Background:
Facial appearance significantly affects psychosocial well-being, and improvement in facial aesthetics is considered an essential outcome of orthognathic treatment. The surgery-first approach (SFA) has emerged as a promising alternative to the conventional orthodontics-first approach (OFA), due to its potential advantages in reducing treatment duration and cost, delivering early aesthetic improvement, and increasing patient satisfaction. However, the impact of the SFA on final facial aesthetics, and how it compares with the OFA, has not yet been investigated. Method: This retrospective study aimed to compare the improvement in facial aesthetics after orthognathic surgery, in an SFA and an OFA group. Pre- and postoperative three-dimensional stereophotogrammetry facial images for 40 patients were evaluated by five professional assessors using the Global Aesthetic Improvement Scale (GAIS). Results: Similar aesthetic improvement outcomes were found for both the SFA and OFA groups. The GAIS score was significantly correlated with the following facial variables: upper lip projection, chin prominence, facial proportions, para-nasal hollowing, lip competence, mandibular projection, and facial profile. No significant correlation was found between the change in aesthetic score and the surgical variables. There was a positive association between the overall GAIS score and the gender and experience level of the individual assessors. Conclusion: This study suggests that the facial aesthetic improvement achieved with the SFA is satisfactory and comparable to that of the OFA.