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Advanced Facial Rejuvenation After Bimaxillary Surgery in Three Different Facial Types

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Abstract

Purpose

Facial aging is the consequence of many mechanisms involving the bones and the “soft tissue” (skin, fat, ligaments, muscles, and periosteum) of the face such as downward migration of the soft tissue, adipose and muscular tissue atrophy, and skeletal resorption. The potential of orthognathic surgery (double jaw surgical advancement) of expanding the skeletal foundation to increase the facial drape support is now recognized and widely popularized by several authors. The aim of this study was to analyze the rejuvenation change of the face after bimaxillary advancement for orthognathic surgery, focusing on the previously mentioned stigmata of the middle and the lower third of the aging face.

Materials and Methods

A retrospective monocentric chart review was conducted for all patients affected by aging signs of the face who underwent orthognathic surgery between January 2015 and December 2019 at the Face Surgery Center (Parma, Italy). During the postoperative follow-up examination, all patients underwent anthropometric photographs and esthetic assessment to evaluate facial rejuvenation after double jaw surgical advancement.

Results

After application of the exclusion criteria, the final study sample included 85 patients (53 females, 32 males). Eighty-three patients (97%) showed a degree of rejuvenation after maxillo-mandibular advancement (MMA); the score of the postoperative face was less than the score of the preoperative face. Two patients reported no significant postoperative change; none reported a more aging face, with a successful “reverse face-lift” occurred in 97% of our cases.

Conclusion

“Reverse face-lift” by bimaxillary advancement is a surgical procedure which is indicated for a selected group of middle-aged patients with a diagnosis of bimaxillary skeletal retrusion or posterior divergence very motivated to an extreme rejuvenation; this procedure provides support for the facial mask resulting in whole facial rejuvenation.

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References

  1. Kligman LH (1989) Photoaging manifestations, prevention, and treatment. Clin Geriatr Med 5:235

    Article  CAS  PubMed  Google Scholar 

  2. Zimbler MS, Kokoska MS, Thomas JR (2001) Anatomy and pathophysiology of facial aging. Fac Plast Surg Clin N Am 9:179

    CAS  Google Scholar 

  3. Naini FB (2010) William Hogarth’s The painter and his pug: defining the “line of beauty.” Arch Fac Plast Surg 12:136

    Article  Google Scholar 

  4. Gosain AK, Klein MH, Sudhakar PV, Prost RW (2005) A volumetric analysis of soft-tissue changes in the aging midface using high-resolution MRI: implications for facial rejuvenation. Plast Reconstr Surg 115:1143

    Article  CAS  PubMed  Google Scholar 

  5. Owsley JQ (1995) Elevation of the malar fat pad superficial to the orbicularis oculi muscle for correction of prominent nasolabial folds. Clin Plast Surg 22:279

    Article  CAS  PubMed  Google Scholar 

  6. Pessa JE, Desvigne LD, Lambros VS, Nimerick J, Sugunan B, Zadoo VP (1999) Changes in ocular globe-to-orbital rim position with age: implications for aesthetic blepharoplasty of the lower eyelids. Aesthet Plast Surg 23:337

    Article  CAS  Google Scholar 

  7. Ilankovan V (2017) Recent advances in face lift to achieve facial balance. J Maxillofac Oral Surg. 16:3

    Article  PubMed  Google Scholar 

  8. Stuzin JM, Rohrich RJ, Dayan E (2019) The facial fat compartments revisited: clinical relevance to subcutaneous dissection and facial deflation in face lifting. Plast Reconstr Surg 144:1070

    Article  CAS  PubMed  Google Scholar 

  9. Ramirez OM (2000) The central oval of the face: tridimensional endoscopic rejuvenation. Fac Plast Surg 16:283

    Article  CAS  Google Scholar 

  10. Isse NG (1998) The endoscopic approach to forehead and brow lifting. Aesthet Surg J 18:462

    Article  CAS  PubMed  Google Scholar 

  11. Mayer DM, Swanker WA (1946) Rhytidoplasty. Plast Reconstr Surg 6(255):1950

    Google Scholar 

  12. Skoog TG (1974) Plastic surgery: new methods and refinements: WB Saunders Company. Elsevier

    Google Scholar 

  13. Mitz V, Peyronie M (1976) The superficial musculo-aponeurotic system (SMAS) in the parotid and cheek area. Plast Reconstr Surg 58:80

    Article  CAS  PubMed  Google Scholar 

  14. Tessier P (1989) Subperiosteal face-lift. Ann Chir Plast Esthet 34:193

    CAS  PubMed  Google Scholar 

  15. Coleman SR (1998) Structural fat grafting. Aesthet Surg J 18:386

    Article  CAS  PubMed  Google Scholar 

  16. Coleman SR, Grover R (2006) The anatomy of the aging face: volume loss and changes in 3-dimensional topography. Aesthetic Surg J 26:4

    Article  Google Scholar 

  17. Trepsat F (2001) Volumetric face lifting. Plast Reconstr Surg 108:1358

    Article  CAS  PubMed  Google Scholar 

  18. Ellenbogen R, Youn A, Yamini D, Svehlak S (2004) The volumetric face lift. Aesthet Surg J 24:514

    Article  PubMed  Google Scholar 

  19. Attenello NH, Maas CS (2015) Injectable fillers: review of material and properties. Fac Plast Surg 31:29

    Article  CAS  Google Scholar 

  20. D’Agostino A, Trevisiol L, Favero V, Gunson MJ, Pedica F, Nocini PF, Arnett GW (2016) Hydroxyapatite/collagen composite is a reliable material for malar augmentation. J Oral Maxillofac Surg 74:238

    Article  Google Scholar 

  21. Lambros V (2007) Observations on periorbital and midface aging. Plast Reconstr Surg 120:1367

    Article  CAS  PubMed  Google Scholar 

  22. Rohrich RJ, Pessa JE (2007) The fat compartments of the face: anatomy and clinical implications for cosmetic surgery. Plast Reconstr Surg 119:2219

    Article  CAS  PubMed  Google Scholar 

  23. Arnett GW, Gunson MJ (2010) Esthetic treatment planning for orthognathic surgery. J Clin Orthod 44:196

    PubMed  Google Scholar 

  24. Raffaini M, Pisani C, Conti M (2018) Orthognathic surgery “again” to correct aesthetic failure of primary surgery: report on outcomes and patient satisfaction in 70 consecutive cases. J Craniomaxillofac Surg 46:1069

    Article  PubMed  Google Scholar 

  25. Reyneke JP, Bryant RS, Suuronen R, Becker PJ (2007) Postoperative skeletal stability following clockwise and counter-clockwise rotation of the maxillomandibular complex compared to conventional orthognathic treatment. Br J Oral Maxillofac Surg 45:56

    Article  CAS  PubMed  Google Scholar 

  26. Arcuri F, Brucoli M, Benech R, Giarda M, Benech A (2011) Maxillomandibular advancement in obstructive sleep apnea syndrome: a surgical model to investigate reverse face lift. J Craniofac Surg 22:2148

    Article  PubMed  Google Scholar 

  27. Bartlett SP, Grossman R, Whitaker LA (1992) Age-related changes of the craniofacial skeleton: an anthropomorphic and histologic analysis. Plast Reconstr Surg 90:592

    Article  CAS  PubMed  Google Scholar 

  28. Pessa JE, Zadoo VP, Mutimer KL et al (1998) Relative maxillary retrusion as a natural consequence of aging: combining skeletal and soft-tissue changes into an integrated model of midfacial aging. Plast Reconstr Surg 102:205

    Article  CAS  PubMed  Google Scholar 

  29. Cocconi R, Raffaini M, Amat P (2016) De l’orthodontie à la chirurgie ortho-faciale. entretien avec renato cocconi et mirco raffaini. Orthod Fr 87:247

    Article  PubMed  Google Scholar 

  30. Rosen HM (2017) Evolution of a surgical philosophy in orthognathic surgery. Plast Reconstr Surg 139:978

    Article  CAS  PubMed  Google Scholar 

  31. Van der Linden C, van der Linden WJ, Reyneke JP (2015) Skeletal stability following mandibular advancement with and without advancement genioplasty. Int J Oral Maxillofac Surg 44:621

    Article  PubMed  Google Scholar 

  32. Arnett GW, Gunson MJ (2004) Facial planning for orthodontists and oral surgeons. Am J Orthod Dentofacial Orthop 126:290

    Article  PubMed  Google Scholar 

  33. Wolford LM, Chemello PD, Hilliard FW (1993) Occlusal plane alteration in orthognathic surgery. J Oral Maxillofac Surg 51:730

    Article  CAS  PubMed  Google Scholar 

  34. Raffaini M, Magri AS, Giuntini V, Nieri M, Pantani C, Conti M (2020) How to prevent mandibular lower border notching after bilateral sagittal split osteotomies for major advancements: analysis of 168 osteotomies. J Oral Maxillofac Surg 78:1620

    Article  PubMed  Google Scholar 

  35. Sherris DA, Larrabee WF Jr (1996) Anatomic considerations in rhytidectomy. Fac Plast Surg 12:215

    Article  CAS  Google Scholar 

  36. Day DJ, Littler CM, Swift RW, Gottlieb S (2004) The wrinkle severity rating scale: a validation study. Am J Clin Dermatol 5:49

    Article  PubMed  Google Scholar 

  37. Casabona G, Frank K, Koban KC et al (2019) Lifting vs volumizing-The difference in facial minimally invasive procedures when respecting the line of ligaments. J Cosmet Dermatol 18(5):1237–1243

    Article  Google Scholar 

  38. Kappos EA, Temp M, Schaefer DJ, Haug M, Kalbermatten DF, Toth BA (2017) Validating facial aesthetic surgery results with the FACE-Q. Plast Reconstr Surg 139:839

    Article  CAS  PubMed  Google Scholar 

  39. Vercruysse H Jr, Van Nassauw L, San Miguel-Moragas J et al (2016) The effect of a Le Fort I incision on nose and upper lip dynamics: unraveling the mystery of the “Le Fort I lip.” J Craniomaxillofac Surg 44:1917

    Article  PubMed  Google Scholar 

  40. Pessa JE (2000) An algorithm of facial aging: verification of Lambros’s theory by three-dimensional stereolithography, with reference to the pathogenesis of midfacial aging, scleral show, and the lateral suborbital trough deformity. Plast Reconstr Surg 106:479

    Article  CAS  PubMed  Google Scholar 

  41. Terino EO (1992) Alloplastic facial contouring: surgery of the fourth plane. Aesthetic Plast Surg 16:195

    Article  CAS  PubMed  Google Scholar 

  42. Lee JH, Kaban LB, Yaremchuk MJ (2018) Refining post-orthognathic surgery facial contour with computer-designed/computer-manufactured alloplastic implants. Plast Reconstr Surg 142:747

    Article  CAS  PubMed  Google Scholar 

  43. Molina-Burbano F, Smith JM, Ingargiola MJ et al (2021) Fat grafting to improve results of facelift: systematic review of safety and effectiveness of current treatment paradigms. Aesthet Surg J 41(1):2021

    Article  Google Scholar 

  44. Tonnard P, Verpaele A, Carvas M (2020) Fat grafting for facial rejuvenation with nanofat grafts. Clin Plast Surg 47:53

    Article  PubMed  Google Scholar 

  45. Marten TJ, Elyassnia D (2015) Fat grafting in facial rejuvenation. Clin Plast Surg 42:219

    Article  PubMed  Google Scholar 

  46. Naran S, Steinbacher DM, Taylor JA (2018) Current concepts in orthognathic surgery. Plast Reconstr Surg 141(6):925e–936e

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Private practitioner “Facesurgery” center, Parma, Italy

    Mirco Raffaini & Alice Magri

  2. Consultant of the Unit of of Maxillo-Facial Surgery, AOUC “Careggi”, Florence, Italy

    Marco Conti

  3. Consultant of the Unit of Maxillo-Facial Surgery, IRCCS “Policlinico San Martino”, Largo Rosanna Benzi 10, 16132, Genoa, Italy

    Francesco Arcuri

Authors
  1. Mirco Raffaini
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  2. Alice Magri
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  3. Marco Conti
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  4. Francesco Arcuri
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Corresponding author

Correspondence to Francesco Arcuri.

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Conflict of interest

The authors have nothing to disclose. This study was conducted in accordance with the current revision of the Declaration of Helsinki. Informed written consent form was obtained from all patients. Current standards of scientific research ethics were applied in the performance of this retrospective study.

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Raffaini, M., Magri, A., Conti, M. et al. Advanced Facial Rejuvenation After Bimaxillary Surgery in Three Different Facial Types. Aesth Plast Surg 46, 183–193 (2022). https://doi.org/10.1007/s00266-021-02399-w

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  • DOI: https://doi.org/10.1007/s00266-021-02399-w

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