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Patient information guide

Orthognathic surgery
Jaw surgery
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Introduction
Orthognathic procedures
Treatment schedule
Agave Clinic
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Content
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Content
Introduction
Orthognathic surgery is an unfamiliar term
to most people. Therefore they are uncom-
fortable, even fearful, in considering it as
a treatment option. The information in this
booklet is designed to take you step by step
through the process involved with orthog-
nathic surgery so you understand the entire
orthodontic and surgical experience. It is
our goal for you to feel completely informed
and comfortable with your treatment.
Patient information guide 4
Combined orthodontic and orthognathic treatment
Orthognathic surgery, also called jaw
surgery, corrects the jaws by means of an
operation. Such corrections are largely
achieved by dissecting the jaw in separate
fragments which are then moved into
new positions and xed with plates and
screws. All incisions are made inside the
oral cavity, avoiding any visible scarring.
Because moving the jaws also moves the
teeth, orthognathic surgery is usually
performed in conjunction with ortho-
dontics so that the teeth are in proper
position after surgery. In diagnosing your
need for orthognathic surgery, the oral
and maxillofacial surgeon and the ortho-
dontist will work closely together. The
orthodontist is responsible for moving
the teeth so they will t together proper-
ly after the jaws have been repositioned.
The maxillofacial surgeon is responsible
for repositioning the jaw so the teeth and
jaws are in proper alignment.
Orthognathic surgery focuses on im-
proving the patients appearance as
well as the functionality of the jaws
and teeth. The aim is to achieve a
proper occlusion (the manner in which
the upper and lower teeth t together)
and a more aesthetically pleasing face.
The word orthodontics comes from the Greek word or-
thos, meaning to straighten, and odons, meaning teeth.
Orthodontics is a specialty of dentistry that is concerned
with the straightening of improperly aligned teeth.
The word orthognathic also comes from the Greek word
orthos, meaning to straighten, and gnathos, meaning
jaw. Orthognathic surgery thus means surgery to
straighten the jaw.
Orthognathic surgery
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Combined orthodontic and orthognathic treatment
Proper occlusion
Many malocclusions are correctable
by wearing orthodontic braces alone.
In some situations, however, the upper
and lower jaws are of a different size or
shape, or are in an incorrect relationship
to one another. In this situation it will
be necessary to align the jaws and the
teeth. In this way the orthodontic result
is not compromised and the optimum
result is achieved as far as long-term
stability, appearance and function are
concerned.
Severe malocclusion (bad bite) may
cause many functional problems. You
may have already experienced some of
the following:
inability to chew food properly
which compromises digestion
speech problems
facial muscle dysfunction character-
ized by headaches, joint pain, etc.
periodontal trauma.
Functionality is increased when teeth
t together rmly, making biting and
chewing food easier. Surgery also allevi-
ates the grinding and pressure associated
with most oral disorders, and prevents
further damage to the affected teeth.
Enhanced facial aesthetics
Patients also enjoy an enhanced facial
prole, since oral disorders frequently
affect facial balance and aesthetics.
Some people may consider having cos-
metic procedures to enhance their new
appearance, such as surgery on the eyes,
nose, forehead, chin or neck. You may
wish to discuss these options with your
surgeon.
Sequence of treatment
Combined orthodontic and orthognathic
treatment often takes considerable time
to complete and therefore requires great
motivation and cooperation from the
patient. A close liaison between the pa-
tient, the orthodontist and the maxillo-
facial surgeon is also important. Several
stages are involved in treatment:
evaluation and planning
pre-surgical orthodontics
surgical treatment
post-surgical orthodontics
follow-up visits
Conclusion
In summary, orthodontics correct ab-
normal tooth position and orthognathic
surgery corrects abnormal jaw position.
Combined orthodontic and orthognathic
treatment provides us with the oppor-
tunity to improve both functional and
cosmetic problems at the same time.
Patient information guide 6
About facial harmony
Dividing the face in thirds
Facial balance typically is assessed by dividing the face in thirds. The upper third is
from the anterior hairline to the point on the midline between the eye-brows (gla-
bella). The middle third reaches until a point immediately under the nose (subnasale).
The lower third ends on the midpoint of the chin (menton). When each of the thirds
is equal, the face is said to be vertically balanced and of ideal proportions.
While tastes do differ,
in orthognathic theory,
a number of guidelines
describe what are the
characteristics of an aes-
thetically pleasing face.
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Orthognathic surgery
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Facial Convexity
Additionally, in prole view the face should have a slight degree of convexity as meas-
ured from the glabella to the subnasale to the menton. Excess facial convexity, atness,
or concavity is felt to be less ideal. Of course it has to be noted that these guidelines
are only idealized concepts. They merely provide a guideline that is not true for every
patient. A wide range of faces defy such absolute canons.
Ideal facial convexity Lack of facial convexity Excess facial convexity
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Orthognathic procedures
This section will describe all orthognathic
procedures performed by Agaves team of
specialists.
In this chapter we discuss the orthognathic pro-
cedures according to their anatomical location:
the upper jaw, the lower jaw and the chin.
Chapter content
Lower jaw surgery
retraction
advancement
retraction
shortening
rotation
widening
retraction
advancement
Upper jaw surgery
Chin surgery
Orthognathic surgery
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Lower jaw surgery
Lower jaw surgery is
done to correct abnor-
malities of the lower
jaw (mandible), which
may be too small or too
large. The jaw can be
advanced or retracted
surgically. Rotation is
also possible.
The most common operation to
advance or retract the jaw is called a
sagittal split osteotomy (see the tech-
nical box). This type of surgery allows
for the placement of bone screws or
plates. Consequently the jaws dont
have to be wired together at the end
of the procedure.
The operation is carried out almost
entirely from inside the mouth to
minimize visible scars on the skin
of your face. It is performed under
general anaesthesia.
It is then xed with small screws
and sometimes plates. It is often
necessary to make a small puncture
incision (a few mm long) low down
on the side of the cheek to allow the
screws to be inserted. These titanium
screws, which are left in place
permanently, do not set off metal
detectors in airports.
The gum inside the mouth is sutured
using dissolvable stitches that may take
3-4 weeks to dissolve Sometimes light
elastics are placed between the teeth
to guide the jaw into the new bite.
Lower jaw surgery may be per-
formed as a single procedure or in
combination with other orthognathic
procedures.
Technical: Sagittal split osteotomy
The lower jaw is split in a vertical
(sagittal) plane on each side with
a small saw behind the last tooth.
The bone is split in a front to back
direction so the two pieces can slide
along each other and still overlap.
The part of the lower jaw with the
teeth is moved forward or backward
as needed to obtain the desired bite
and appearance.
Patient information guide 10
When the lower jaw
grows out too far in front
of the upper jaw, this
results in mandible prog-
nathism. The lower teeth
are more pronounced than
the upper teetha condi-
tion called underbite.
Orthognathic surgery can be used to
slide the lower jaw back.
Retraction of the lower jaw
Orthognathic surgery
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Advancement of the lower jaw
The underdevelopment of
the lower jaw is called ret-
rognatia. In this case, the
lower teeth are positioned
too far behind the upper
front teeth (overbite).
This condition can be treated by surgi-
cally advancing the lower jaw.
Patient information guide 12
Upper jaw surgery
Upper jaw surgery is
necessary to correct ab-
normalities of the superior
jaw bone (maxilla).
The upper jaw may be or narrow, too
long, too short, too far forward or too
far back to t the lower jaw properly. In
maxilla surgery, the upper jaw can be ro-
tated or repositioned forward, backward,
or it can be raised or lowered. Also,
asymmetries between different sides of
the face can be corrected. Widening of
the upper jaw is possible by a surgical
split in the midline followed by distrac-
tion (see technical box on page 17).
Upper jaw surgery is performed mainly
by utilizing a bone dissecting procedure
called Le Fort I osteotomy (see techni-
cal box).
A Le Fort I osteotomy is the most
commonly used procedure to
make bone incisions in the upper
jaw. This procedure is performed
under general anaesthesia.
The operation is carried out
entirely inside the mouth. A U-
shaped incision is made through
the gums above the upper teeth
to gain access to the jawbone.
The gum is then raised off the
bone.
The upper jaw incisions are
made with highly specialised
tools, which allow for a control-
led parting of the bone.
Additional bone is removed if
the upper jaw is to be shortened.
Bone can be added if necessary
to lower the jaw and make it
longer (bone graft).
The upper jaw bone is then moved
into its nal position (planned
prior to your surgery) and held in
place with tiny titanium plates and
screws, which are left in place
permanently.
The gums are stitched back into
place with dissolvable stitches.
These stitches may take three to
four weeks to dissolve.
After the bones heal together, the
jaw regains its normal strength.
Technical: Le Fort I osteotomy
Orthognathic surgery
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Advancement of the upper jaw
The underdevelopment of
the upper jaw is called
horizontal maxillary
deciency. The lower teeth
are in front of the upper
teeth a condition called
underbite.
These patients may have a sunken in or
very at face. Facial contour and dental
occlusion can be harmonized with the
advancement of the upper jaw by cutting
it horizontally and moving it forward.
Patient information guide 14
Shortening of the upper jaw
Vertical maxillary excess
is when the upper jaw
(maxilla) has grown too
far down.
When smiling, too much gingiva is visible
(gummy smile) and often there are dif-
culties in putting the lips together. Not
only is this situation cosmetically undesir-
able, it can also result in sore, red, bleeding
gums from chronic exposure to air.
This problem can be orthognathically cor-
rected by excising a segment of upper jaw,
therefore elevating the level of the teeth.

Orthognathic surgery
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Rotation of the upper jaw
When only the back por-
tion of the upper jaw is
overdeveloped vertically,
this will result in the in-
ability for the front teeth
to meet a condition
called open bite (aper-
tognathia).
As the back portion of the upper jaw
grows vertically downward, the lower jaw
will open in a clockwise direction. This
explains why open bite patients have a
long facial appearance. There is little or
no ability to bite using the front teeth.
This makes eating a challenge, and causes
problems with swallowing, speech, and
often resulting in red swollen gums due
to chronic air exposure. This condition
can be corrected by removing a wedge of
bone in the upper jaw.
Patient information guide 16
Widening of the upper jaw
When the upper jaw is
too narrow, this results in
what is called a transverse
maxillary deciency. This
narrowness can cause the
upper teeth to bite inside
the lower teeth (crossbite),
crowding of the teeth,
or black corridors upon
smiling.
The patient may have a smile that
shows mostly the two prominent front
teeth, with the others in shadow (buc-
cal corridors). Also crossbites can have
a pronounced effect on the overall facial
appearance.
With a distraction procedure the upper
jaw can be widened until it ts around the
lower jaw. Surgery is used to separate the
two halves of the upper jaw and a distrac-
tion device is placed into the jaw. The
patient has to turn the expansion screw of
the device every day for about two weeks.
New bone lls in between the gradually
widened two halves. Orthodontic treat-
ment will close the gap created by the
distraction (for more information see the
technical box on the next page).
Orthognathic surgery
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The surgical procedure to make the
bone incisions in the upper jaw is
the same as previously explained
in the Le Fort I osteotomy of the
upper jaw. However, to create two
halves one more incision is made
vertically on the midline of your
upper jaw.
A distraction device is placed with
a little plate on each side of the
palatal bone of the upper jaw. At
the end of the operation, a small
blocking screw is inserted.
Activation phase
A new consultation is scheduled a
week later. The blocking screw will
be removed and the activation of
the device can start. The distractor
has a center screw that must be
turned with a key. The divider is
activated by placing the key into
the key-hole in the center screw and
then gently pushing toward the back
of the mouth.
Each day, we open the palate
0,5 mm. So, after 10 days, we can
expect an opening of 5 mm between
the two front teeth.
The screw usually has to be turned
for 1 to 3 weeks depending on the
amount of widening needed.
Consolidation phase
Once the widening of the palate is
achieved, the xing screw is placed
again. The distractor should be kept
rm and immobile in the mouth for
3 to 5 months. This allows time for
new bone to form and ensures that
the widening will not relapse.
In this phase, the orthodontist may
begin treatment to close the gap
between the front teeth.
Later on, the plates on both sides of
the palate will be removed surgically
under local anaesthesia.
Before distraction.
After the activation phase.
After orthodontic treatment.
Technical and practical: Distraction of the upper jaw
Patient information guide 18
Chin surgery
A particular process, known as a slid-
ing genioplasty, involves separating a
horseshoe-shaped piece of the chin bone
from the lower jaw and sliding it either
backwards or forwards, and nally xing
it in place using titanium screws.
The prole of a patient can be sig-
nicantly altered with a chin procedure.
This, in turn, has a signicant effect on
overall facial symmetry.
Men and women look best with certain
types of chins. A small chin can make a
large nose look even bigger, or conversely,
a large chin may even make a large nose
look tiny for the face. This chin/nose
relationship must be harmonious.
A central consideration in deciding if
chin remodeling alone is appropriate is
whether dental occlusion (the way your
teeth meet) is correct or not.
Some faces have a poor
projection of the chin, an
overprojected chin, or a
problem with the width or
height of the chin. Chin
surgery can be used to
improve the appearance
of a persons chin.
Chin surgery is carried out under
a general anaesthetic and takes
about one hour.
An incision is made inside the
mouth, so no scar will be visible
on the outside.
The chin is cut from back to front
on both sides, using a powered
saw with a special blade to
separate the edge of the chin. The
bone segment is then slid forward
or backward, or any direction
desired. If needed, a segment of
bone can be removed.
The piece is then secured with
permanent titanium miniplates
and screws, which will never be
removed.
If dental occlusion is satisfactory, the
appearance of the chin can be dealt
with by chin surgery alone.
If it is not, a combination of upper or
lower jaw surgery may be needed.
Technical: Sliding genioplasty
Orthognathic surgery
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Advancement of the chin
If only the lowest third of
the face is sunken in, yet
the occlusion is normal, a
chin advancement may be
the solution. Especially in
men, it can help to make
the face look stronger.
Patient information guide 20
Retraction of the chin
In patients with an over-
projected chin and a
normal occlusion, the chin
as a separate entity can
be retracted.
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Treatment schedule
Evaluation and treatment planning
Pre-surgical orthodontics
Surgery
Post-surgical orthodontics
Follow up visits
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The following is a general sequence of events that
occurs once your treatment begins. Please remember
that each treatment plan and case may vary from this
general sequence of events.
12-18 months
3-9 months
Treatment schedule
2 weeks
1 week
6 months
Patient information guide 22
Evaluation and planning
Photographs
Frontal and prole facial photographs are
an essential part of the overall planning
of the case. These images serve as visual
aids for bony and soft tissue analysis so
that the facial aspects of treatment can
be thoroughly evaluated. Photographs of
the teeth will also be taken to provide an
accurate record of the mouth at the time
treatment begins.
Cephalometric radiograph
This side view radiograph of the face al-
lows us to compare your tooth and jaw
relationships to normal or ideal measure-
ments. Computerized analysis permits the
prediction of planned bone movements
and resulting soft tissue response through
the merger of the facial pictures with the
cephalometric radiograph.
Panoramic radiograph
The panoramic radiograph is a compos-
ite view of the teeth as well as both jaws.
In one lm, it shows us if you have the
normal number of teeth, wisdom teeth,
or impacted teeth.
During your rst visit, a set of diagnostic records will be made to determine the
nature of your problem and what can be done to correct it. After processing and
analyzing these records, we will meet you to discuss your treatment options. The
following explains the individual records that may be taken and their purpose.
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Orthognathic surgery
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Dental models
Dental models will be used to study the
problems that exist at the beginning of
the treatment and are used for reference
during pre-treatment planning.
A new software has been developed by Medicim
in Belgium, called Maxilim. Using the Maxilim
software we can make virtual incisions to move
the jaws and chin as planned, then show the
potential result to the patient. Small corrections
can be made on the computer during the consul-
tation. If the patient likes the result, we send the
data to Belgium. After a week, we receive a set
of acrylic templates that will enable the surgeons
to follow the computer plans precisely during the
actual procedure.
The use of Maxilim software permits us to predict
the facial changes which you might expect with
treatment. To be able to do this, a conebeam
CT scan will need to be taken. A conebeam CT
has the advantage of extremely low radiation
dosage plus the fact that the patient is in a sitting
position, which gives a more natural appearance
of the soft tissues. Please note that the use of
Maxilim is not standard and will increase the
cost of your treatment.
Optional: Conebeam CT
Patient information guide 24
Pre-surgical orthodontics
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Pre-surgical orthodontic treatment often involves xed
brace treatment lasting 12-18 months and is essential for
the stability of the result.
The purpose of orthodontic therapy is to
level and align the teeth so that once the
surgeon moves the jaw bones, the teeth
will t together.
Orthodontists are specialised dentists
that are typically required to complete
an additional three to four years of post-
dental school education before becoming
a certied practitioner of orthodontics.
Tooth irregularities are treated using
corrective appliances known as braces.
Braces are made from wires and springs
attached to tiny metal plates or a plastic
mould. Braces use gentle pressure to
slowly shift teeth into their new posi-
tions. Modern orthodontic treatment
uses very mild pressure to reduce the
discomfort. Also, modern braces are less
noticeable than old-fashioned braces.
The braces remain in position during the
operation to aid the surgeon in position-
ing the jaws correctly.
Orthognathic surgery
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The surgery
Pre-Operative Instructions
You should not eat or drink anything
8-10 hours before surgery.
Arrange the necessary time off from
work or school. Most patients will
need one to four weeks of convales-
cence.
To avoid pulling clothes over your
head postoperatively, bring some
button-down or zippered shirts.
We strongly advise you to stop smok-
ing three weeks before surgery, as
smoking counteracts wound healing.
The operation
You will be admitted to the hospi-
tal the morning of your scheduled
surgery. The length of your surgery
depends on the procedure being per-
formed, but normally ranges from 2
to 5 hours.
Orthognathic surgery is performed
under general anaesthesia.
Intravenous uids are administered at
the time of surgery. The I.V. is used
during surgery to maintain adequate
uid levels and is used after surgery
to administer pain medication, an-
tibiotics, etc. It is generally removed
the day after surgery.
Complications
The possible complications include:
Bleeding.
Infection.
Nerve injury (permanent numbness
of the lip, tongue, cheek, etc.).
Relapse or return to original jaw po-
sitioning.
Damage to teeth.
Scarring.
Temporomandibular (TMJ, or jaw
joint) problems.
Nasal airway obstructions.
Non-union (inadequate closure) of
the bone.
Sinusitis (swelling of the nasal si-
nuses).
All of these are rare.
Patient information guide 26
Post-operative instructions:
Cooling: During the rst postop-
erative hours a mask with a constant
temperature of 15 degrees Celsius will
cool the surface of your face and keep
bruising and swelling to a minimum.
This will add to your comfort and as-
sist you in a more rapid recovery from
surgery. Never theless you should be
prepared to be seriously bruised and
swollen for about one week.
Pain: Postoperative pain normally is
surprisingly mild. We will provide you
with painkillers for the rst few days.
Food: It is a good idea to only eat soft
foods for the rst few weeks. After
about a month, patients can switch to
foods with regular consistencies.
Aftercare: Normally, you will be dis-
charged from hospital by your surgeon
one or two days after surgery. If alone,
one of our nur ses will accompany you
to your hotel. You will have daily revi-
sions in Agave Clinic during your stay
in Marbella.
Our team is permanently at the pa-
tients disposal. Contact with our
specialist during ofce hours can be
made by telephoning our direct line.
After hours this contact is available
through the 24-hour emergency serv-
ices of the USP hospital.
Before you leave Marbella you will be
seen again at Agave Clinic. If neces-
sary, sutures will be removed 5 to 7
days, before leaving Marbella.
Working: About two to three weeks
after surgery you can start working
again. The swelling will disappear
completely in about six months.
Sports: Refrain from contact sports
for 6 weeks.
Oral hygiene: We will provide you
with a post-surgical antiseptic mouth-
wash, with which you should rinse
as directed until you can brush your
teeth normally. However, you should
try to switch to fully cleaning your
teeth with a toothbrush, toothpaste
and dental oss as soon as possible.
Mouth opening: Immediately after the
operation you should actively exercise
your jaw (using your chewing muscula-
ture, not by manipulating your jaw with
your hands). Practice gently opening
your mouth and moving your jaw from
side to side. This ensures a speedy re-
covery of normal jaw function.
The cooling mask against
pain and swelling.
Orthognathic surgery
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Post-surgical orthodontics
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Usually a period of post-surgical orthodontics are
required after the surgery to ne-tune the bite. This nish-
ing period usually lasts between 6 to 9 months.
Three weeks after surgery, the orthodon-
tist continues with the treatment plan.
The tooth arcs were already in line, but
now the relationship between them has
been normalized by the surgeon. The or-
thodontist will now work to netune the
bite so all the lower teeth make contact
with the corresponding upper teeth.
Fixed retainer for the lower teeth.
Removable retainer for the upper
teeth.
Retention
Usually a xed retainer will be bonded to
the inside of the lower front teeth before
removing the braces. The upper retainer
is usually removable. One week after
removing your braces, you will receive
this retainer and instructions on care
and use.
Retention is a crucial part of your or-
thodontic treatment. Retainers are to
be worn at all times during the rst few
months to one year following treatment.
Once you have reached a point where
your teeth and bones have stabilized,
you will be able to limit the use of your
retainer to sleeping only. Keep in mind,
however, that the more the retainers are
worn, the less chance there is of teeth
moving out of place.
The cooling mask against
pain and swelling.
Patient information guide 28
Follow up
5
One, three and six weeks after surgery we
would like to check your bite and evalu-
ate your healing progress
Once your treatment is complete, a set
of nal records will be taken at Agave
Clinic. These records consist of the same
records taken at the time of your initial
visit. This appointment is generally 1-2
weeks after your braces are removed.
Six months later one more visit to the
orthodontist is necessary to check your
bite and to adjust your retainer (for the
last time!).
Orthognathic surgery
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Frequently asked questions
Do I need to follow a spe-
cial diet after the surgery?
You should only eat soft foods for the
rst weeks. After about a month, pa-
tients can switch to normal foods.
In principle, patients can eat anything
they want to, just not always in the way
that theyre used to. Food can be nely
shredded with a food processor, blender,
or mixer.
When can I start practi-
tioning sports?
Bone healing will take 6 weeks. After
that the bone will be as strong as before
the operation and you can practice any
sports you like again.
Will the plates and screws
be removed?
No. Plates and screws are usually not re-
moved, only in the rare case of infection.
Will my jaw break more eas-
ily after such an operation?
No. Once the bone is completely healed,
your jaw is as strong as before.
When can I start working
again?
Most people start working after two to
three weeks.
Do the plates activate
metal detectors?
No, they are too small for that.
How long will the swelling
last?
About 90% of the swelling will subside
in 3 months. But it takes up to 6 months
for the swelling to disappear completely.
Is orthognathic surgery
painful?
The postoperative pain is remarkably
mild and can be managed with standard
painkillers. The swelling, however, causes
discomfort for 1 to 2 weeks.
Is orthognathic surgery
dangerous?
This type of surgery, in the hands of an
experienced team, is very safe and has a
very predictable outcome. In very rare
cases a second surgery in the rst week
after the initial intervention is necessary,
because the position of the jaws is not
as planned. Apart from complete sensory
nerve damage, resulting in permanent
numbness in half of the lower lip and
chin (which is extremely rare), no major
complications exist.
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Agave Clinic is an international pioneering
centre dedicated to complete oral and facial
reconstruction. Our goal is to achieve natural
looking beauty by creating facial harmony.
Agave Clinic
Orthognathic surgery
31
To create facial harmony you need to
be able to manage not only the facial
skin, but also the facial bone and teeth.
In our centre we perform:
dentistry and implants,
orthodontics,
maxillofacial surgery,
and facial plastic surgery.
Because we have this complete team of
experts for dentistry and facial surgery un-
der one roof you can be sure that all possible
options will be taken into consideration and
you will get the most comprehensive treat-
ment plan options to solve your problems. It
is the wide variety of treatments offered in
combination with this close collaboration be-
tween professionals that makes Agave Clinic
really unique.
Agave Clinic is truly international because
of its multilingual staff and the proximity to
an international airport. Our staff are fully
conversant in English, German, Spanish,
Dutch and Portuguese. For all other lan-
guages we can provide an interpreter.
Agave Clinic is only a 25 minute taxi drive to
Malaga International Airport. Each month we
also have consultations in London, Blaricum
and Papendrecht (the Netherlands).
In Agave Clinics state-of-the-art facility,
you are sure to receive rst-rate service in
a modern atmosphere. Here our experi-
enced team of professionals utilise the latest
technologies for a detailed examination and
radiological assessment.

Patient information guide 32
Surgeries requiring general anaesthesia take
place in the adjacent USP Hospital. Agave
Clinic not only cooperates closely with the USP
Hospital, but also serves as its maxillofacial and
dentistry department. This hospital houses a team
of more than 150 medical specialists, with six
operating theatres, an intensive care unit as well
as an Emergency Services department. Agave
Clinic can be contacted 7 days a week, 24 hours a
day, through the USP Emergency Services.
The founding of Agave Clinic
Agave Clinic was founded by Dr. Bart van
de Ven (the Netherlands) and Dr Daniel
Simon (Brazil). They got to know and
appreciate each others expertise during
two missions in Vietnam and Kenya for the
Cleft Surgery Organization (CSO). CSO
is another initiative of Dr Bart van de Ven.
Its mission is to provide free cleft surgery
for affected children from poor families
(www.cleftsurgery.org).
Dr Bart van de Ven and Dr Daniel Simon
not only shared their passion for the Cleft
Surgery Organization, but also shared
the dream of starting an all-round clinic
for facial surgery and dentistry in Europe,
where patients could access quick and
superior treatment options.
Orthognathic surgery
33
Patient coordination
Our patient coordinator, Lilia Koss, looks after pa-
tients that have to stay in Marbella a bit longer after their
surgery. She assists with accommodations, recommends
airlines and organizes your taxis and appointments.
panion; patients who travel alone may be
recommended an extended hospital stay
or nursing care in the hotel (additional
fees involved).
Consultations and check-
ups abroad
Each month we have a day of consulta-
tions and check-ups in the UK (London)
and in the Netherlands (Blaricum and Pa-
pendrecht). You can make an appointment
by contacting Agave Clinic in Marbella. If
youre interested in dental implants and
have a panoramic x-ray it would be very
useful to bring it with you.
Hotels in Marbella
We will help you nd your preferred
accommodations nearby and assist with
reservations. Room service, internet
and other amenities are available upon
request. Prices may vary according to the
season.
Flying to Malaga
Our patient coordinators will suggest air-
lines from your country to Spain. From
Agave Clinic to Malaga international
airport is only a 25 minutes taxi drive.
More than 60 airlines y to Malaga.
Well pick you up from the airport and
bring you back for free.
About 40% of the population of Marbel-
la is of non-Spanish origin so youll nd
English-speaking people everywhere.
Aftercare in Marbella
Our personal care and attention contin-
ues long after your procedure. During the
rst week post-op, you will have daily re-
visions in Agave Clinic. Once you return
home, we hope to arrange for 3-month,
6-month and 1-year evaluations with the
surgeons. It is highly recommended to
our surgical patients to come with a com-
Patient information guide 34
Address:
Website:
Email:
Tel Agave clinic:
Tel USP Hospital:
Contact information
Each month, we also have a day of consultations and check-ups in the United Kingdom (London) and in the
Netherlands (Blaricum and Papendrecht). You can make an appointment by contacting Agave Clinic in Marbella.
Av. Severo Ochoa, 24. Marbella, Spain (next to USP hospital)
www.agaveclinic.com
info@agaveclinic.com
+34-952.864.191
+34-952.774.200
If you have any questions,
please dont hesitate to contact us.
Av. Severo Ochoa, 24. Marbella, Spain
www.agaveclinic.com
info@agaveclinic.com
+34-952.864.191
+34-952.774.200
Address:
Website:
Email:
Tel Agave clinic:
Tel USP Hospital:
General conditions
You can nd the general conditions of Agave clinic
on www.agaveclinic.com/EN/conditions.php.