What does Surgery First consist in?

Surgery First is a surgical methodology which has revolutionised the field of orthognathic surgery in recent years. It is considered an alternative to the conventional procedure of orthodontics - orthognathic surgery - orthodontics because it proceeds directly with orthognathic surgery, which is then followed by post-surgery orthodontic treatment.

Thus, Surgery First is presented as a methodological and technical revolution for four main reasons:

  • The patient does not require orthodontic treatment before having orthognathic surgery: the orthodontic treatment required by the conventional procedure deters some patients from having surgery. Now, thanks to this protocol, all patients with well-aligned teeth and who only require correction of the disharmony between their maxilla and mandible, can omit pre-surgery orthodontics.
  • Treatment time is shorter: no orthodontic treatment is required prior to orthognathic surgery and therefore the patient’s total treatment time is considerably reduced, by approximately one year or 18 months.
  • The patient can choose the time that suits them best to start orthognathic surgery: the conventional methodology depends inevitably on orthodontic treatment prior to surgery, lasting for approximately one year. The candidate for Surgery First, not needing to have pre-surgery orthodontic treatment, can choose the time that suits them best to have their orthognathic surgery.
  • The patient can appreciate the results of the operation immediately after orthognathic surgery: with Surgery First, the patient can enjoy their new appearance within a few days of surgery, when the inflammation disappears. Furthermore, post-surgery orthodontic treatment is much shorter than with the conventional method.
surgery first

This methodology is carried out whenever possible, as it has many benefits for the patient; it allows the harmony and balance of the patient’s facial features to be achieved in an extraordinarily short time.

For this reason, it is very important that the specialists, both the orthodontists and the maxillofacial surgeons, always assess whether the patient is a suitable candidate for the Surgery First procedure.

One of the most recent articles published by Dr. Federico Hernández Alfaro, On a definition of the appropriate timing for surgical intervention in orthognathic surgery, defines six protocols for action, or “time categories”, depending on when the surgical intervention is carried out: Surgery First, Surgery Early, Surgery Last, Surgery Late, Surgery Only, Surgery Never.

The maxillofacial surgeons at the Maxillofacial Institute, pioneers in orthognathic surgery, have been applying the Surgery First methodology for many years now and have had hugely successful results. Some more articles recently published by Prof. Hernández Alfaro and his team on this innovative protocol are: Surgery first in orthognathic surgery: A systematic review of the literatura and Surgery First in Orthognathic Surgery: What Have We Learned? A Comprehensive Workflow Based on 45 Consecutive Cases.

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