The Importance of Individualised Jaw Surgery Planning
Orthognathic surgery aims to improve the relationship between the jaws, teeth, face and airway. While the principles of treatment planning are universal, the concept of an “ideal” facial outcome is not.
Facial proportions, skeletal anatomy, soft tissue characteristics and aesthetic norms vary considerably between populations. As a result, a surgical plan that produces an excellent outcome for one patient may be entirely inappropriate for another.
Modern orthognathic surgery therefore requires an appreciation of both individual anatomy and knowledge of ethnic facial variation. The objective is not to make every face conform to a single standard. Rather, it is to create balance, harmony and function while respecting the patient’s natural facial identity.
Moving Beyond Traditional Cephalometric Norms
Historically, orthognathic surgery planning in the UK relied heavily on cephalometric analyses developed using predominantly Caucasian populations. Many of the measurements still taught today were derived from relatively narrow population groups. While these analyses remain useful, they have limitations when applied across diverse ethnic backgrounds. A treatment plan based solely on achieving cephalometric norms risks producing results that appear unnatural for the individual patient.
Modern planning increasingly recognises that facial attractiveness cannot be reduced to a series of numerical measurements. Clinical judgement and facial analysis are often more important than rigid adherence to population averages.
Pursuing Facial Harmony
One of the most important principles in modern orthognathic surgery is that treatment should enhance facial balance rather than diminish identity. Patients generally wish to look like a more balanced version of themselves.
Successful surgery should therefore preserve the features that contribute to an individual’s identity while addressing genuine skeletal disharmony. This distinction is particularly important when considering facial projection, lip support, jaw prominence and soft tissue balance.
East Asian Orthognathic Surgery Planning
Many East Asian populations demonstrate characteristic facial features that differ from traditional Caucasian cephalometric norms.
Features may include:
- Greater facial width
- More prominent cheekbones
- Increased soft tissue fullness
- Relative bimaxillary protrusion
- Less nasal projection
- A flatter midface profile
As a result, treatment planning may differ substantially from that used in a patient of Northern European ancestry.
For example, while maxillary advancement may improve facial balance in one patient, excessive advancement in another may create an unnatural prominence of the midface.
Similarly, incisor position and lip projection are often evaluated differently because greater lip fullness may represent a normal and attractive ethnic characteristic rather than a deformity requiring correction.
South Asian Orthognathic Surgery Planning
South Asian populations display considerable diversity, reflecting the enormous geographic and genetic variation across the Indian subcontinent. However, certain tendencies are commonly encountered.
Many patients demonstrate:
- Strong facial projection
- More prominent nasal structures
- Fuller soft tissues
- Moderately prominent dentition
- Greater lower facial projection than Northern European norms
Treatment planning therefore requires careful evaluation of both skeletal and soft-tissue relationships. In some cases, aggressive maxillary advancement or mandibular advancement may produce excessive projection rather than improved balance.
Black and African Orthognathic Surgery Planning
Patients of African ancestry frequently demonstrate facial characteristics that differ substantially from traditional Caucasian cephalometric standards. Common features may include:
- Greater lip prominence
- Bimaxillary proclination
- Greater soft tissue thickness
- Wider nasal structures
- Increased facial convexity
Historically, there was a tendency to interpret these normal ethnic characteristics as skeletal abnormalities because they differed from Caucasian norms. Modern orthognathic planning recognises that this approach is flawed. A treatment outcome should be judged against what appears balanced and attractive within the context of the individual’s overall facial characteristics, not against a single universal template. Excessive efforts to reduce lip support or facial projection may therefore produce unnatural outcomes despite technically “ideal” cephalometric measurements.
Middle Eastern Orthognathic Surgery Planning
Patients of Middle Eastern ancestry often demonstrate strong skeletal projection and well-developed facial features. Treatment planning frequently requires careful consideration of:
- Nasal projection
- Maxillary position
- Chin projection
- Lip support
- Facial convexity
Airway Considerations Remain Universal
Although aesthetic preferences vary between populations, airway physiology does not. Patients of all ethnic backgrounds can develop:
- Obstructive sleep apnoea
- Airway restriction
- Maxillary constriction
- Mandibular deficiency
The principles of airway-focused planning therefore remain broadly similar regardless of ethnicity. Aesthetic decisions may differ, but maintaining or improving airway health remains a universal priority.
Why Ethnicity Is Only One Piece of the Puzzle
Although ethnic background provides useful context, it should never determine treatment planning by itself. Variation within populations is often greater than variation between populations. Two patients of the same ethnicity may have completely different:
- Facial proportions
- Skeletal relationships
- Soft tissue characteristics
- Aesthetic priorities
- Airway requirements
The modern surgeon therefore evaluates the individual first, using ethnicity as one factor among many.
The Modern Approach
Dr Tom Pepper combines:
- Facial soft tissue analysis
- Skeletal analysis
- Occlusal assessment
- Airway evaluation
- Three-dimensional imaging
- Individual patient goals
within a framework that respects both anatomy and identity. The aim is not to create a generic “ideal face”, but a face that looks balanced, natural and harmonious while preserving the characteristics that make the individual recognisably themselves.
