Orofacial Harmonization at the CFO: What the Resolutions Say

Dentists who work with orofacial harmonization (HOF) need to know a set of rules from Brazil's Federal Council of Dentistry (CFO) that has been changing since 2019. They define the specialty, list areas of competence, set prohibitions and, in 2026, reorganized the topic with new resolutions and a technical note.

This page summarizes what the text of each rule says, with a link to the official source. Texts checked on the CFO website on October 20, 2026. It does not state what any given professional can or cannot do, does not replace reading the rule in force and is not legal advice. The court dispute over CFO Resolution 198/2019 is detailed in the HOF court dispute, and registration as a specialist in HOF as a dental specialty.

What is the legal basis for the resolutions?

CFO resolutions rely on two main laws, cited in the texts themselves:

• Law No. 5,081/1966, which regulates the practice of dentistry. Article 6, item I, assigns to the dentist the practice of all acts pertaining to dentistry that arise from knowledge acquired in a regular course or postgraduate program.
• Law No. 4,324/1964, which establishes the dental councils and gives them the authority to regulate professional practice.

The point in dispute in court is precisely how far a resolution can go in detailing what the law says. Medical entities argue that some rules expanded authority; the CFO argues they only organize what Law No. 5,081/1966 already allows.

What are the CFO rules on HOF?

Status only means what is known on the date of checking. Council rules can be amended, repealed or suspended at any time, including by court decision.

What does CFO Resolution 198/2019 say?

This is the rule that created the specialty. In summary, the text:

• Recognizes HOF as a dental specialty (art. 1).
• Defines HOF as a set of procedures performed by the dentist within their field of practice, responsible for the aesthetic and functional balance of the face (art. 2).
• Lists the specialist's areas of competence (art. 3), including the use of botulinum toxin, facial fillers and autologous platelet-leukocyte aggregates in the orofacial region and in attached and related structures; intradermotherapy and percutaneous collagen-inducing biomaterials (the biostimulators); biophotonic procedures and laser therapy; and facial lipoplasty, including removal of the buccal fat pad (buccal fat removal) and surgical techniques to correct the lips (lip lifting).
• Sets the requirements for specialization courses (art. 5): a minimum course load of 500 hours, with at least 400 in the core area, 50 in the related area and 50 in mandatory subjects, and lists the minimum subjects for each area.
• Defines transition rules (art. 9) for registering those who were already practicing or had courses started before the rule.

The expression "attached and related structures," repeated in art. 3, led to broad interpretations. CFO Resolution 230/2020 itself cites these "extensive interpretations mistakenly attributed" as the reason for issuing the prohibitions.

What does CFO Resolution 230/2020 say today?

Issued in August 2020 to regulate art. 3 of 198/2019, it has three parts:

1. Prohibition of facial surgeries (art. 1). It prohibits the dentist from performing alectomy, blepharoplasty, crow's feet surgery or brow lifting, otoplasty, rhinoplasty and rhytidoplasty or face lifting. Since CFO Resolution 285/2026, a sole paragraph says this prohibition does not apply to the specialist registered in Orofacial Aesthetic Surgery, under its own resolution, nor to specialists in HOF and in Oral and Maxillofacial Surgery and Traumatology regarding the procedures that each specialty's rules assign to them.
2. Prohibition of advertising (art. 2). It prohibits advertising and promotion of non-dental procedures outside the dentist's training, such as eyebrow and lip micropigmentation, permanent makeup, eyebrow design, removal of facial and neck tattoos, rejuvenation of the neckline and hands, and hair loss treatment.
3. Accountability (arts. 4 and 5). Anyone who performs, coordinates, teaches courses on or contributes to the prohibited procedures faces an ethics disciplinary proceeding, and entities that offer these courses can have their registration canceled.

The original art. 3, which prohibited procedures in anatomical areas other than the head and neck, was repealed by CFO Resolution 285/2026. The anatomical area topic is now handled in CFO Resolution 284/2026.

What changed with the March 2026 rules?

Within a few days, the CFO published three resolutions that fit together:

• 284/2026 recognizes that the dentist's anatomical area of practice covers the head and neck region, including contiguous, attached and related structures, and states that clinical and surgical treatment of malignant neoplasms is not within the dentist's competence. It repeals CFO Resolution 176/2016.
• 285/2026 adjusts 230/2020 to coexist with the new specialty, as described above.
• 286/2026 recognizes Orofacial Aesthetic Surgery (CEOF) as a specialty, with registration and transition rules that presuppose prior registration in HOF and in oral and maxillofacial surgery, a list of procedures and facility requirements. Art. 5 says the surgical procedures established by the HOF and oral and maxillofacial rules are not restricted by it.

For those who work only with injectables, the most visible practical effect is one of context: HOF now shares the regulatory debate with a new surgical specialty, and headlines mix the two. In conversations with patients and colleagues, it is worth keeping them apart.

What about the TRF1 decision of August 2026?

On August 19, 2026, the 8th Panel of the TRF1, by majority, declared CFO Resolution 198/2019 illegal, in a lawsuit brought by medical entities. The CFO said it will appeal and that, at that point, there was no change in responsibilities. According to legal coverage, the 2026 resolutions were not the subject of that ruling. The case number, effects and how to follow it are in the HOF court dispute.

What about advertising?

Two CFO rules weigh on HOF promotion: art. 2 of 230/2020, which prohibits advertising non-dental procedures, and CFO Resolution 196/2019, which allows publishing diagnostic and treatment-completion images of treatments done by the professional themselves, with informed consent, and prohibits images of the procedure in progress outside scientific publications, as well as expressions of sensationalism, self-promotion or promise of results. The Dental Code of Ethics completes the picture.

The practical principles, including why a Harmy projection can never be published as a result, are in what you may advertise under CFO and CONAR rules (CONAR is Brazil's advertising self-regulation council). To use a patient's image, use a specific image use consent form; there is an image use consent template.

How do you follow the rules without relying on a social media post?

1. Read at the source. The CFO's system of normative acts publishes the text with amendments annotated, as we did on this page.
2. Check the wording in force. Old resolutions receive new paragraphs and repealed articles; a PDF downloaded years ago may be out of date.
3. Follow your CRO. Regional councils guide application in the state and carry out inspections.
4. Note the date you checked. When you decide something based on a rule, record the date and link.
5. Separate rule from opinion. Statements from associations and course materials are interpretations; the rule is the published text.

And in Harmy?

Compliance checklist for CFO rules

1. Current texts of 198/2019, 230/2020 and the 2026 rules read at the official source.
2. CFO Technical Note No. 001/2026 read in full.
3. Specialty registration checked with the CRO, when applicable.
4. Progress of the TRF1 case and CFO notes followed.
5. Advertising reviewed against 196/2019, art. 2 of 230/2020 and the Code of Ethics.
6. Patient record, consent and image consent for each patient.
7. Date and link of each consultation of the rules recorded.