Operative protocol for re-do orthognathic surgery

This study aimed to analyse the spectrum of unsatisfactory outcomes requiring secondary surgery, the technical challenges involved, and the results achieved in a cohort of patients undergoing reoperative orthognathic surgery. A retrospective, single-centre study was conducted on all patients who underwent secondary orthognathic surgery at the Face Surgery Center (Parma, Italy) between January 2014 and June 2024. All patients had previously undergone orthognathic procedures by other surgeons abroad and were dissatisfied with the aesthetic outcomes. The final sample included 72 patients (50 women, 22 men), with a mean age of 25.8 years (range 18-43) at reoperation. All patients were treated by revision bimaxillary surgery; it was combined with: septorhinoplasty (52 patients, 72.2%); genioplasty (36 patients, 50%); mandibular remodelling (nine patients, 12.5%); mandibular angle prostheses (three patients, 4.1%); eyelid surgery (two patients, 2.7%). The main defects after primary surgery were (each individual case may incorporate several defects): enlargement or deformation of the nose (86%); facial asymmetry (57%); chin projection deficiency (50%); irregular mandibular borders (48%); and malocclusion (42%). No skeletal relapses occurred postoperatively; after surgery Class I occlusion was achieved in all patients. Bimaxillary procedures combined with facial lipofilling led to improved aesthetic outcomes in most patients.