Craniofacial surgery

It should not be forgotten that the skeleton, the bones, represents the foundation of a face. The muscles, fat and skin follow the contour of this bony foundation. If the proportions of the facial bones are unattractive, there will be an immediate effect on the appearance of the face.
We have long known how to analyse the components of the facial bones and to identify an anomaly of the forehead, the orbits, the cheekbones, the upper jaw or the mandible. Until recently, however, the possibilities for correction were very limited: grafts were simply added in the case of a depression, and orthodontic treatment was used to realign the teeth when there was a mismatch between the jaws.

Over the past twenty years, particularly in France, surgery of the facial skeleton has developed remarkably. It can now correct major malformations by advancing an entire face, remodelling a forehead, or bringing the eyes and their orbits closer together.

Developed for these major anomalies, this surgery of the facial skeleton, with its principles of repositioning misplaced bony elements, is now proving perfectly applicable to the usual cases of minor anomalies.

A slightly flat face may be due to a slight recession of the upper jaw. The teeth meet edge to edge, or are slightly offset. A moderate advancement of the upper jaw will bring forward the base of the nose and the upper lip, and the teeth will be in a good position.

Hollow cheeks may be due to a deficiency of the cheekbones, and augmentation at this level will provide better balance.
An over-projected chin can be corrected by reducing the tip of the chin if the teeth are well positioned, or by setting back the whole mandible if the lower teeth are too far forward. Insufficient projection will be corrected by advancing the chin.

A careful study, with X-rays and often the cooperation of an orthodontist, is necessary before all these procedures.
General anaesthesia is almost always required, but the hospital stay is very short, and these procedures, which are performed without visible scars, through the inside of the mouth, cause very little pain.

I wanted to draw your attention to these new surgical possibilities, because such a procedure, well designed and well executed, can bring considerable improvement in the case of a disharmonious facial skeleton.