From the Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University; Plastic and Cleft-Craniofacial Surgery, A&D DermePlastique; Department of Plastic Surgery, Royal Devon & Exeter Hospital; and Department of Plastic Surgery, Xiamen Chang Gung Hospital.
Plast Reconstr Surg. 2021 Dec 1;148(6):1350-1356. doi: 10.1097/PRS.0000000000008581.
Patients with maxillomandibular disharmony may present with a flat to concave midface. The effects of orthognathic surgery concomitant with midface fat grafting on facial appearance and midface volumetric and positional change have not formally been assessed to date. The authors' approach for synchronous orthognathic surgery and fat grafting is described and evaluated. Adult female patients (n = 20) who underwent synchronous two-jaw orthognathic surgery and cheek-specific fat grafting (1.9 ± 0.6 cm3 per side) for correction of skeletal class III deformity and anteromedial cheek deficiency were prospectively included. Preoperative and postoperative photographs were appraised by 42 blinded raters using facial appearance scales for beauty, attractiveness, and pleasantness parameters. The three-dimensional midface soft-tissue volume change and postoperative cheek mass position were computed. Facial imaging data from gender-, ethnic-, and facial pattern-matched adult patients (n = 20) who underwent isolated two-jaw orthognathic surgery (n = 20) were included for comparison. The three-dimensional facial norms database-derived cheek mass position information (2.19 ± 1.31mm) was also adopted for analysis. Patients treated with the synchronous procedure had significantly (p < 0.001) increased facial appearance-related perception change for beauty (2.9 ± 1.6), attractiveness (2.8 ± 1.8), and pleasantness (3.0 ± 1.5) parameters, three-dimensional midface volume change (1.8 ± 0.5 cm3), and postoperative cheek mass position (2.16 ± 0.47 mm) in comparison with those treated with the isolated procedure (2.0 ± 1.5, 1.9 ± 1.6, 2.3 ± 1.6, 0.6 ± 0.2 cm3, and 1.84 ± 0.43 mm, respectively). Healthy female individuals had similar and larger cheek mass position than patients treated with synchronous (p > 0.05) and isolated (p < 0.001) procedures, respectively. Synchronous orthognathic surgery and check-specific fat grafting resulted in superior enhancement of facial appearance and midface volume and position compared with isolated orthognathic surgery.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
上颌骨和下颌骨不协调的患者可能表现为中面部平坦或凹陷。迄今为止，尚未正式评估正颌手术联合中面部脂肪移植对面部外观和中面部体积及位置变化的影响。本文描述并评估了同步正颌手术和脂肪移植的方法。前瞻性纳入 20 例因骨骼 III 类畸形和中面部前内侧凹陷接受同步双颌正颌手术和颊部特异性脂肪移植（每侧 1.9±0.6cm3）的成年女性患者。42 位盲评者使用面部美观、吸引力和愉悦感评分评估术前和术后照片。计算三维中面部软组织体积变化和术后颊部质量位置。纳入 20 例接受单纯双颌正颌手术的性别、种族和面部模式匹配的成年患者（n=20）的面部成像数据进行比较。还采用三维面部正态数据库得出的颊部质量位置信息（2.19±1.31mm）进行分析。与接受单纯手术治疗的患者相比，接受同步手术治疗的患者在面部美观相关感知变化方面有显著改善（美丽：2.9±1.6；吸引力：2.8±1.8；愉悦感：3.0±1.5）、三维中面部体积变化（1.8±0.5cm3）和术后颊部质量位置（2.16±0.47mm）（分别为 2.0±1.5、1.9±1.6、2.3±1.6、0.6±0.2cm3 和 1.84±0.43mm）。与接受同步（p>0.05）和单纯（p<0.001）手术治疗的患者相比，健康女性的颊部质量位置相似但更大。与单纯正颌手术相比，同步正颌手术和颊部特异性脂肪移植可显著改善面部外观和中面部体积及位置。
临床问题/证据水平：治疗性，III 级。
