Aesthetic facial skeletal surgery-evolution of thought and technique

Since the beginning of time, humans have made efforts to change their appearance for better or worse. With the evolution of surgical technique, procedures originally intended to repair congenital or acquired facial anomalies became safe and efficacious, leading to their adoption in facial aesthetic surgery. Parallel to the development of procedures for facial soft tissues was the development of techniques for surgery of the facial skeleton, with a variety of autogenous bone grafting techniques, osteotomies, and utilization of alloplastic bone substitutes. These procedures evolved to more sophisticated techniques of osteotomy and movements of facial regions to correct acquired developmental or functional conditions, such as malocclusion, orbital dystopia, midface retrusion, and so on. As surgeons developed the techniques in facial surgery, the interplay of the bony foundation and soft tissue was understood and better appreciated. A fundamental and core concept was discovered: Soft tissue overlying the bone defined the contour and appearance of the face, whereas the bony foundation provided attachment and support to the soft tissue. This interdependent relationship served as a scaffold, for which techniques of aesthetic facial surgery evolved. As practitioners became more skilled in the execution of these reconstructive procedures, the logical next step was to apply them to correct facial differences, which were primarily aesthetic. What has evolved over the last 50 years has been the progression of craniomaxillofacial surgical techniques from their application in reconstructive craniomaxillofacial surgery to their current use in aesthetic surgery of the facial skeleton.