Cosmetic enhancement associated with surgery for obstructive sleep apnea

Objective: To document the capacity of surgery for obstructive sleep apnea (OSA) to incorporate techniques that incidentally improve the cosmetic feat ures of the patients, Study Design: Retrospective analysis of surgical outc omes at an academic practice. Methods: Moderate to severe OSA usually requi res multilevel pharyngeal surgery, including tongue base surgery, The surgi cal procedures, including hyoid myotomy and mandibular osteotomy with tongu e advancement, afford the opportunity to address cosmetic deficits, such as microgenia and excessive submental skin and fat. Outcomes achieved using t hese procedures over a 4-year period were analyzed. Results: Of 428 consecu tive patients presenting for evaluation of sleep-related breathing disorder s, 212 were deemed surgical candidates, Ninety-seven of these had office-ba sed procedures for snoring, upper airway resistance syndrome, or mild OSA. The remaining 115 had formal surgical procedures done, and 68 of these had multilevel pharyngeal surgery. Of these, 12 had defined cosmetic deficienci es that were addressed at the time of the sleep apnea surgery. There were 7 men and 5 women, with a mean age of 48.2 years. The group was moderately o bese (mean BMI = 31.8) and had moderate to severe OSA (mean RDI = 37.0, mea n LSAT = 78%). Cosmetic deficits identified included turkey gobbler deformi ty (n = 8), microgenia (n = 6), excessive submental fat (n = 2), and nasal deformity (n = 1); several patients had more than one addressable problem. All patients achieved an improved postoperative appearance. Representative photographs are presented. Conclusions: A surgical approach to the manageme nt of sleep apnea affords an opportunity to also address cosmetic deficienc ies, including excessive submental skin and fat, microgenia, and nasal defo rmities.