11.0: Thursday, March 17, 2005

Determinants of Perioral Aesthetics: Achieving Soft Tissue Changes through Hard Tissue Interventions

David Morris, MD and Joseph Daw, MD, DDS.


In the perioral region, certain dentofacial proportions have been established as aesthetically pleasing. Many aesthetic operations focus solely on soft tissues. In planning dentofacial procedures we attempt to achieve a simultaneous aesthetic and functional improvement. The goal of this work is to review the determinants of perioral aesthetics as defined by pertinent anatomy. We describe our preoperative assessment, therapeutic strategy, and the resultant aesthetic change in a series of skeletal surgical interventions.

Five young adults with the following diagnoses were evaluated preoperatively: vertical maxillary excess, horizontal maxillary deficiency, bimaxillary protrusion, mandibular retrognathia, mandibular prognathia. Preoperative evaluation of the perioral soft tissues and cephalometric analysis was performed. Incisor exposure, lip competence and position, and mentalis strain were graded. Aesthetic shortcomings were noted. Following orthognathic correction an identical grading was done.


Each patient demonstrated functional improvement while aesthetic goals were achieved with respect to preoperative planning. There were no complications with the procedures.


Achieving an optimal aesthetic result depends on accurate appreciation of the soft and hard tissue relationship preoperatively. Through recognition of abnormal relationships of the dentition and maxillofacial skeleton to perioral soft tissues, with incorporation into the surgical plan, aesthetic goals can be maintained during orthognathic procedures.