Zonal analysis in contemporary aesthetic orthognathic surgical planning

Maxillofacial Plastic and Reconstructive Surgery

Table 3 Impact of surgical procedures in different zones

	Primary procedures	Ancillary procedures	Secondary procedures	Potentially detrimental procedures^a
Zone I	Le Fort I osteotomy High-level osteotomies Segmental osteotomies Distraction osteogenesis	ANS reduction Pyriform guttering	Rhinoplasty Fat grafting	Alar base cinch suture V–Y closure Excision of buccal fat pad
Zone II	Mandibular osteotomy (usually sagittal split ramus osteotomy) Osseous genioplasty Segmental osteotomies Distraction osteogenesis Rotational movements		Fat grafting Onlay implant Facelift Neck lift Liposuction
Zone III	High-level osteotomies		Fat grafting Inferior orbital rim implant Malar implant Midface lift

ANS Anterior nasal spine
^aThis is based on clinical experience and views about the potential detrimental nature of such procedures may vary (see text for further explanation)