When evaluating the problem of mandibular excess (prognathism), emphasis should be given to the overall appearance of the face with less concern about specific ceph-alometric (x-ray) measurements.

The orthodontist's goal will be to remove all dental compensations (poor positioning of the teeth) while the surgeon's objective is to reposition the jaws to achieve a functional occlusion and to enhance facial aesthetics.

The philosophy for management of the mandibular "prognathic" patient is toward surgically moving the upper jaw forward to achieve normal occlusal relations with enhancement of the skeletal volume. The lower jaw generally requires surgical repositioning to achieve improved proportions and symmetry. Reshaping of the chin is often necessary for ideal facial aesthetics.

These procedures stretch and align the facial skin. This results in loss of unattractive folds, leveling of the lips, and lessening of the deep skin creases that would worsen with aging.

Example (figure 3).

Example (figure 4).