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Facial bone contouring
In Asians, wide, flat and large face, prominent zygoma (cheek bone)
and mandible (jaw bone), weak and retruded chin, flat or retruded
forehead are quite common.
So, facial bone contouring to make their face small, shallow and bossy
such as zygoma reduction, mandible reduction, chin augmentation, forehead
augmentation are very popular.
When we assess facial proportion, we divide face 3 horizontal and
5 vertical pieces which should be similar.
Facial bone contouring is the most important surgery in face because
balance between the structures in face is more important than the
shape of each structure.
Jaw (Mandible) Reduction
If the patient have wide or prominet jaw, mandible reduction and Botox
injection to masseter muscle are recommended.
There are two methods in mandible reduction (mandible angle resection
and sagittal splitting osteotomy).
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Mandible angle resection
Triangular bone is resected at mandible angle to make mandible
angle smoother.
Evenif the effect in side view is great, the effect in front
view is relatively small.
So, this is recommended to whom has prominent mandibular angle
from side which can make masculine look.
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Sagittal splitting osteotomy
Outer cortex of mandible is removed.
The width of jaw can be decreased a lot in front view and the
jaw outline in side view is slightly smoothened.
This is recommended to whom has wide jaw which can make heavy
look.
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Surgical technique
Under general anesthesia, the angle bone will be cut through intraoral
incision.
Postoperative swelling and bruise will persist for a week.
Recommended stay in Korea : 6 days
Cheek (Zygoma) Reduction
Cheek bone reduction is the key procedure to make Asian people's
face smaller and very popular surgery in my clinic.
Zygomatic (cheek) bone is a thin arch like bone which has both ends
attached to skull and there is a empty space beneath zygomatic bone.
In zygomatic reduction, both ends are cut and the intervening bone
segment (zygomatic bone) is moved inward, backward and downward.
So, cheek prominence is depressed and the patient can get small,
shallow face and smoother, smarter impression.
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Surgical technique
Through intraoral incision and a small preauricular stab incision,
both ends of cheek bone are cut.
Postoperative swelling and bruise will persist for about 2 weeks.
Recommended stay in Korea : 6 days.
Three points
zygoma reduction
To make the zygomatic curve more natural and smoother, OZ doctors
cut 3 points in zygoma including anterior cut through intraoral
incision, middle greenstick fracture at zygomatico temporal
suture line and posterior cut through a stab incision in sideburn.
Preauricular stab incision is so short (about 3 mm) and is concealed
in hair and sideburn, it is innoticeable. |
Possible complications in facial bone contouring
- Bleeding and prolonged swelling :
- Infection :
- Asymmetry or Over resection :
A careful preoperative assessment and a complete bone reshaping
instruments can prevent such problems.
- Injury to facial nerves :
The facial nerve to forehead can be injured.
The simplest way to avoid facial nerve injury is not to operate
along the pathway of the nerve.
By approaching to anterior zygoma through intraoral incision and
posterior zygoma through preauricular incision, I can avoid the
risk of facial nerve injury which pass through middle zygoma.
Controversies in zygomatic reduction
- Bone shaving vs. bone movement.
Thickness of zygomatic bone is only 1 mm.
So, bone shaving usually yield less than 1 mm change.
On the other hands, bone can be moved inward much more upto 1
cm because there is a empty space between the zygoma and skull.
- Fixation vs nonfixation
After mobilization of zygomatic bone, I usually don't fix the
moved bone.
To maintain the stability of the moved bone, I keep trying to
maintain the integrity of periosteum and limit the dissection
of zygoma.
By the aids of this limited dissection, bone can be fixed by natural
forces of muscles and periosteum.
It is a great advantage not to use any foreign material in fixating
the moved bone segment.
- Incisions of zygomatic reduction
There are many types of incisions in zygomatic reduction.
The oldest one is scalp incision and intraoral incision. Because
of the scar, morbidity and risk of facial nerve injury, it is
rarely used.
The most popular one is intraoral and preauricular incision. By
the aid of this approach doctors can avoid the risk of injury
to facial nerve. By incising only 3 mm in sideburn, preauricular
incision become innoticeable.
If the patient needs only anterior cheek reduction, the opertion
can be performed only through intraoral incsion.
- Skin Sagging after zygoma reduction
Many people are afraid of skin sagging after zygoma reduction.
But if the patients are young and doctor dissect minimally, skin
sagging is not happened.
Chin
Surgery
While patients seeking advice about facial cosmetic surgery often
focus on structures such as the nose, the eyes, the facial plastic
surgeon's assessment frequently identifies the lower third of the
face as an area that could be surgically modified to improve overall
facial appearance and harmony.
The profile of a patient can be significantly altered with either
a chin augmentation or reduction procedure. This, in turn, has a significant
effect on overall facial symmetry.
Several surgical options exist for the treatment of chin deformities.
Augmentation Mentoplasty for retruded or short chin :
Augmentation of chin is performed simply by inserting a implant
(silicone rubber, Gore tex, Medpore, Fat.) through intraoral incision
under local anesthesia..
Protruded mouth will look retruded as a secondary effect.
Operation time : 30 minutes
Recommended stay : 6 days
In severe or complicated case, sliding genioplasty under general anesthesia
is required.
Reduction Mentoplasty for protruded or long chin :
Under general anesthesia, middle part of chin bone is removed
and lower portion is reattached to upper portion of chin to maintain
the shape of chin, muscle connection and blood supply to chin bone.
Forehead Augmentation
To augment flat or uneven forehead, custom made silicone implant or
fat graft are used.
Each method has its own advantages and disadvantages.
If you prefer silicone implant, you should stay in Korea for more
than 2 weeks because I need time to make custom made silicone implant.
If you prefer fat graft, you should stay in Korea for more than 5
to 6 days.
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Silicone Implant |
Fat Graft |
| Advantages |
Permanent result.
Needs only one treatment |
No incision and no scar
Short recovery time |
| Disadvantages |
It will take about a week to make a custom made silicone implant
using plaster caster.
It needs 4 to 5 cm incision in scalp.
Ffluid collection around the implant and long recovery time. |
40 % resorption after 6 months
Repeated treatments are required |
custom made silicone forehead implant which was made from plaster
cast model |
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