The "Surgery-Only" Paradigm in Orthognathic Surgery: A Contemporary Analysis of Three Indications

Orthognathic surgery is applied to correct significant skeletal discrepancies in the maxillofacial region. In recent years, increasing attention has been directed toward the Surgery-First Approach (SFA), which is believed to offer notable advantages. This approach primarily addresses underlying skeletal irregularities. Given the substantial impact of facial appearance on psychosocial well-being, the enhancement of facial aesthetics is recognized as one of the primary goals of orthognathic treatment. Within this context, the SFA has emerged as an alternative to the conventional approach due to its potential benefits, such as reducing overall treatment duration and cost, enabling early aesthetic improvements, and enhancing patient satisfaction. Parallel to these developments, the Surgery-Only (SO) approach is also being considered in selected cases with appropriate indications. Particularly with advances in anchorage systems, successful outcomes can be achieved in suitable patients without the need for orthodontic treatment, along with a reduced risk of relapse. In this study, three specific indications of the SO approach are detailed with three case reports for each indication. It is suggested that the SO approach can be a successful treatment alternative when selected for the right indications. The main purpose of this study is to assess the potential benefits and factors to be considered when considering orthognathic surgery as the primary treatment option in the context of the SO approach in carefully selected patients.