Surgical-orthodontic approach for facial rejuvenation based on a reverse facelift

Abstract

Background Orthodontic treatment combined with a maxillomandibular advancement (MMA) can be an effective option for patients who need not only corrected occlusion but also facial rejuvenation. In this case series, two patients underwent orthodontic treatment and bimaxillary orthognathic surgery involving MMA, one of them with a counterclockwise rotation of the occlusal plane (OP). Findings In both cases, the face was rejuvenated, a functional occlusion was established, and the posterior airway space (PAS) was widened. Conclusions The facial mask ages three dimensionally. MMA should be offered to patients who have insufficient skeletal projection and are considering improving their facial appearance beyond just correcting a malocclusion problem. The reverse facelift provides more soft-tissue support, resulting in mid- and lower-face rejuvenation.

Evolution and Trends of Facial Plastic Surgery and Facial Aesthetic Procedures in India: From Awakening to Revival

“…It is an aesthetically superior approach to parotidectomy, 53 thyroidectomy, 54 and orthognathic correction for facial rejuvenation. 55 …”

Maxillomandibular Advancement for Obstructive Sleep Apnea Syndrome: Long-Term Results of Respiratory Function and Reverse Face-Lift

“…Maxillomandibular advancement provides support for soft tissue, making them look younger. 14,15,[30][31][32] The effect of bimaxillary advancement with counterclockwise rotation (CCWR) for dentofacial deformities on the soft tissue of the facial mask has long been studied; however, to the best of our knowledge, the resultant facial changes in the sense of rejuvenation have not been adequately investigated, and the concept of "reverse face-lift" 14,15 has been little or anecdotally mentioned and detailed in the scientific literature. Simultaneous maxillary and mandibular advancements integrated with CCWR of the occlusal plane change significantly the skeletal framework of the face, improving soft tissue support and resulting in the rejuvenation of the lower middle third and the lower third of the face.…”

“…Anthropometric photographs were taken in a standardized way including frontal, lateral, and inferior views of the face to investigate "reverse face-lift." 14,15 Patients were standing, with natural position of the head, teeth in occlusion, and tongue relaxed without swallowing. Stigmata of a standard aging face (midface and lower third) were categorized into 7 points: right and left nasolabial folds, right and left facial jowls with the absence of straight jawline, right and left labiomental fold, and submental fat redundancy (double chin feature).…”

“…12,13 The potential of orthognathic surgery (double jaw surgical advancement) of expanding the skeletal foundation to increase the facial drape support and to rejuvenate the face by a "reverse face-lift" is now recognized. 14,15 However, MMA may compromise facial esthetics if the narrowness of the pharyngeal space is not caused by the hypoplastic maxillofacial skeletal. Where a negative impact occurs, this may include an excessively protruding profile, bulging upper lip, enlarged nostrils, and nasal base.…”

“…Moreover, it projects the soft tissue of the cheeks, the mouth, and the nose in the aging face, which is characterized by multiple signs affecting the middle third (development of the nasojugal fold and accentuation of the para-buccal fat pad), and the lower third (formation of the facial jowls, evidence of the labiomental fold, and accentuation of the submental fat pad) 12,13 . The potential of orthognathic surgery (double jaw surgical advancement) of expanding the skeletal foundation to increase the facial drape support and to rejuvenate the face by a “reverse face-lift” is now recognized 14,15 . However, MMA may compromise facial esthetics if the narrowness of the pharyngeal space is not caused by the hypoplastic maxillofacial skeletal.…”