Facial contouring surgery encompasses a range of procedures aimed at reshaping and refining the facial structure. These techniques can address various aesthetic concerns, such as wide cheekbones, a square jawline, or a disproportionate chin. While facial contouring is performed worldwide, it is particularly prevalent in Asia, especially South Korea, where a delicate and feminine facial shape is often desired. This article provides an overview of facial contouring surgery techniques, including reduction malarplasty (zygoma reduction) and angleplasty (mandibular angle reduction), and considerations for selecting appropriate procedures.
Understanding Facial Contouring
Facial contouring is the art of changing the shape of your face. It can make your face look slimmer, your cheekbones more pronounced, and your jawline sharper. Think of it as a real-life filter that enhances your features. The goal? Facial contouring is all about shaping your face. It’s like sculpting but with your own features.
Ethnic Considerations
Shape and size of the facial skeleton are fundamental determinants of facial appearance. Difference in facial skeletal support is one of the most important factors distinguishing people of different ethnic background. When analyzed from the anterior view, a Caucasian face tends to be longer and narrower than that of Southeast Asians. When seen in cross section, it has relatively greater anterior projection and decreased width. Conversely, the Asian face tends to be wider and shorter when observed from an anterior view. In Western cultures, facial skeletal contouring mostly involves augmentation, whereas skeletal reduction is most often performed in Oriental societies.
Asian facial skeletal contouring procedures are performed frequently in Asia, especially in South Korea. These surgeries decrease the width and sharp angularity of the cheek bones and jaw. These surgeries address facial characteristics that tend to be more prominent in individuals of North Eastern Asian descent. However, these procedures are not limited to Asians. Asian people, especially women, prefer a more delicate and feminine facial shape. To achieve a softer and better facial contour, there are several procedures to change the facial skeleton.
Available Procedures
In Asia, there are many aesthetic procedures available to achieve a softer and better facial contour: malarplasty (zygoma reduction), angleplasty (mandibular angle reduction), genioplasty, orthognathic surgery, rhinoplasty, forehead plasty (fronto-orbital burring), and so forth. The two most popular operations are zygoma reduction and angle reduction. Facial contouring includes both surgical and non-surgical treatment approaches. Well-known facial contouring treatments include FaceTite, AccuTite, and Myellevate. Each method offers unique benefits, such as sculpting the chin and jawline or tightening the skin around the eyes and neck.
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Preoperative Assessment and Planning
Before the operation, the surgeon should carefully interview the patient and perform a physical examination that includes inspection and palpation of facial bones. The surgeon must assess the contribution of both soft tissues and bony framework to the patient's facial deformity. Anthropometric and radiologic evaluations are important steps in the surgical planning. Facial analysis with the “golden facial mask” makes it easy to recognize facial imbalances and malposition of facial structures. It also provides a useful patient interview tool. In addition, a three-dimensional computed tomography (CT) scan gives detailed information on the underlying skeleton and helps to determine where the osteotomies should be made. The three-dimensional skull model made from the CT data can be used for surgical planning as well as for simulation surgery. These studies can be used to measure the amount of bone needing resection. With these visual studies, it is then easier to explain to the patient the goals and expectations from the surgery, its limitations, and possible complications.
Surgical Techniques
Surgical facial contouring and sculpting is a cosmetic procedure designed to slim down certain areas of the face while volumizing others to optimize the way highlights and shadows are cast on the facial structure to create a more contoured facial appearance. Most patients undergo facial contouring and sculpting to get rid of the appearance of “chubby” cheeks and/or loose skin and fat beneath the chin.
Zygoma Reduction (Malarplasty)
Reduction malarplasty, or zygoma reduction, aims to decrease the sharp outward contour of the cheekbones. A lot of techniques have been developed independently by several authors. Various approaches can be chosen, such as intraoral or external skin incisions. There as also different contouring methods that can be chosen depending on the patient's morphology and the surgeon's technical preferences. The different osteotomy techniques used to mobilize the zygomatic complex can be classified according to the specific portion that is being repositioned. This procedure is performed through an “L-shaped” osteotomy (cutting of the bone) of the zygoma. The zygomatic arch is then fractured. The segment of bone is shaved down and reinserted with inward rotation of the zygomatic arch to decrease the lateral protrusion.
Surgical Approaches
The malar complex can be exposed and manipulated through intraoral, coronal, or preauricular incisions. Contouring the malar complex using burring alone (and no osteotomies) has several limitations, including difficulty in maintaining symmetry, loss of normal cheekbone curvature, and a limited reduction.
Osteotomies for malar complex repositioning can be performed via a coronal incision or through combined intraoral and preauricular incisions. Malar reduction with osteotomies and repositioning through a bicoronal incision has advantages. A wide operative field allows for precise osteotomies and repositioning. In a middle-aged female patient, a forehead lift can be performed without additional incisions.
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With the intraoral approach alone, exact osteotomies can be performed after exposure of the zygoma, from the zygomaticomaxillary suture to the lateral orbital rim, and after zygomatic arch degloving. Cheek droop is consequently a major complication from solitary intraoral approach. Adequate exposure for osteotomies can often be gained only after extensive soft tissue detachment. The masseter's origin should be preserved to ensure minimal cheek drooping after reduction. The main advantage of this technique is that it spares the preauricular scar. It is also less invasive than the bicoronal approach and has a shorter operative time.
Osteotomy Techniques
Osteotomy techniques can be subdivided according to the portion of zygomatic complex that is repositioned: body, arch, or both. This subdivision depends on the patient's morphology and the surgeon's technical preferences. A method of mobilizing the zygomatic complex could be subdivided according to a specific repositioning portion of zygoma: body, arch, or both.
When both the zygomatic body and arch are prominent, the complex is mobilized as a unit and repositioned in a proper location. There are two osteotomy sites: the zygomatic body and arch. The zygomatic body osteotomy is performed inferolaterally to the orbit, at the zygomaticomaxillary buttress, leaving the orbital rim intact. After two parallel vertical osteotomies are performed on the zygomatic body, the midsegment is removed to allow for latter medial displacement of the zygoma. Next, the zygomatic arch is cut posteriorly, allowing free movement of the malar complex. The zygomatic arch is depressed medially. The stable, non-osteotomized part of the arch often overlaps the mobile arch to allow for zygomatic body retrusion.
When lateral protrusion of the arch is prominent and body protrusion is mild, incomplete osteotomy of the zygomatic body area and complete cut of the arch is indicated. The protruding part of the zygomatic body is shaved, and a lateral corticotomy (not a complete osteotomy) is performed using a reciprocating saw. The zygomatic arch is then osteotomized. The arch is depressed medially, hinging at the zygomatic corticotomy. When there is predominant lateral protrusion of the zygomatic body, but the arch is straight and has a normal shape, complete osteotomy of the body and greenstick fracture of the arch are performed. The zygomatic body osteotomy is done with a reciprocating saw.
When the intraoral route is chosen, a sharp, curved osteotome is slid against the medial aspect of the arch until the desired osteotomy location on the posterior arch is reached. An incomplete arch osteotomy is performed from deep to superficial with the osteotome. The point of fracture is at the anterior part of the zygomatic tubercle (skeletal landmark) or the anterior sideburns line (surface landmark).
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Alternative Techniques
There are also other ways to achieve zygoma reduction. Multiple incomplete osteotomies can be performed on the zygomatic body and arch using either a saw or an osteotome. Digital pressure is then used to reposition the bone under direct vision. This can be done either through an intraoral or a temporo-preauricular incision. Zygoma reduction is achieved blindly through a small 5-mm intraoral stab incision. After multiple complete and incomplete osteotomies of the zygomatic body and arch (usually on its medial aspect), pressure from both hands is used to compress the complexes in place.
Mandibular Angle Reduction (Angleplasty)
Reduction angleplasty, or mandibular angle reduction, aims to improve the contour of the chin and decreases the width and height of the jaw. Resection and contouring methods for a prominent mandibular angle can be subdivided according to the specific type of anomaly. The chin is modified through a “T-shaped” osteotomy, and secured with surgical screws. The mandible (jaw bone) is contoured with osteotomies as well. This procedure is for those individuals that are satisfied with the shape of the chin but unsatisfied with the width and height of the mandibular angle. The mandible is contoured to create a more feminine jaw line. This procedure is for those individuals who require narrowing of the jawline.
The “square-face” appearance brought by exaggeratedly prominent mandibular angles usually gives a severe and masculine appearance. A more delicate and feminine facial shape can be obtained by resecting prominent mandibular angles. Most reduction angleplasty techniques are performed through an intraoral approach. It is now recognized that the square-face appearance is due to a posterior projection and/or lateral flaring of the osseous mandibular angle.
Surgical Techniques
Baek et al first reported the resection of prominent mandibular angle using an oscillating saw through intraoral incisions. Later, they refined their contouring method to obtain better facial appearance in both lateral and frontal views. They classified patients according to the anatomic type of mandibular angle: lateral bulging, posteroinferior projection, or both. For the “lateral bulging” type, a parasagittal osteotomy of the angle is done with the reciprocating saw. For the “posteroinferior” type, a curved posterior osteotomy is performed with a 90-degree oscillating saw.
Yang and Park reported angle resection with serial ostectomies, proceeding from the posterior ramus to the anterior body. After removal of the first, most posterior segment, it became easier to cut the more anterior second segment. A third segment, more anteriorly, was at its turn more easily resected.
To achieve a natural-looking mandibular angle, the lateral cortex of the mandibular angle can be removed with parasagittal mandibular angle cortectomies. The lateral mandibular body, angle, and ascending ramus are exposed. Horizontal and vertical osteotomies are done with the reciprocating saw. An osteotome is used to remove the lateral cortex and some portion of the ascending ramus en bloc. Additional bone can be removed if symmetry is not adequate. Additional resection is sometimes limited by the trajectory of the inferior alveolar nerve, which can become exposed by burring deeper. This procedure provides a good result in both lateral and frontal views. It also avoids injury to the facial nerve and vessels as well as subcondylar fracture.
Alternative Approaches
All the described operative methods can be performed through an intraoral approach. In some cases, an additional external skin incision can make it easier to operate. Those who have a narrow intergonial distance, or posteromedially tilted angles, give limited intraoperative visual assessment and offer difficult instrument placement during an intraoral approach. Submandibular skin incision gives a good access to the angle area and allows the surgeon to proceed easily. Angle reduction also can be performed by a combination of internal and external methods. Mandibular angle is exposed through a 3-cm intraoral incision. After subperiosteal dissection, a 3-mm stab incision is made below the chin line. The reciprocating saw is inserted intraorally and the saw handle brought outside through the stab skin wound. Lee et al reported a minimally invasive method using a special rasp and saw with openings for irrigation and suction. After a 4- to 6-mm stab incision is made behind the ear, the instrument is introduced subperiosteally and the mandibular angle is rasped or cut.
Genioplasty
Adjustments to chin width and projection can also further harmonize and improve facial balance. This surgery is highly personalized, considering the length, width, and protrusion of the chin to ensure a natural and harmonious outcome. By addressing common concerns such as a short chin, the procedure harmonizes the chin with the overall facial proportions. This can be done to decrease the width or height of the jaw or chin, narrow the cheekbones, soften the angles, and enhance overall contour.
Non-Surgical Facial Contouring Techniques
When it comes to refining your face without going under the knife, non-surgical techniques like fillers, Botox, and thread lifts are your go-to options. These methods are less about downtime and more about giving your face a fresh, rejuvenated look without the commitment of surgery. Dermal fillers are also useful in facial contouring to build up the cheekbones to the desired volume and projection, and ensure the jawline is smoothly and strongly contoured. These volume additions can be performed with filler injections or with fat grafting (the transfer of fat from one area of the body to another).
Facial contouring is a modern technique for improving facial features. This treatment offers a pathway to enhancing your beauty and achieving aesthetic goals. Embrace your unique beauty while magnifying your best features with treatments like Accutite, Facetite, and Morpheus8.
- Fillers: Fillers, made from substances that mimic what’s naturally under your skin, plump up areas that have lost volume or smooth out lines. They’re quick, with immediate results, and can last from 6 months to over a year.
- Botox: Botox, on the other hand, relaxes the muscles that cause wrinkles, making it perfect for erasing those frown lines and crow’s feet. Results kick in after a few days and can keep your face smooth for about 3 to 4 months. Neuromodulators, such as BOTOX® Cosmetic and Dysport®, may be injected into the masseter muscles, which are just above the angle of the jaw, which results in facial slimming as these muscles relax and lose volume.
- Thread Lifts: Thread lifts use medical-grade thread material to lift and reposition the skin for a more defined facial contour. They’re a bit more involved but still far from actual surgery, offering results that can last up to 2 years.
- Fat Grafting: Volume loss is a significant part of the aging process. This is especially true in the midface and lower eyelid region. Fat grafting is a two-stage technique for replacing this lost volume using a patient’s own tissues. The fat is typically harvested from the lower body (abdomen, thighs, or buttocks and then processed for implantation into specific areas of the face. Besides using your own natural tissue, this procedure is done under local anesthesia, which is what also makes it different from commercial filler products, such as Restylane or Juvederm. Although some fat will survive permanently, you may require a touch-up years later in order to maintain a lasting result.
Post-Operative Care and Recovery
Mild to moderate pain (especially the day of the surgery) is typical. Swelling is unavoidable and most significant approximately 72 hours after surgery. Liquid diet for the first 5-7 days.
The initial recovery time is around three weeks, giving your body time to heal and allowing the majority of swelling to decrease. While it can take up to a year for the swelling to fully resolve and the fine details to emerge, the transformation will be immediate.
After undergoing facial contouring, it’s important to adhere to specific post-operative care guidelines to ensure proper healing and optimal results. These guidelines typically include:
- Managing Discomfort: Taking prescribed pain medication to alleviate any discomfort.
- Dietary Recommendations: Following a prescribed diet consisting of soft or liquid foods to minimize strain on the facial structures.
- Activity Restrictions: Avoiding strenuous activities that could impede the healing process.
- Follow-Up Appointments: Attending scheduled follow-up appointments with the surgeon to monitor progress and address any concerns.
- Swelling Management: Ice application, head elevation, and soft foods are recommended during the recovery period.
- Lifestyle Adjustments: Eating right, staying hydrated, and not smoking can all help your skin stay in good shape.
Considerations and Choosing a Technique
Choosing the right facial contouring technique is crucial for getting the results you want. Think about what you want to change about your face. The decision should be based on a thorough understanding of various factors that can influence the outcome. What exactly are you looking to change? Is it your cheekbones you want more defined, or is it the jawline that’s been bothering you? Being clear on this with your doctor will help a lot.
- Age and Skin Type: Different techniques are better suited for different ages and skin conditions.
- Desired Outcome: Clearly define what changes you want to achieve.
- Consultation with a Qualified Professional: An in-depth consultation with a skilled practitioner is essential.
- Customization: Facial contouring should be customized to suit your unique facial features.
- Surgical vs. Non-Surgical: Surgical procedures like a facelift or liposuction offer permanent changes but come with longer recovery times. On the other hand, non-surgical methods such as fillers or Botox are less invasive, have quicker recovery, but the results are temporary.
Always consult with a professional to weigh the pros and cons based on your health, budget, and desired outcome. Remember, what works for someone else may not work for you.
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