A relative deficiency in midface projection may be congenital or may be acquired. It is often associated with occlusal disharmonies. Augmentation has been proposed to improve the appearance of patients with a flat malar eminence, to create a more youthful-looking face, to make the face more oval, and to deemphasize prominent nasal or mental profiles, especially when the alteration of form is combined with an impairment of function, such as a malocclusion. In our efforts to achieve optimal functional and aesthetic results with long-term stability, we use maxillo-malar osteotomy less frequently than we have in the past. It is possible to achieve excellent results performing maxillary osteotomies at Le Fort I level and augmenting the malar area with porous polyethylene implants.