Patients undergoing orthognathic surgery view aesthetic outcomes with high importance (Hertanto et al., 2021). Correction of dentofacial deformity by bilateral sagittal split osteotomy (BSSO) can improve facial aesthetics (Choi et al., 2021; Torgersbråten et al., 2021). In this regard, improving facial appearance may drive overall satisfaction after surgery (Zins et al., 2008; Tan et al., 2020). Therefore, the BSSO may change patients both physically and psychologically (Zamboni et al., 2019; Zaroni et al., 2019). However, one of the most notable negative outcomes is an unsightly facial scar, which is a common reason for patients' dissatisfaction, and by which patients were inconvenienced in their daily lives (Zamboni et al., 2019; Raffaini et al., 2018). Additionally, patients who report unsatisfactory facial aesthetics are more likely to pursue reoperation (Raffaini et al., 2018).

To date, most published studies focus on evaluation of scars after secondary cosmetic procedures or after mandibular fractures rather than orthognathic surgery (Hudise et al., 2020; Nowair et al., 2022; Boehle et al., 2015). Some evaluate the complications of different techniques used for rigid fixation after BSSO (Verweij et al., 2014; Ferri et al., 2019). None address facial scar outcomes after orthognathic surgery. Published literature on scar scales has also addressed analysis of scars caused by burns or injuries and on the basis of treatment methods such as laser or surgery (Vercelli et al., 2009; Bae and Bae, 2014; Vahldieck et al., 2022). One of the most frequently, scar scales used for the assesment of newly developed operative scars is the Stony Brook Scar Evaluation Scale (SBSES) (Bae and Bae, 2014). Although the SBSES was not designed to measure final scar appearance, it was nevertheless used for evaluation of long-term scar status and was also validated for the long-term scar assessment (Singer et al., 2007). The SBSES calculates and aggregates points in 5 categories: width, height, color, suture marks, and overall appearance. Each category has 2 items, and 0 or 1 point is added before deriving the total score (Draaijers et al., 2004; Singer et al., 2007; Hyldig et al., 2020). Ultimately, it provides an objective feedback regarding the cosmetic appearance of scars and allows for concrete notation of visible aspects of scars (Singer et al., 2007). Despite extensive research into scar evaluation, currently there is no widely accepted method for assessment of scars following orthognathic surgery and therefore little is known about scar perception after jaw surgery. Moreover, given the typical variability of evaluators' ratings, studies are needed to test the reliability of scar scales (Vercelli et al., 2009; Bae and Bae, 2014).

The aim of the present study was to evaluate facial scars resulting from a transbuccal approach during osteosynthesis of a sagittal split osteotomy.