Facial Contour Refining after Surgery-First SSRO with Computer-Assisted Design in East Asians



Surgery-first sagittal split ramus osteotomies (SF-SSRO) are an effective treatment for patients with dental malocclusion. However, some patients with mandibular prognathism usually have facial deficiencies which cannot be corrected completely after orthognathic surgery. These are not accepted because the remaining facial contours are in disharmony.


Twenty-five patients, who were unsatisfied with their appearances after SF-SSRO and orthodontics, were included. The preoperative CTs were used to investigate patients for facial deformity. To achieve a harmonious facial contour, mandible long-curve osteotomy/mandible U-shaped osteotomy, genioplasty or facial autologous fat grafting was selected depending on patients’ contour deformities with the assistance of CAD.


Among the patients who underwent osteotomy, the gonial angle was improved from 111.16° ± 9 to 111.58° ± 9.06 after SF-SSRO because of distal fragment setback and rotation. After facial refine surgery, the gonial angle was significantly increased to 121.69°±2.41 (p < 0.05). And the mandibular width was decreased from 11.29 cm ± 0.44 to 10.45 cm ± 0.39 (p < 0.05) after mandibular outer plate griding. All patients were shown no signs of infection, massive bleeding, and osteonecrosis in the early stage. After follow-up time, they were all satisfied with their results and most of them recovered from lip numbness.


This study indicated the clinical feasibility of two-stage orthognathic and facial bone contouring surgery for the treatment of dentofacial deformities. Two-stage facial contouring surgery can provide esthetic improvement for more accuracy in refining the facial contour.

Level of Evidence IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5


  1. 1.

    De Nuccio F, De Nuccio F, D’Emidio MM, Pelo S (2017) Surgery-first: a new approach to orthognathic surgery. Oral Implantol (Rome) 9:98–102

    Article  Google Scholar 

  2. 2.

    Hunsuck EE (1968) A modified intraoral sagittal splitting technic for correction of prognathism. J Oral Surg 26:250–253

    CAS  PubMed  Google Scholar 

  3. 3.

    Yunfeng L, Zhiai H, Bin Y, Yao L, Xiaochun R, Songsong Z (2016) Combined use of facial osteoplasty and orthognathic surgery for treatment of dentofacial deformities. J Oral Maxillofac Surg 74:2505.e1-2505.e12

    Article  Google Scholar 

  4. 4.

    Chul-Hwan K, Ju-Hyun L, Ju-Yeon C, Jae-Hoon L, Kyung-Wook K (2007) Skeletal stability after simultaneous mandibular angle resection and sagittal split ramus osteotomy for correction of mandible prognathism. J Oral Maxillofac Surg 65:192–197

    Article  Google Scholar 

  5. 5.

    Yanju X, Xiumei S, Lin W, Yaoyao Z, Kai C, Guomin W (2017) The application of 3d printing technology for simultaneous orthognathic surgery and mandibular contour osteoplasty in the treatment of craniofacial deformities. Aesthetic Plast Surg 2017:1413–1424

    Google Scholar 

  6. 6.

    Jae-Seung K, Hyun-Ho C, Sung-Ho R, Jae-Hyun K, Seung-Ho L (2001) Gonial angle reduction during mandibular sagittal split ramus osteotomy. J Kor Oral Maxillofac Surg 27:258–265

    Google Scholar 

  7. 7.

    Al-Hiyali A, Ayoub A, Ju X, Almuzian M, Al-Anezi T (2015) The impact of orthognathic surgery on facial expressions. J Oral Maxillofac Surg 73:2380–2390

    Article  Google Scholar 

  8. 8.

    Jeffrey L, Leonard K, Michael Y (2018) Refining post-orthognathic surgery facial contour with computer-designed/computer-manufactured alloplastic implants. Plast Reconstr Surg 142:747–755

    Article  Google Scholar 

  9. 9.

    Chenzhi L, Xiaolei J, Xianlei Z, Guodong S (2019) En-bloc U-shaped osteotomy of the mandible and chin for the correction of a prominent mandibular angle with long chin. J Craniofac Surg 30:1359–1363

    Article  Google Scholar 

  10. 10.

    Chao Z, Li T, Fuanchiang C, Jiajie X, Jianjian L, Fang X, Jingyi Z, Meibang X, Xiaolei J (2014) Single stage surgery for contouring the prominent mandibular angle with a broad chin deformity: en-bloc Mandibular Angle-Body-Chin Curved Ostectomy (MABCCO) and Outer Cortex Grinding (OCG). J Craniomaxillofac Surg 42:1225–1233

    Article  Google Scholar 

  11. 11.

    Yu-Fang L, Yun-Fang C, Chuan-Fong Y, Yin-An C, Yu-Ray C (2019) Long-term outcomes of bimaxillary surgery for treatment of asymmetric skeletal class III deformity using surgery-first approach. Clin Oral Investig 23:1685–1693

    Article  Google Scholar 

  12. 12.

    Jiyin L, Sun-Youl R, Hong-Ju P, Min-Suk K, Seunggon J, Jeong JH, Hee-Kyun O (2017) Changes in condylar position after BSSRO with and without Le Fort I osteotomy via surgery-first approach in mandibular prognathism with facial asymmetry. Oral Surg Oral Med Oral Pathol Oral Radiol 123:661–669

    Article  Google Scholar 

  13. 13.

    Farhad G, Hamed G, Saeid T, Hamid Reza E (2018) Improvement of esthetic, functional, and social well-being after orthognathic surgical intervention: a sampling of postsurgical patients over a 10-year period from 2007 to 2017. J Oral Maxillofac Surg 76:2398–2403

    Article  Google Scholar 

  14. 14.

    Reitzik M (1980) Skeletal and dental changes after surgical correction of mandibular prognathism. J Oral Surg 38:109–116

    CAS  PubMed  Google Scholar 

  15. 15.

    Xiaobin M, Tao W, Dongkun Y, Guimei Z (2011) The dynamics of blood supply of animal experimental study for simultaneous mandibular sagittal split osteotomy and mandibular angle plasty. J Chongqing Med Univ 6:718–720

    Google Scholar 

  16. 16.

    Epker BN (1984) Vascular considerations in orthognathic surgery. I. Mandibular osteotomies. Oral Surg Oral Med Oral Pathol 57:467–472

    CAS  Article  Google Scholar 

  17. 17.

    Baek SM, Baek RM, Shin MS (1994) Refinement in aesthetic contouring of the prominent mandibular angle. Aesthetic Plast Surg 18:283–289

    CAS  Article  Google Scholar 

  18. 18.

    Liebregts J, Xi T, Timmermans M, de Koning M, Bergé S, Hoppenreijs T, Maal T (2015) Accuracy of three-dimensional soft tissue simulation in bimaxillary osteotomies. J Craniomaxillofac Surg 43:329–335

    Article  Google Scholar 

  19. 19.

    Rafael D, Cesar RA, Celso B, Cassio RA (2018) Autologous free fat grafting for management of the facial contour asymmetry. J Craniofac Surg 29:878–886

    Article  Google Scholar 

  20. 20.

    Denadai R, Buzzo CL, Raposo-Amaral CA, Raposo-Amaral CE (2019) Facial contour symmetry outcomes after site-specific facial fat compartment augmentation with fat grafting in facial deformities. Plast Reconstr Surg 143:544–556

    CAS  Article  Google Scholar 

  21. 21.

    Yuching W, Christopher W, Betty P, Huiling C, Yuehtse L, Yenchang H, Chunshin C, Yufang L, Philip C, Yuray C (2017) Orthognathic surgery with simultaneous autologous fat transfer for correction of facial asymmetry. Plast Reconstr Surg 139:693–700

    Article  Google Scholar 

  22. 22.

    Youwei C, Lunjou L (2011) Facial asymmetry: etiology, evaluation, and management. Chang Gung Med J 34:341–351

    Google Scholar 

  23. 23.

    Takanobu M, Kotaro Y (2015) How does fat survive and remodel after grafting? Clin Plast Surg 42:181–190

    Article  Google Scholar 

  24. 24.

    Roger K Jr, Raoul-Emil K, Jorge LH, Khalil K, Luca L, Dennis O (2014) Diffusion and perfusion: the keys to fat grafting. Plast Reconstr Surg Glob Open 2:e220

    Article  Google Scholar 

Download references

Author information



Corresponding author

Correspondence to Xiaolei Jin.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Human and Animal Participants

All procedures performed in studies involving human participants were in accordance with the ethical standards of the hospital research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed Concent

Patient consent was obtained from all participants. The poll of patients in this study and patient's data have not used in other published papers.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Lai, C., Song, G., Zong, X. et al. Facial Contour Refining after Surgery-First SSRO with Computer-Assisted Design in East Asians. Aesth Plast Surg (2021). https://doi.org/10.1007/s00266-021-02181-y

Download citation


  • Orthognathic surgery
  • Surgery-first
  • Sagittal split ramus osteotomies
  • Mandibular plasty
  • Computer-assisted design