Skeletal movements have a significant impact on aesthetic outcomes in surgery of the jaws. This includes vertical and AP changes that have been planned but are executed with a negative effect on the outcome. Planning of surgical procedures is limited by the record taking process. Mistakes may exist in the face bow transfer and the CR/CO position. The use of imaging that is not accurate and does not reflect the patient in a repose position are both conditions that magnify mistakes in the record taking process. Care in collecting all information related to the patient deformities will yield data that will make the final outcome more accurate. The records taken must be perfect to plan the surgery for a perfect outcome. The clinical examination provides the surgeon the data necessary so that the plan ultimately is a true representation of the patient so that the final outcome produces the correct movements of the jaws. If errors exist on the record process it will impact the aesthetic and occlusal outcomes. Built in errors will be magnified in the final result. Newer techniques for 3D planning will be presented to avoid the mistakes that can impact facial aesthetics after orthognathic surgery.

The final result must be the result of careful planning that includes the clinical exam, laboratory workup and 3D imaging workup with skeletal prediction. The actual surgical plan is simulated in the computer software yielding a close similarity to the actual patient outcome.