2023-06-01 10:04:27
“This is a type of surgery that allows a face that is dysmorphic to become a face with harmony. Orthofacial surgery modifies the size and position of the different bones of the face such as the maxilla, especially the mandible, chin, nose, cheekbones…”, explained to EFEsalud the director of the Maxillofacial Institute at the Teknon Medical Center in Barcelona, Federico Hernández Alfaro.
It is a “deep” and permanent cosmetic surgery unlike facial fillers, such as hyaluronic acid, which do not correct the structural problem, but are effective in temporarily “camouflaging” small facial defects, such as a small chin or a small chin. cheekbone more sunken than another.
It is a growing aesthetic demand, “60 or 65% of the patients who ask us for a better jaw definition are men and 45% are women,” says the surgeon.
“Perhaps men tend to ask more for a well-defined and well-projected mandibular and chin contour. The woman usually expresses that she wants a more defined neck or that that double chin is no longer visible ”, she indicates.
“And they are two sides of the same thing -he points out- by placing the jaw in its place and giving it the appropriate size, greater definition, also the double chin or the sagging of the neck tissues disappears”.
“You can’t imagine the number of people who undergo facelifts or liposuction attempts to remove fat from their neck every day and all they need is for us to put their jaw in place because they don’t have fat, what they do have it is the skin and muscles that sag because his jaw is too small”, says the doctor.
The “facepush”, the opposite of the facelift
“The most common orthofacial surgery is the one that consists of moving forward, giving more size to the bones of the face, especially the jaw or cheekbones. But, sometimes, the problem is the opposite, for example, a patient with a very large jaw, in that case it is to reduce it”, explains the also professor of Maxillofacial Surgery at the International University of Catalonia.
In this surgery, the concept has been developed “facepush” or, literally, pushing the face, which is antagonistic to a facelift or facelift, which consists of stretching the skin and muscles and trimming excess skin.
Thus, the “facepush” consists of projecting the bones of the face forward, in harmony, and this movement “gives tension to the skin and muscles and achieves the effect of facial rejuvenation by improving the support of the soft tissues of the face.” face, eliminating the double chin and projecting the lips”, explains the doctor.
But also in cases where the jaw is too large and the lower teeth are in front of the upper ones, the jaw is displaced backwards.
In the case of having a prominent chin, a cut is made in the chin and it moves backwards, it is the so-called mentoplastywhile if it is a matter of a few millimeters it can simply be filed down.
orthofacial surgery techniques
According to Hernández Alfaro, “one of the great developments that we have made in the field of orthofacial surgery is precisely to propose, invent and publish in scientific journals a whole series of minimally invasive surgery techniques.”
“This surgery allows, through small incisions in the gum, to reach the maxillary bone, the mandible and the chin and make tunnels under the gum. With a very fine ultrasonic saw, we make small cuts in the bones that allow them to move in any direction”, describes the specialist.
“The mandible on each side -precise- is formed by two sheets and what we do is separate these two sheets, we slide one sheet over the other in one direction if I want to lengthen the jaw and in the opposite direction if I want to shorten it”.
After this bone slide, a small sheet of titanium is placed, the same material used for dental implants, with small screws of the same metal to keep the bone in its new position.
“These titanium materials are totally biocompatible and although these plates and screws function for the 3 or 4 months it takes for the bone to heal, since they are made of titanium, they do not have to be removed.”
Twenty years ago, steel was used, which was not biocompatible like titanium, and which had to be removed in a new operation once the bone was welded, in addition to ringing in metal detectors, so the patient had to carry a certificate that would justify it.
What risks can this surgery entail?
According to Dr. Hernández Alfaro, all surgery may have a risk of infection or bleeding, but in the case of orthofacial surgery there are two reasons that minimize it.
The first is that it is designed on a 3D virtual platform that allows virtual surgery before going to the operating room, on the computer, and through a scanner of the patient’s face where the exact three-dimensional position of bone placement is calculated.
“I already know what I am going to do exactly to the millimeter, so there is no room to improvise. I know what I’m going to find, what I’m going to do and how it’s going to look like, ”she says.
The second reason is that “all this series of minimally invasive surgery techniques allows the intervention to be carried out through tiny incisions in the gum, altering the muscles very little, the important structures in the face and, therefore, greatly minimizing the risks,” he says.
Anesthesia, hospitalization, recovery…
General anesthesia is necessary for operations in which various structures of the face are addressed. The normal thing is one night in the hospital and discharge the next day.
In cases of operating only the chin, or the jaw, or an increase in the cheekbones, or slight changes in the nose, it can be done with local anesthesia and sedation and on an outpatient basis.
The most complex surgeries can last about two hours and a simple one, such as the one on the chin, about 20 minutes.
Recovery also depends on the type of surgery and occurs with inflammation that can normalize in 3 or 4 weeks in the most complex cases.
“If we perform a mentoplasty or a simple rhinoplasty, the patient can lead a normal life in a week,” says the surgeon who highlights the influx of patients from other countries to this center.
a new face
If several structures of the face are modified, the appearance of the face changes and this could cause a certain rejection in the patient by not recognizing himself.
“Although the change is very important, when patients after surgery start to socialize again and return to work and the people around them tell them …we see you much better or you are much more handsome or pretty… that acts as positive reinforcement”, says the doctor.
“But in the cases that we perceive before the surgery that the patient is going to have difficulties accepting a new image or that the change is going to be very important… in these cases we always make a prior assessment and a subsequent follow-up with psychologists,” he specifies. .
The doctor assures that the image, which we see in the world of entertainment and television, of “retreaded” faces or with inflated faces is due to malpractice in the application of hyaluronic acid fillers that “camouflage”, so temporary, defects and that should be used for small corrections.
In order to have a benchmark for facial harmony when planning surgery, the team at the Instituto Maxilofacial del Teknon Center has researched for years and have published in scientific journals what they have called the “Barcelona line”.
“It is a line that starts from the upper part of the root of the nose and goes down vertically, perpendicular to the ground or perpendicular to the computer screen. For a face to be harmonious, the entire lower part of the face has to be in front of that line.
A beneficial surgery for sleep apnea
“Most of the patients we treat with orthofacial surgery techniques are aesthetically motivated. Another 20% of patients come with a functional motivation, occlusion or bad fit of the teeth because they are not well placed; and the rest, 25% and increasing, are patients with a very serious problem called obstructive sleep apnea“, explains the specialist.
And one of the causes is the lack of size of the maxilla and especially of the mandible, “so that the patients who have the lower part of the face smaller or more sunken, many of them have a significant respiratory problem, a problem of sleep apnea”.
Orthofacial surgery allows the maxilla and mandible to advance so that the respiratory tube located behind the nose and mouth does not collapse, which is narrower in these cases and collapses when the patient is lying down and asleep and for what it is also useful of reference the “Barcelona Line”.
“It is the only potentially curative treatment,” says Dr. Hernández Alfaro.
Orthofacial surgery also has a positive effect on the oral health because it returns a correct occlusion and for this it is necessary in some cases an orthodontic treatment prior to surgery that allows ordering the teeth.
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