In craniofacial surgery simulations, the realistic prediction of a patient's postoperative appearance is of utmost importance. Due to the complexity of biomechanical behavior of soft tissue simplified models such as widespread linear elastic models are usually applied. However, large deformations often occurring in craniofacial surgery can't be accurately modeled via linear elastic approach, since it is generally limited by the assumption of small deformations. In this paper, we present an adaptive nonlinear elastic approach based on the finite element discretization of 3D patient's model, which is free of linearization limitations and yields more realistic results in simulations of large facial tissue deformation.© (2002) COPYRIGHT SPIE--The International Society for Optical Engineering. Downloading of the abstract is permitted for personal use only.