FACIAL BONES CONTOURING

In Indians, 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,nose reshaping & 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 BONE REDUCTION

If the patient have wide or prominent 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).

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.

Mandible Angle Resection

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.

Sagittal Splitting Osteotomy

Surgical Technique
Under general anesthesia, the angle bone will be cut through intraoral incision. Postoperative swelling and bruise will persist for a week.

CHEEK BONE REDUCTION

Cheek bone reduction is the key procedure to make Asian people's face smaller. 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.



SurgicalTechnique
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.

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.

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.

	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. Fluid 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