**BACKGROUND:** Both internal and external distraction devices have been used successfully in correcting midface hypoplasia. Although the indication for surgery and the osteotomy techniques for a Le Fort I and Le Fort III may be similar, deciding when to use an internal vs external device has not been well studied. We studied patient reported outcomes using the FACE Q Patient Reported Outcomes Instrument and functional surveys for internal and external devices for both Le Fort I and Le Fort III patients.

**METHODS:** Midface hypoplasia patients who underwent distraction advancement after Le Fort I and Le Fort III were surveyed using the FACE-Q survey and a functional survey. Equal groups of internal and external device patients were compared (n=64). Data recorded included: Sex, age, follow-up, diagnosis, OR time, EBL, Length of stay, distraction length, consolidation time, and complications. FACE Q scales included: Satisfaction with Facial Appearance, Social Function (confidence), Psychological Well-being, Early life impact (recovery), and Satisfaction with Outcome and Decision. Functional surveys included Airway/Breathing (correction of sleep apnea, removal of tracheostomy), Ocular/Vision (globes protection), Occlusion/Eating, and Speech/Articulation.

**RESULTS:** Internal and external device groups were similar with regards to patient demographics (Craniofacial diagnosis, mean age (14.4 years), sex, follow-up), operative time, EBL, distraction length (24.2 vs 25.1), and follow-up. Consolidation times differed (Internal=1.1 vs External=3.6 months). For FACE Q appearance appraisal (Overall Appearance, Cheeks, Nose, Upper lip/Smile), there were similarities in domain and scale. For Functional surveys (Airway/Breathing, Ocular Vision, Occlusion/Eating, Speech/Articulation), there were also similar scoring between groups. However, internal device patients had superior scores compared to external devices with FACE Q for Quality of Life including: Social Function (80.9 ± 19 vs 68.9 ± 18), Early Life Impact (92.9 ± 22 vs 62.4 ± 11), Dental anxiety (70.2 ± 17 vs 48.3 ± 10), and Psychological Well-being (87.8 ± 18 vs 68.6 ± 11). In addition, internal device patients were better with FACE Q Satisfaction Decision (81.2 ± 19 vs 56.9 ± 10) and Satisfaction Outcome (91.0 ± 22 vs 84.7 ± 18).

**CONCLUSIONS:** Le Fort I and Le Fort III distraction patients had similar patient reported outcomes for appearance and functional improvement while using internal or external devices; however, those with internal devices were more satisfied with their quality of life and decision to undergo the procedure.
