Sir, in a time of austerity and increasing surgical waiting lists, the time taken for completion of combined orthognathic and orthodontic treatment is inevitably prolonged.

In addition, there is an increase in the use of dermal fillers from both medical and dental practitioners, as well as beauticians. Perhaps unsurprisingly in this context, it has been observed that several of our patients have used dermal fillers whilst awaiting their initial assessment, or during the primary orthodontic treatment to disguise any perceived aesthetic defect.

This is troublesome for both planning any potential orthognathic movements, due to the altered soft tissue contour, and may possibly adversely affect the surgical outcome.

We would stress the importance of the general dental practitioner in advising patients to avoid such treatments before or during any orthognathic treatment.