J Oral Mawllofac
Surg
491139.1990
What it lakes to Make a Pretty Face patient cannot recognize the difference, which is so obvious to us in before-and-after photographs. Patients need to understand these factors before deciding whether or not to have esthetic surgery performed. They also need to understand the technical limitations of such surgery, the predictability of the procedures, and, even more importantly, the unpredictability of the procedures. An informed patient is generally more cooperative and easier to please. When performing esthetic surgery, we also have to reevaluate our criteria for normality. Measuring angles and planes on cephalometric radiographs and attempting to meet arbitrarily set standards may have worked with orthognathic surgery, but in other facial areas we need to be more creative. We must look at faces and not jaws or cheeks or noses. We have to realize that normality is a range, and that individuality is more important than conformity. Esthetic surgery is an art as well as a science. Moreover, we must not forget that what we like may not be what the patient likes. It has been shown that the greatest degree of satisfaction occurs when the patient’s opinions are considered in making the final esthetic choices. Finally, with esthetically oriented treatment plans, the mechanical, functional, and even the esthetic standards may be met and the results still deemed a failure because the patient’s psychological needs have not been met. Before beginning any procedure, it is essential to thoroughly ascertain the emotional desires, hopes, and expectations of the patient. Patients often blame adverse life situations on perceived facial abnormalities that are either minor or nonexistent, and attempts to deal with these issues surgically are doomed to failure. Likewise, even correction of obvious deformities may never be completely satisfactory to the patient because they are not the real basis of the problem. Recognition of these situations will avoid considerable grief for all concerned. Clearly, esthetic surgery is a multifaceted challenge for the oral and maxillofacial surgeon. Properly done in the patient who is both cognitively and emotionally prepared, it can be a most gratifying experience. Otherwise, it can be a potential disaster. As we go about the business of expanding our scope, we need to constantly bear in mind that it takes more than technical skills to bring a smile to a pretty face.
We currently live in a health- and fitness-oriented society. The general public is virtually innundated with television documentaries, radio programs, and countless magazine and newspaper articles dealing with the benefits of proper diet and exercise. Physical appearance and youthfulness also have taken on great significance, not only because looking better and feeling better seem to go together, but also because of the impression that attractive persons are more qualified and reliable, and the finding that they are generally better received than their lessattractive peers. All of this has led to a greater public interest in facial esthetics, and concerns about appearance and self-image are fast becoming even more important than concerns about health. As oral and maxillofacial surgeons, we have long been interested in facial esthetics through our involvement in orthognathic surgery. Although initially these efforts were directed mainly to alterations in dental and skeletal relationships, it soon became clear that significant changes in facial appearance were an added benefit of these procedures, and that the latter was oftentimes the stated or unstated reason for patients seeking our services. It also has become evident that orthognathic surgery only addresses a part of what concerns many patients, and that we can readily provide a more comprehensive service by also undertaking the correction of these related complaints. However, this represents a shift in emphasis from functional to esthetic considerations, and we need to prepare ourselves carefully for the psychological as well as the technical aspects of these procedures. Orthognathic surgery has been perhaps the most gratifying aspect of our specialty because, for the first time, we are doing procedures that are satisfying to the patient as well as to us. Moreover, we have generally started with marked deformities, for which any change is a significant improvement. This may not be the case with changes in other parts of the facial skeleton, and especially with soft-tissue alterations. We need to look carefully at the lessons we have learned, or should have learned, from our experience with orthognathic surgery, as well as what can be gleaned from the experiences of others. Even with orthognathic procedures, often there are times when our enthusiasm for the results far exceeds that of the patient. This does not mean that something is wrong, but rather that we can view patients in ways that they cannot view themselves. Other times, the changes are so subtle that the
DANIEL M. LASKIN
1139
Surg
491139.1990
What it lakes to Make a Pretty Face patient cannot recognize the difference, which is so obvious to us in before-and-after photographs. Patients need to understand these factors before deciding whether or not to have esthetic surgery performed. They also need to understand the technical limitations of such surgery, the predictability of the procedures, and, even more importantly, the unpredictability of the procedures. An informed patient is generally more cooperative and easier to please. When performing esthetic surgery, we also have to reevaluate our criteria for normality. Measuring angles and planes on cephalometric radiographs and attempting to meet arbitrarily set standards may have worked with orthognathic surgery, but in other facial areas we need to be more creative. We must look at faces and not jaws or cheeks or noses. We have to realize that normality is a range, and that individuality is more important than conformity. Esthetic surgery is an art as well as a science. Moreover, we must not forget that what we like may not be what the patient likes. It has been shown that the greatest degree of satisfaction occurs when the patient’s opinions are considered in making the final esthetic choices. Finally, with esthetically oriented treatment plans, the mechanical, functional, and even the esthetic standards may be met and the results still deemed a failure because the patient’s psychological needs have not been met. Before beginning any procedure, it is essential to thoroughly ascertain the emotional desires, hopes, and expectations of the patient. Patients often blame adverse life situations on perceived facial abnormalities that are either minor or nonexistent, and attempts to deal with these issues surgically are doomed to failure. Likewise, even correction of obvious deformities may never be completely satisfactory to the patient because they are not the real basis of the problem. Recognition of these situations will avoid considerable grief for all concerned. Clearly, esthetic surgery is a multifaceted challenge for the oral and maxillofacial surgeon. Properly done in the patient who is both cognitively and emotionally prepared, it can be a most gratifying experience. Otherwise, it can be a potential disaster. As we go about the business of expanding our scope, we need to constantly bear in mind that it takes more than technical skills to bring a smile to a pretty face.
We currently live in a health- and fitness-oriented society. The general public is virtually innundated with television documentaries, radio programs, and countless magazine and newspaper articles dealing with the benefits of proper diet and exercise. Physical appearance and youthfulness also have taken on great significance, not only because looking better and feeling better seem to go together, but also because of the impression that attractive persons are more qualified and reliable, and the finding that they are generally better received than their lessattractive peers. All of this has led to a greater public interest in facial esthetics, and concerns about appearance and self-image are fast becoming even more important than concerns about health. As oral and maxillofacial surgeons, we have long been interested in facial esthetics through our involvement in orthognathic surgery. Although initially these efforts were directed mainly to alterations in dental and skeletal relationships, it soon became clear that significant changes in facial appearance were an added benefit of these procedures, and that the latter was oftentimes the stated or unstated reason for patients seeking our services. It also has become evident that orthognathic surgery only addresses a part of what concerns many patients, and that we can readily provide a more comprehensive service by also undertaking the correction of these related complaints. However, this represents a shift in emphasis from functional to esthetic considerations, and we need to prepare ourselves carefully for the psychological as well as the technical aspects of these procedures. Orthognathic surgery has been perhaps the most gratifying aspect of our specialty because, for the first time, we are doing procedures that are satisfying to the patient as well as to us. Moreover, we have generally started with marked deformities, for which any change is a significant improvement. This may not be the case with changes in other parts of the facial skeleton, and especially with soft-tissue alterations. We need to look carefully at the lessons we have learned, or should have learned, from our experience with orthognathic surgery, as well as what can be gleaned from the experiences of others. Even with orthognathic procedures, often there are times when our enthusiasm for the results far exceeds that of the patient. This does not mean that something is wrong, but rather that we can view patients in ways that they cannot view themselves. Other times, the changes are so subtle that the
DANIEL M. LASKIN
1139
