Facial Contouring vs Orthognathic Surgery: Key Points & Differences
- Dr. Park
- Apr 23
- 5 min read
Many patients are curious about the differences between facial contouring surgery and orthognathic (double jaw) surgery. Recently, there has been growing interest in orthognathic surgery performed without extensive orthodontic treatment, which we'll refer to as 'No-Braces Orthognathic Surgery'.
Traditionally, orthognathic surgery primarily focused on correcting functional issues like malocclusion (bite problems). However, no-braces orthognathic surgery aims to achieve ideal facial proportions and balance by repositioning the jawbones, even when the patient's existing bite (occlusal relationship) is relatively stable.
This means no-braces orthognathic surgery doesn't necessarily require pre- and post-operative orthodontic treatment (braces) but can still offer distinctive aesthetic and functional benefits that may be difficult to achieve with facial contouring alone.
Today, I want to clearly explain the differences between orthognathic surgery and facial contouring surgery, illustrating with a real patient case how no-braces orthognathic surgery can be an effective option in specific situations. I hope this information helps those wondering about the differences between jaw surgery and facial contouring.
Case Study Introduction and Treatment Plan
The patient we'll discuss presented with a lower jaw that appeared somewhat protruded relative to her forehead and desired a narrower overall facial width.
Her bite analysis showed a relatively stable Class I molar relationship, making her a suitable candidate for no-braces orthognathic surgery, maintaining her existing occlusion.
Surgical Plan: Occlusion-Maintained Orthognathic Surgery with Clockwise Rotation
Maxilla (Upper Jaw) -
Le Fort I Osteotomy: The upper jawbone was sectioned and repositioned 1.5mm superiorly at the front teeth, 3.5mm superiorly at the molars, shifted 0.3mm to the left overall, and moved 3.2mm posteriorly relative to the front teeth.
Mandible (Lower Jaw) - BSSRO (Bilateral Sagittal Split Ramus Osteotomy): The lower jawbone was sectioned for repositioning.
Mandibular Angle Reduction: The jaw angle area was reshaped for a smoother contour.
Chin - T-Osteotomy Genioplasty: The chin's width was narrowed while maintaining its vertical length.
Surgical Results Analysis
Skeletal Changes: Post-operative 3D CT analysis confirmed the lower jaw moved 3.95mm superiorly and 2.89mm posteriorly.
골격 변화 
교합 유지 양악 시계방향 회전술 Facial Width Reduction: A noticeable reduction in facial width from the front view was achieved. This is possible because orthognathic surgery allows for adjusting the angle of the mandibular ramus (the back part of the lower jaw) and rotating it medially (inward), effectively narrowing the frontal appearance. This patient clearly showed facial narrowing due to the medial movement of the mandibular ramus.
하악지의 내측 이동 
얼굴 폭 변화 Bone Remodeling: At the 11-month post-operative CT scan, approximately 6mm of natural bone regeneration was observed at the mandibular angle reduction site. This is part of the body's normal healing process. Ultimately, an approximate 6mm reduction in the jaw angle prominence was maintained.
양악수술 11개월 Soft Tissue Changes: Comparing soft tissues at 1 year and 6 months post-op showed a smoother, superiorly repositioned mandibular angle line and a clear reduction in frontal facial width. Cross-sectional CT views also confirmed the decrease in facial width.
양악수술 1년 6개월 Occlusion and Tooth Alignment: While the primary goal was no-braces orthognathic surgery maintaining the original bite, minor finishing orthodontics were performed post-operatively for optimal teeth alignment. A slight increase in the buccal (outward) inclination of the teeth compared to immediately post-op is a result of this final alignment phase. The final occlusion remained stable.
술전 술후 교합변화
Key Differences: No-Braces Orthognathic vs. Facial Contouring Surgery
The difference between jaw surgery and facial contouring isn't just about function. Since no-braces orthognathic surgery can be applied even without significant functional problems, the post-operative appearance and the scope of improvement clearly distinguish it from facial contouring.
Scope and Goals:
Facial Contouring: Primarily focuses on reshaping the outer contours of the face – cheekbones, jaw angles (square jaw), and chin. It involves trimming or repositioning parts of the bone but does not change the overall jaw position or the bite significantly.
No-Braces Orthognathic Surgery: Involves cutting and repositioning the entire upper (maxilla) and/or lower (mandible) jawbones in three dimensions. While maintaining the existing occlusion, it adjusts the position, length, and angle of the jaws to improve overall facial balance, proportion, and even functional aesthetics (like easier lip closure).
Nerve Injury Risk:
Facial Contouring: Aggressive bone removal, especially for significant asymmetry correction or jaw reduction, can carry a relatively higher risk of injuring the inferior alveolar nerve (sensory nerve for the lower lip and chin). Caution is needed when large amounts of bone need to be removed near the nerve canal.
No-Braces Orthognathic Surgery: By moving the entire jaw segment, the nerve canal within the bone is also repositioned. This can, in certain cases, allow for more significant skeletal changes with potentially less risk to the nerve compared to extensive bone shaving in contouring surgery alone. For example, correcting asymmetry might be limited by nerve proximity in contouring, whereas orthognathic surgery can safely reposition the nerve before making necessary bone movements or combining with contouring techniques for a more effective outcome.
Submental Fat (Double Chin) Improvement:
Facial Contouring: As it primarily reshapes bone, it has minimal direct impact on the soft tissues under the chin, offering little to no improvement for a double chin.
No-Braces Orthognathic Surgery: When the jaws (especially the lower jaw) are moved backward or upward, the position of the tongue and surrounding muscles/soft tissues also changes. The tongue acts as crucial support for the submental area. Elevating the tongue's base strengthens this support, often leading to a natural improvement in the double chin area and a more defined jawline.
Facial Width and Asymmetry Correction:
Facial Contouring: Typically reduces facial width via mandibular angle reduction or outer cortex shaving (corticotomy).
No-Braces Orthognathic Surgery: Can address facial width and asymmetry more fundamentally by adjusting the angle and rotation of the mandibular ramus and repositioning the jaw body. This impacts not just the frontal view but the overall 3D facial balance.
Lip Competence and Functional Aesthetics:
Issues like difficulty closing the lips naturally (lip incompetence) or chin wrinkling upon lip closure (mentalis strain or "cobblestone chin") are often related to underlying jaw position discrepancies.
Facial Contouring: Cannot fundamentally resolve these issues. Genioplasty (chin surgery) can alter chin shape but has limited effect on achieving relaxed lip closure.
No-Braces Orthognathic Surgery: By adjusting the vertical and horizontal positions of the upper and/or lower jaws, it can facilitate natural lip closure, reduce chin muscle strain, and improve overall functional aesthetics. As seen in the case study, even without significant changes in chin projection, improvements like superior repositioning of the maxilla can greatly enhance the appearance and function around the mouth.
Conclusion: Advantages and Considerations of No-Braces Orthognathic Surgery
No-Braces Orthognathic Surgery offers the following potential advantages:
Distinct Aesthetic Improvements: Can address facial proportions, asymmetry, jawline definition, and perioral aesthetics that may be beyond the scope of facial contouring alone.
Reduced Nerve Injury Risk (Relative): In specific scenarios, allows for significant skeletal changes while potentially offering greater nerve safety compared to aggressive contouring.
Natural Jawline Contouring: Creates a harmonious jawline by influencing soft tissues, including potential improvement in the submental (double chin) area.
Shortened or Eliminated Orthodontic Period: For patients with a good existing bite, the lengthy pre- and post-surgical orthodontic phase can be significantly reduced or avoided.
Long-Term Stability: Repositioning the skeletal foundation itself generally leads to stable, long-lasting results.
However, it's crucial to understand that no-braces orthognathic surgery is a complex procedure that is more extensive than facial contouring and requires a high level of surgical expertise. Therefore, thorough consultation and precise diagnosis with an experienced Oral and Maxillofacial Surgeon are essential to determine candidacy and establish the most appropriate treatment plan for your specific needs and goals.
I hope this explanation has helped clarify the differences between orthognathic surgery and facial contouring. Choosing the right procedure depends entirely on your individual condition and aesthetic goals, making an in-depth discussion with a specialist paramount.
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