Orthognatic surgery or cheek implants and orbital rim implants first?

Hi doctors. I had a consultation with both a maxillo facial surgeon and an oculoplastic surgeon. I agreed with the first that i needed to get my upper jaw brought down and forward (my teeth (and bite) are perfectly straight, they just dont show enough). I also got prominent eyes due to sunken cheeks. So i agreed with oculoplastic surgeon to get orbital rim implants and cheek implants. However, they both claim their surgery should come first. Which one really should be done first? Thank you

Doctor Answers 2

Surgery timing

you must do the maxillary surgery first; or you risk contaminating the implants if they are placed first. there is NO choice. also, the maxillofacial surgeon should be able to do all of it in one surgery - not sure why you would do 2 surgeries.

Vancouver Oral & Maxillofacial Surgeon
5.0 out of 5 stars 22 reviews


Dear Joan

As a Maxillofacial surgeon I perform both orthognathic and facial implants surgery. If the decision has been made to have both surgeries to improve your facial aesthetics as well as facial proportions, my recommendation is to have both procedures at the same time. The reason is that the upper jaw surgery and the implant surgery utilize the same intra oral incision. If you require jaw surgery to bring your upper jaw down and forward this means that you have a midface deficiency  in the vertical dimension. If the implants are place first they will almost definitely be in the way of the bone cut of the upper jaw. So if having the two surgeons work together or having the Maxillofacial surgeon do everything is not feasible you should ideally have the maxilla repositioned and healed  as this will alter the relationship of the submalar fullness and hence require a smaller malar/submalar implant.  If the implant is place first the maxillofacial surgeon may have to remove implants to  perform his surgery. 
Virtual surgical planning is available and can help your surgeon with the planning of the jaw surgery and positioning of the implants. I highly suggested this approach 
best of luck 
Dr M

Manolis Manolakakis, DMD, FACS
Shrewsbury Oral & Maxillofacial Surgeon
5.0 out of 5 stars 12 reviews

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