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Evolution of a Surgical Philosophy in Orthognathic Surgery

Rosen, Harvey M. M.D., D.M.D.

Plastic and Reconstructive Surgery: April 2017 - Volume 139 - Issue 4 - p 978–990
doi: 10.1097/PRS.0000000000003216
Pediatric/Craniofacial: Special Topic

Summary: A surgical philosophy of orthognathic surgery is presented. It has evolved over an entire surgical career as orthognathic surgical goals have evolved to become primarily aesthetic. In this context, the occlusal result serves as a means of achieving the aesthetic ends. It relies on the physical examination, using qualitative concepts of facial appearance, to be the most important determinant of treatment plans. It makes a distinction between a quantitatively normal face and one that is visually well proportioned and emphasizes the attributes of the soft tissue. The emotional expression of the patient is also considered in treatment planning. By using surgical tactics that provide control of facial projection and height, this philosophy affords the surgeon an opportunity to manipulate the skeletal elements to the extent that one can simultaneously achieve a well-proportioned face and favorably influence the appearance of the soft tissues and facial countenance.

Malvern, Pa.

From the Division of Plastic Surgery, Pennsylvania Hospital, Philadelphia, and University of Pennsylvania Craniofacial Program, Philadelphia.

Received for publication August 18, 2016; accepted October 12, 2016.

Disclosure: Dr. Rosen has no financial information to disclose. No funding was received for this article.

Harvey M. Rosen, M.D., D.M.D., 357 Applebrook Drive, Malvern, Pa. 19355,

©2017American Society of Plastic Surgeons