Management for patients with skeletal Class III malocclusion is orthognathic surgery which involves both orthodontics and surgery. Nowadays, there are two approaches for orthognathic surgery: orthodontics-first and surgery-first approaches. The orthodontics-first approach, or presurgical orthodontics treatment, causes longer treatment time and worsens facial appearance before surgery compared with a surgery-first approach. Conversely, with the surgery-first approach or the surgery-first-orthognathic-approach (SFOA), correction can be resolved more rapidly. SFOA needs high level skill of orthodontist and surgeon and also needs good cooperation between them to accomplish best results. The purpose of this article is to review the concept, indications, contraindications, the stages of treatment and advantages, and disadvantages of SFOA.

Keywords: Surgery first approach, Surgery first orthognathic approach, SFOA, No presurgical orthodontics, Skeletal anchorage system, Regional acceleratory phenomenon, RAP