Facial Bone Surgery vs Plastic Surgery

So, you’ve made up your mind. You want to change a feature of your face. You might not be happy with the looks of a certain facial area, or may even have a medical need for an intervention. But what type of surgery do you need?

Choosing between facial bone surgery or plastic surgery is not an easy choice. In this article we highlight the differences between the different types of interventions and shine a light on the advantages and disadvantages of both.

Deciding which type of facial surgery is right for you is complicated and is a decision you should take by speaking with medical professionals. It is crucial to understand the differences between facial plastic surgery and facial bone surgery and how they can compliment each other, as in some cases even a combination of both types of surgeries is recommended. Both are primarily aesthetically motivated, although bone surgery is usually related to functional aspects as well.

When is Facial Bone Surgery indicated?

Maxillofacial surgery is the medical term for the type of surgery that Facial Bone Surgery forms part of. “Maxillo” is Latin for “jawbone”, the term “maxillofacial” refers to the jawbones and the face.

Facial Bone Surgery is usually indicated when there is a defect in the formation or development of the bones that form your face. These defects can affect children, adolescents, and adults and thus may be recommended to people of any age.

Examples of facial deformities or distortions may include;

Asymmetric bone growth
Excessive bone development
Underdeveloped bone
Defects in bone development

Facial Bone Surgery is often recommended for patients with a modified bone shape due to an external factor such as;

Facial tumors
Trauma (facial fractures)
Previous (unsatisfactory) surgery

In short, Facial Bone Surgery is indicated to restore harmony or proportion on the facial level.

When is Facial Plastic Surgery indicated?

The term plastic surgery comes from the Greek word plastikos, which literally translates as “to form or to mold”. Facial Plastic Surgery addresses the soft tissue of the face, all those “layers” that make up our face, other than the bone. It usually involves modifications of the skin and underlying tissue, but also the fasciae, fat and muscle.

The main objective of facial plastic surgery is the modification of the appearance and/or position of facial areas, either by elimination, tightening-resuspension or mobilization techniques.

Plastic surgery can be applied to;

Correct or camouflage deeper defects on the bone level without having to alter the facial structure
Restore functional alternations, such as a facial paralysis
Rejuvenate facial features
Enhance facial features

Who can perform each surgery

Traditionally, the plastic surgeon has always been the medical reference when operating on the facial region, especially if the desired changes were aesthetically motivated. On the other side, functional modifications to the face are performed by otolaryngologists, ophthalmologists or maxillofacial surgeons.

However, this trend has changed over the past years. All the aforementioned specialists could perform any type of facial surgery as long as they have the necessary skills, training and specialization.

We advocate subspecialization within such an important region as the facial, given the complexity of each region, it is necessary that there are specialists in each of the different areas such as rhinoplasty surgery, oculoplasty (eye), structural bone surgery, otoplasty, facelift/neck lift or hair surgeons.

Characteristics of different surgery types

Generally speaking, bone surgery is performed on deeper, underlying structures, which the outer layers of tissue rest on. This is why harmonizing the bone structure results in highly noticeable changes on the exterior, with a beautifying effect. Addressing the bone structure also implies greater durability over time, as results are permanent.

Nowadays, most types of facial bone surgery are performed through hidden scars.

With today’s technology, the results of bone surgery are highly predictable. Using specific software, 3D CT scans of the patient’s facial structure are used to simulate the intervention on a computer, prior to the actual surgery. This allows anticipating any unforeseen risks. To further eliminate potential risks and increase precision and predictibility, the CT scans are used to create surgical cutting guides, which allow transferring the virtual planning to the operating theater.

Soft tissue surgery is less predictable, since it is applied on different types of facial tissue, with a high dependence on the quality of each patient’s own healing. For plastic surgery, there is no reliable software to translate virtual surgery into reality. This does not mean that this type of surgery is freehand art, techniques are highly protocolized and technology is available to discover any anatomical problem of each patient before surgery. But it is a type of surgery that implies a high degree of specialization and experience.

Examples of different types of surgeries

Examples of Facial Bone Surgery procedures are;

Frontoplasty, surgery on the forehead region
Maxilloplasty, jaw contouring surgery
Rhinoplasty, surgery on the bone and nasal cartilage
Orthognathic surgery, to mobilize the upper maxillary bone and/or jaw

Examples of Plastic Surgery procedures are (among many others);

Brow lift surgery
Lip lift
Blepharoplasty, eyelid surgery
Otoplasty, ear surgery
Facial lipofilling, using fat

Combining Facial Bone Surgery and Plastic Surgery

Both types of surgery can be combined on the same patient, and even in the same surgical intervention. Soft tissue surgery can enhance the effects of facial bone surgery and often is applied as a complementary procedure.

Examples of facial bone surgery combined with plastic surgery include;

Combining a forehead reduction with a repositioning of the eyebrows and a simultaneous hair transplant.
Performing a rhinoplasty with a lip lift
Applying jaw recontouring surgery and a facelift during the same intervention

The postoperative process

It is true that bone surgery has always been considered aggressive, since it involves the modification of the skeleton of the face. This is only partially true, it is correct that modifications on the bone level imply an important inflammatory during the post-op phase. However, techniques and technology within the field underwent severe development over the past years, making the postoperative period increasingly comfortable and painless.

Applied techniques to improve the post-operative period and limit this to just a couple weeks are;

Using piezoelectric scalpels to make incisions and bone cuts to create accurate cuts, limiting the risk to damage surrounding tissue
Advances in Minimally Invasive Surgery allow for smaller and often hidden incisions
Specific post-operative therapy, such as Hilotherapy, in which a cooling mask is applied on the operated area to increase bloodflow to reduce inflammatory
Lymphatic drainage decreases any edema and speeds the recovery and adjustment of the soft tissues
Accupuncture speeds up the body’s ability to regenerate tissue, besides of that it has a relaxing effect, which has a positive effect on your recovery as well

In addition to the depth of the area to be worked on, the area that is operated on must also be taken into consideration. Lift surgery for example, is a soft tissue surgery but it also involves significant postoperative inflammatory and sick leave.

The recovery period for most surgeries is limited to just a few days, even for procedures such as jaw contouring, rhinoplasties, lip lifts and blepharoplasties.

In general, none of the facial surgeries represent much of a problem in terms of functionality or pain. However, as the face is the first thing people see from each other, most patients choose to be a few days “out of the game” until their physical appearance returns to normal.