Facial profile aesthetics – a comparison of conventional and surgery-first approach
DOI:
https://doi.org/10.20883/Keywords:
facial aesthetics, facial profile, surgery‑first approach, orthognathic surgery, skeletal class III malocclusionAbstract
Introduction. The surgery‑first approach is increasingly used in orthognathic surgery as an alternative to conventional treatment sequencing. By performing skeletal correction at the beginning of therapy, this method allows for an immediate improvement in facial aesthetics.
Aim. This study aims to present the surgery‑first approach in the management of skeletal anterior jaw discrepancies, focusing on its aesthetic outcomes as well as its benefits and limitations.
Material and methods. A literature review was conducted using PubMed and Google Scholar, following descriptors: facial aesthetics, facial profile, surgery- first approach, orthognathic surgery, and skeletal class III malocclusion. Articles published in English and Polish between 2021 and 2025 were included.
Results. The literature review showed that the surgery‑first approach provides immediate improvement in facial profile aesthetics, shortens overall treatment time, and maintains stable postoperative outcomes.
Conclusions. The surgery‑first approach is a promising alternative to conventional treatment, particularly with regard to facial aesthetics and early patient satisfaction.
Downloads
References
Psomiadis S, Sifakakis I, Iatrou I, Gkantidis N. Aesthetic impact of orthognathic surgery vs orthodontic camouflage in Class II Division 1 patients with convex facial profile: a follow-up using combined frontal and profile views. J Clin Med. 2025;14(12):4277. https://doi.org/10.3390/jcm14124277
Pamukçu H, Özsoy S, Tüz HH, Polat-Özsoy Ö. Orthognathic surgery-first approach with lingual appliances: a case report. Aust Orthod J. 2022;38(1):1-12. https://doi.org/10.21307/aoj-2022.001
AlOtaibi NM, Liu CH, Benington PCM, Ayoub AF. Improvement in facial aesthetics of orthognathic patients after surgery-first approach. Br J Oral Maxillofac Surg. 2023;61(10):666-671. https://doi.org/10.1016/j.bjoms.2023.08.213
Gandedkar NH, Chng CK, Tan W. Surgery-first orthognathic approach case series: salient features and guidelines. J Orthod Sci. 2016;5(1):35-42. https://doi.org/10.4103/2278-0203.176657
Peiró-Guijarro MA, Guijarro-Martínez R, Hernández-Alfaro F. Surgery first in orthognathic surgery: a systematic review of the literature. Am J Orthod Dentofacial Orthop. 2016;149(4):448-462. https://doi.org/10.1016/j.ajodo.2015.09.022
Millesi GA, Zimmermann M, Eltz M. Surgery first and surgery early treatment approach in orthognathic surgery. Oral Maxillofac Surg Clin North Am. 2023;35(1):71-82. https://doi.org/10.1016/j.coms.2022.06.010
Hoang TA, Lee KC, Chuang SK. The surgery-first approach to orthognathic surgery. J Craniofac Surg. 2021;32(2):e153-e156. https://doi.org/10.1097/SCS.0000000000006942
Komisarek O, Kożuch K, Tuczyńska A, Matthews-Kozanecka M. Pilot study on comparative assessment of facial profile changes using photographic images and cephalometric radiographs: a pre and post-orthodontic treatment analysis. J Face Aesthet. 2023;6(1):9-15. https://doi.org/10.20883/jofa.66
Choi JW, Lee JY. Current concept of the surgery-first orthognathic approach. Arch Plast Surg. 2021;48(2):199-207. https://doi.org/10.5999/aps.2020.01305
Anwar M, Benington PCM, Gillgrass TJ, Ayoub AF. Surgery-first approach for correction of class III dentofacial deformity with Le Fort I osteotomy; is it advantageous? Br J Oral Maxillofac Surg. 2022;60(9):1234-1239. https://doi.org/10.1016/j.bjoms.2022.07.005
Kong L, Liu X, Zhang J. Combining a digital design-mediated surgery-first approach and clear aligners to treat a skeletal Class III defect for aesthetic purposes: a case report. J Int Med Res. 2022;50(4):03000605221094524. https://doi.org/10.1177/03000605221094524
Hernández-Alfaro F, Mezquida-Fernández C, Brabyn PJ, Querejeta-Lomas E, Torres-Gaya J, Valls-Ontañón A. Redefining our protocol of the orthognathic surgery-first approach after 10 years of experience. Br J Oral Maxillofac Surg. 2022;60(8):1102-1107. https://doi.org/10.1016/j.bjoms.2022.04.006
Li M, Shen S, Huang J, Wang Y, Bao J, Wang B, et al. The skeletal stability of combined surgery first approach and clear aligners in skeletal Class III malocclusion correction: a randomized controlled trial. J Clin Med. 2024;13(3):872. https://doi.org/10.3390/jcm13030872
Benington P, Anwar M, Mohan A, Gillgrass T, Ayoub A. Outcome measures of the surgery first approach for orthognathic correction of dentofacial deformities. Br J Oral Maxillofac Surg. 2024;62(1):71-75. https://doi.org/10.1016/j.bjoms.2023.10.023
Desai O, Kshirsagar R, Singh V, Nair VS, Pawar S, Jain S. Orthognathic surgery: Is surgery first approach a viable option in orthognathic surgery? Natl J Maxillofac Surg. 2025;16(1):3-6. https://doi.org/10.4103/njms.njms_114_23
Zammit D, Ettinger RE, Sanati-Mehrizy P, Susarla SM. Current trends in orthognathic surgery. Medicina (Kaunas). 2023;59(12):2100. https://doi.org/10.3390/medicina59122100
Sharma VK, Yadav K, Tandon P. An overview of surgery-first approach: recent advances in orthognathic surgery. J Orthod Sci. 2015;4(1):9-12. https://doi.org/10.4103/2278-0203.149609
Yao K, Zhu G, Chen M, Zhang B, Wu Y, Li P. Effect of surgery-first orthognathic approach on oral health-related quality of life: a systematic review. Angle Orthod. 2020;90(5):723-733. https://doi.org/10.2319/112619-749.1
Klimek E, Dąbrowska A, Matthews-Brzozowski A, Nijakowski K. Ocena estetyki twarzy na podstawie fotografii – pierwsze wrażenie i linie estetyczne. Część I. J Face Aesthet. 2024;7(2):99-108.
Su W, Zhang Y, Meng Q, Zhang X, Lv Y, Shi X, et al. Impact of presurgical orthodontic decompensation on alveolar bone morphology and defects in patients with skeletal Class III high-angle malocclusion. Am J Orthod Dentofacial Orthop. 2026;169(2):189-201.
Khalil AS, Alrehaili RS, Bajunaid M, Alhazmi M, Alshami A, Alharthy B, et al. Does surgery-first orthognathic approach improve quality of life of orthodontic patients with skeletal Class III malocclusion? A systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Cureus. 2025;17(3):e81433. https://doi.org/10.7759/cureus.81433
Published
Issue
Section
License
Copyright (c) 2026 The copyright to the submitted manuscript is held by the Author, who grants the Journal of Face Aesthetics (JoFA) a nonexclusive licence to use, reproduce, and distribute the work, including for commercial purposes.

This work is licensed under a Creative Commons Attribution 4.0 International License.
