Middle-third facial advancement: treatment considerations in atypical cases.

A systematic evaluation of facial esthetics in individuals with dentofacial and craniofacial deformities is necessary to achieve optimum results. This is especially true in deformities of the middle third of the face, as cephalometric analyses provide minimal useful information about frontal facial esthetics. Further, three-dimensional interrelations of the appearance of the forehead, nasal dorsum, globe, infraorbital, malar, and paranasal regions cannot be adequately evaluated through cephalometric examination. Many individuals with facial deformities do not have stereotyped deformities, and, therefore, the use of "standard" operations to correct apparently similar deformities will result in less than optimal results.