A stream of celebrities that have undergone orthognathic surgery are fueling a cosmetic surgery boom in South Korea. In addition to thousands of personal and commercial blogs that present a keen interest in this ‘life-changing’ surgery, makeover television shows showcase the very best of orthognathic surgery results. The problem is that orthognathic surgery, which is a radical solution to correct malocclusion and maxillomandibular deformities, is misinterpreted as a cosmetic treatment. Because potential risks and negative consequences of orthognathic surgery—such as skewed mouth, chronic jaw pain, permanent facial numbness or paralysis—are not being mentioned, people with no real dental or jaw flaws go through the painful process just to have a small face with a ‘V-shaped’ chin and jawline.
Orthognathic surgery involves a bone-cutting procedure—Le Fort I in conjunction with a bilateral sagittal split osteotomy being most common— that realigns the upper and lower jaws where the two main nerves, the trigeminal and lingual nerve, are located. As a result, it can be extremely complex and dangerous, particularly when performed by general plastic surgery practitioners and in those patients who do not suffer from severe functional problems, and can result in increasing serious complications, including irreversible nerve damage and mortality. However, many doctors are keeping silent as orthognathic surgery costs 20 thousand dollars on average, generating bigger profits than other types of plastic surgeries. The demand for orthognathic surgery has continuously increased because of higher personal incomes, greater interest in facial aesthetics, and plastic surgery clinics’ intense marketing efforts. In addition, although the procedure remains expensive, prices continue to decline, making it more affordable.
Despite the cosmetic jaw surgery boom, oral and maxillofacial surgeons who have specialized in correcting dentomaxillofacial deformities claim that patients with significant structural deficiencies of the mandible or maxilla should consider distraction osteogenesis, a competing treatment of orthognathic surgery that is known to be safer and more reliable. Distraction osteogenesis has become a mainstay of treatment for pediatric patients in particular because its gradual bone lengthening process and progressive bone generation ability avoids the morbidity of conventional orthognathic surgery. Although orthognathic surgery is frequently performed due to its low technical difficulty and immediate results, its use is limited to the correction of the anatomical anomalies of pediatric patients or adult patients with severe skeletal deformities. Depending upon the maxillary-mandibular opening and the degree of bony and soft-tissue exposure required for device placement, distraction osteogenesis can be done by using internal or external devices. Despite the great disadvantage of second operation for removal, recent clinical data support the superiority of internal over external devices due to their precise and predictable vector of lengthening, and decreased risks of infection as well as facial scarring. Although external devices offer better 3-dimentional control during the distraction process, they carry greater risks for pin tract infection compared to internal devices. Recent studies have also suggested that distraction osteogenesis, as a staged approach, allows patients to achieve greater soft tissue relaxation and significant movement of the craniofacial skeleton with lower relapse rates.
Nonetheless, there is still debate over distraction osteogenesis versus orthognathic surgery among oral and maxillofacial surgeons. Both types of surgery should not be performed as a way to improve physical appearance when clinical symptoms are minor and when safer, less invasive alternative non-surgical treatment options, such as orthodontic braces, BOTOX injections, and massage therapies can result in better outcomes. Because there is no currently available scientific analysis of whether patients definitely need the surgery or not, doctors must take comprehensive steps to evaluate the severity of deformities of patients. Oral and maxillofacial surgeons warn that patients must consult with experienced doctors prior to undertaking orthognathic surgery and carefully consider the potential risks that the surgery entails. The importance of proper presurgical orthodontics and solid presurgical planning to guarantee predictable results must also be emphasized.