A facial appearance of premature aging due to poor bone support of the soft tissues is frequently found in patients with midface hypoplasia. This study was performed to evaluate the changes in the soft tissues of the cheek area in patients subjected to bimaxillary orthognathic surgery. The cheek line angle and length of 27 consecutive patients who underwent bimaxillary surgery, were measured on cone beam computed tomography scans obtained before surgery and at 1 and 12 months after surgery using 3D software. Changes between time-points were analyzed. Bimaxillary surgery was virtually planned in all patients using the Barcelona line protocol. The results showed a mean decrease in cheek angle of 5 ± 5° (P < 0.001). This decrease was reflected in a more anterior-projected cheek and was related to forward movement of the upper and lower incisors (x-axis) (r = -0.469, P = 0.014 and r = -0.440, P = 0.021, respectively). There was 3D stability of the hard and soft tissue changes at the 1-year postoperative follow-up. The results indicate that bimaxillary surgery performed following the Barcelona line as a planning reference could improve midfacial soft tissue support by means of a more anterior-projected cheek.
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