Midface augmentation using bony segments obtained from sagittal splitting angle ostectomy in Asians

BACKGROUND: Asians characteristically have flat or broad and round facial features. These characteristics are primarily attributable to enlarged and widened jawbones, impressive muscles associated with mastication, and a zygomatic arch involving the masseter. Their faces appear flat, with midface regression in the center. This regression is often combined with a narrow nasolabial angle and a depressed alar base and cheeks. METHODS: Between June of 1999 and March of 2002, 32 patients underwent facial contouring surgery for prominent mandible angles and subsequent rhinoplasty. After bilateral prominent mandible angle modification, midface augmentation was accomplished using bony segments obtained from sagittal splitting angle ostectomy. The bony fragments were inserted via an intraoral approach into the paranasal area, trimmed, and then reshaped with an osteotome. RESULTS: Of these 32 patients (31 women and one man), 47 percent were in their thirties. The amount of reduction of the distance between mandible angles on the frontal view, the extent of protrusion of the paranasal area on the profile view, and the degree of patient satisfaction were the primary areas of postoperative evaluation. Complications included one wound infection and two cases of wound dehiscence. All but two patients were satisfied with their results. CONCLUSIONS: Satisfactory aesthetic results were obtained with a one-stage modification of the mandible angles and advancement of the midfacial area. The advantages included the absence of any additional costs and a low infection rate. None of the disadvantages of an autologous transplant were present, and the procedure yielded aesthetically superior results. The authors advocate this method.