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Case Study – Partial Thickness Jaw Angle Reduction Surgery

 

Background: Reduction of the width of the lower face refers to jaw angle reduction. The ramus of the mandible (aka the jaw angles) creates the widest part of the lower face due to the outward flare of the jaw as it moves from the chin in front backward. Reduction of this part of the jaw helps narrow the lower face in the front view as well as can change at the shape of a prominent jaw angle from  the side view.

The traditional approach to jaw angle reduction is that of full-thickness bone removal. Known as an amputation technique, the angle of the jaw is cut away as the full-thickness bone cut comes forward below the level of the inferior nerve into the lnferior border anteriorly. This type of jaw surgery has its origins from the Pacific Rim where the often very large and protruding angels of the Asian face, particularly in females, requites a aggressive type of bone reduction.

As such jaw reduction has gained popularity around the world, it has become used in many non-Asian faces for jawline slimming. While effective for some patients it does not produce as successful a result in Caucasian jaw angles that do have a large amount of flare or bone thickness. It often leads to creating a whole new set of aesthetic problems from over-resection and loss of soft tissue support. I have seen numerous Caucasian patients that have gone overseas for this surgery to come in later for reconstruction of their removed jaw angles.

While jaw angle reduction can still be done in non-Asian mandibles, patient selection is key as well as the choice of surgical technique to do it..

Case Study: This young female wanted to reduce the squareness of her jaw angles. Despite being very small in stature she had a square jaw angle. Her jaw was angular even though her mandible was not overly big.

Under general anesthesia an inttraoral approach was done using posterior vestibular incisions. The entire outer cortical layer of bone was removed over the angle area using a handpick and burr. Over the most posterior angle point the tip of the angle was burred away in a full-thickness fashion.

The partial-thickness jaw angle reduction method is often more appropriate for the Caucasian jawline. Burring can reduce up to half of the thickness of the jaw angles. It can also be used to blunt the jaw angle point. It creates a noticeable change without risking a soft tissue sag later from loss of bony support. It is also safer technique with risks of bleeding or nerve damage In the properly selected patient, it is an effective jaw contouring method.

Highlights:

1) Jaw angle reduction can be done using either a partial-thickness or a full-thickness approach.

2) The advantages of a partial thickness technique is that the soft tissue support over the jaw angles is maintained.

3)  Blunting of the jaw angle point can still be done without a completely full-thickness bony cut.

Dr. Barry Eppley

Indianapolis, Indiana


Dr. Barry EppleyDr. Barry Eppley

Dr. Barry Eppley is an extensively trained plastic and cosmetic surgeon with more than 20 years of surgical experience. He is both a licensed physician and dentist as well as double board-certified in both Plastic and Reconstructive Surgery and Oral and Maxillofacial Surgery. This training allows him to perform the most complex surgical procedures from cosmetic changes to the face and body to craniofacial surgery. Dr. Eppley has made extensive contributions to plastic surgery starting with the development of several advanced surgical techniques. He is a revered author, lecturer and educator in the field of plastic and cosmetic surgery.

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