Modern Orthognathic Surgery in Private Practice: Insights from 500 Consecutive Cases.

Aesthetic motivations have increasingly guided patient decisions in orthognathic surgery, particularly in private practice. This study presents descriptive observations from a single private practice, with a focus on patient motivations, surgical protocols, and trends that reflect the rise of the aesthetic-driven era in orthognathic surgery. A retrospective analysis was conducted on 500 consecutive orthognathic surgery patients treated from January 2020 to April 2025 in a private clinical setting. All procedures followed a standardized minimally invasive orthognathic surgery (MIOS) protocol. Data were collected using standardized clinical interviews. Patients were asked to report their primary motivation for treatment (aesthetic, breathing, or occlusal). The cohort consisted of 319 women (63.8%) and 181 men (36.2%), with a mean age of 27.4±9.1 years. Aesthetic concerns were cited as the primary motivation in 69.2% of cases, followed by breathing-related complaints (23.4%) and occlusal issues (7.4%). Among patients motivated by aesthetics, the most common concerns were poor chin projection (65.0%) and facial asymmetry (31.2%). Bimaxillary surgery with genioplasty was the most frequent procedure (61.8%). A surgery-first approach was adopted in 37.6% of cases, and 8.6% underwent surgery without orthodontic preparation. Aesthetic motivation was more prevalent among female patients (77.4%). Surgery-first protocols were more common among older patients (mean age 34.7 versus 27.4). Patients with occlusal motivations more frequently received isolated maxillary or mandibular procedures. In this analysis, aesthetic goals were the leading motivation for orthognathic surgery. The findings reflect a shift in patient expectations and planning strategies, emphasizing the growing importance of facial aesthetics in modern orthognathic practice. These insights, although not generalizable, offer a descriptive perspective on the evolving profile of the orthognathic patient in aesthetic-focused clinical settings.