I have had double jaw surgery (a maxillary advancement of 8mm and a 6mm BSSO). The thing is that I am not very satisfied with the result as I would like more maxillary advancement. Would it be possible to get a lefort 1 a second time for more advancement ? Thank you.
It is certainly possible. But not recommended. I assume your occlusion is satisfactory. To further advance the maxilla would then also require advancement of the mandible. To do both jaws, the old hardaware would need to be removed, the bones re-cut and new fixation placed.
I would be happy to schedule a video visit should you want.
Dr. Peter J. Taub, MD, MS
New York, NY
After a LeFort I/BSSO, if the occlusion (i.e. bite) is good, a surgeon cannot selectively re-advance the midface without disturbing the occlusion. To obtain more midface advancement, a surgeon would have to re-advance the upper and lower jaws. Assuming that the occlusion is satisfactory, a patient would be far better off using midface and/or mandibular implants to selectively augment the skeleton. I've done this many times in my own patients and in patients referred to me. Typically, I find that patients with unsatisfying midface advancement after a LeFort I really wanted midface advancement above the level of the LeFort I segment. I point this out to my patients before LeFort I surgery and, unfortunately, I sometimes have to point this out to patients referred to me after their procedure with another surgeon. In sum, a post-LeFort I/BSSO patient with satisfactory occlusion should identify which areas remain insufficiently treated and consider implant augmentation.