 Orthodontist: An Roels