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Archive for the ‘jaw angle reduction’ Category

Tissue Responses to Jaw Angle Reduction Surgery

Sunday, July 3rd, 2016

 

Reducing the width of the jaw angles is known as a gonioplasty procedure. It gets this name because the prominence of the jaw angles is known as the gonial angles which is located at the very back end of the lower border at the back of the jaw. When the width is aesthetically excessive, the jaw angles can be reduced by several different methods.

Jaw angle reduction surgeryThe method chosen for jaw angle reduction depends on the final shape of the bone that one desires. The traditional jaw angle procedure is an amputation of the jaw angle by an osteotomy cur. This will raise the height of the jaw angle while making it more narrow. Burring reduction or splitting off the outer cortex will keep the jaw angle shape the same while making it more narrow.

In the January 2016 advanced publication issue of the Annals of Plastic Surgery an article was published entitled ‘Reduction Gonioplasty: Bone Regeneration and Soft Tissue Response’. The goal of the published study was to evaluate the tissue responses of reduction gonioplasty and to determine what effects it had on the aesthetic outcome. The surgical technique used consisted of a high-speed rotary cutting bur from the new gonial point to the inferior mandibular rim under the second premolar. Then an elongated osteotomy line (mandibular-chin body osteotomy) was performed with a reciprocating saw. A total of almost fifty patients were treated and followed for up to one year. Bone regeneration in the burring ostectomy region and in the ostectomy region was usually less than 1mm. The soft tissue response followed the bone reduction fairly closely.

Bone regeneration occurs very minimally after jaw reduction. The little that does occur does not affect the final aesthetic outcome in terms of width reduction, The soft tissue response ratio is higher in the anterior mandible,and the outcome of reduction gonioplasty is a thinner lower face.

This paper is a bit mistitled since the procedure done and studied is actually closer to a v-line jaw reshaping (minus the chin) than an isolated jaw angle reduction. But the point remains the same in that whatever scar and small amount of bone regeneration that occurs after surgery does not affect the eventual aesthetic outcome.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Jaw Asymmetry Correction

Sunday, September 27th, 2015

 

Background: Facial asymmetry is not uncommon and can occur from multiple causes. One of the most common is that from plagiocephaly where the entire craniofacial skeleton rotates or twists around a central axis resulting in a classic pattern of skull and facial bone asymmetries. But most facial asymmetries do not have such well identified causes and are usually idiopathic….it is just the way the face developed.

Jaw or mandibular asymmetries are one of the most common and identifiable anatomic causes of facial asymmetry. The size of the lower jaw and the importance of the chin and jaw angles on facial appearance can make even small jaw asymmetries very noticeable. Jaw asymmetries come in a wide variety of types but most commonly it presents when one side of the jaw has either overgrown or one side has under developed. This results in a twisting of mandible such that the chin is deviated either towards the smaller side or away from the overgrown side.

Many jaw asymmetries are associated with a malocclusion (bite that is off) which is best treated by a combined orthodontic and jaw surgery combination. But when the bite is acceptable or the patient does not want to undergo orthognathic surgery, aesthetic correction of the jaw asymmetry can still be done.

Jaw Asymmetry 3D CT scan front view Dr Barry Eppley Indianapolis Jaw Asymmetry 3D CT scan Dr Barry Eppley IndianapolisCase Study: This 22 year old male has lower facial asymmetry with a smaller right side, a chin deviation to the right and a more pronounced left jaw side/angle. A 3D CT scan shows that the right mandible was shorter and the left  mandible was longer. This created the chin deviation to the right of the facial midline.

Cin Osteotomy for jaw Asymmetry Dr Barry Eppley IndianapolisUnder general anesthesia he had a left jaw angle reduction, a right jaw angle implant placed (width only jaw angle implant) and a leveling chin osteotomy. All jaw procedures were done from an intraoral approach. Reduction of the left jaw angle accounted for a 5mm narrowing of the jaw angle flare. A 7mm wide lateral jaw angle implant was placed on the right. The intraoral chin osteotomy consisted of an asymmetric wedge  removal and shifting of the chin bone back towards the midline.

Jawline Asymmetry Correction result front view Dr Barry Eppley IndianapolisJawline Asymmetry Correction result oblique view Dr Barry Eppley IndianapolisHis jaw asymmetry correction surgery showed a good improvement. In an ideal world I wish just reducing the larger jaw on the left side of his face would straighten it but that almost never can happen by itself. The reason is that you can not reduce the larger bone enough to make a big difference. (there are teeth and nerves in the bone so that is a limiting factor as to how much bone can be reduced) For these reasons this is why most jaw asymmetry corrections must employ a ‘three point’ approach. This means all three points of the jaw (chin and two jaw angles) are treated. Reducing the left jawline, straightening the chin and augmenting the right jaw angle in this case provides the most comprehensive approach to jaw asymmetry correction. Even with this approach perfect lower facial symmetry is not usually possible. But it is usually the best approach to mask the lower facial disproportion which now exists.

Highlights:

1) Jaw and lower facial asymmetry is a developmental deformity that usually affects the entire jawbone from angle to angle.

2) It is rare that just treatment of one side of the jaw asymmetry will result in a very good correction.

3) Jaw asymmetry correction is best done by treating the three points along the jawline, the chin and both jaw angles.

Dr. Barry Eppley

Indianapolis, Indiana

Three-Dimensional Jaw Angle Surgery

Saturday, July 4th, 2015

 

Changing the mandibular jaw angle can be one of the most challenging of all aesthetic facial skeletal surgeries. It is a tight space to work in from an intraoral approach and visualization is almost always suboptimal. Loupe magnification and a head light would be considered critical in any type of jaw angle surgery particularly that of bone reshaping/reduction.

Jaw Angle OstectomyWhile jaw angle reduction is not a commonly performed aesthetic procedure in Caucasians, it is extremely common in Asians who frequently have a more square face with prominent jaw angles. Thus there have been many variations in the Asian plastic surgery literature as to how to perform an ostectomy of the jaw angles. Given the difficulty in performing the procedure there is no universally described method that can completely avoid uneven or asymmetric posterior mandibular contours.

In the July 2015 issue of the Annals of Plastic Surgery, the article entitled ‘Endoscopic-Assisted Intraoral Three-Dimensional Reduction Mandibuloplasty’ was published. In this paper the authors describe a jaw angle reduction technique done in over 100 patients over a three year period. This was a one-stage long-curved ostectomy combined with a splitting corticectomy done through an intraoral approach with the assistance of an endoscope. The one-stage long-curved ostectomy and corticectomy were performed using an oscillating saw with angles of various degrees and length under direct vision. Their results showed good three-dimensional changes to the jaw angle with lower facial width reduction. Patient satisfaction was high. These changes, as would be expected, increased the height of the gonial angle and the mandibular plane angle as well. No major complications occurred from bone fracture to facial nerve injury.

The value of the endoscope is not clear from reading this article but what is most evident is that effective reduction of the jaw angle requires a combination of bony techniques. The actual jaw angle must be removed and the bone thinned by removing the outer bony cortex. This can make the face look thinner from the front view and have a smooth line from the side view. The jaw angle will get higher and there is the risk of loss of some soft tissue support so over resection of bone should be avoided.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Female V-Line Jaw Narrowing Surgery

Tuesday, March 24th, 2015

 

Background: Jaw or jawline reduction surgery is directed towards narrowing the lower third of the face. Very square or wide lower faces is either considered too masculine or aesthetically undesired in women in particular and in some men. While widely considered an Asian (particularly Korean) type surgery, it is becoming more commonly requested amongst Caucasians as well to help slenderize their face.

There are non-surgical and surgical methods for jaw reduction (so called V-line jaw surgery) based on the anatomy of the mandible and its soft tissue attachments. A wide lower face can be caused by masseter muscle enlargement due to congenital development or bruxism and is treated non-surgically by Botox injections. Masseter muscle reduction is often a necessary part of jawline narrowing but mandibular bone changes are usually the cornerstone of V-line jaw narrowing.

Inferior Alveolar nerve in Jaw line Narrowing Dr Barry Eppley IndianapolisIn narrowing the jawline it is necessary to create the visual effect of a less wide mandible from angle to chin. While it is commonly perceived that the bone is cut from the sides of the jawline from back to front, this is not how it is actually done. The location of the inferior alveolar nerve in the mandible as it courses through the bone and its exit from the mental foramen anteriorly make such a bone reduction approach surgically very difficult with a high risk of nerve injury. Thus most commonly chin and jaw angle bony procedures are done to create the v-line jaw narrowing effect,

Case Study: This 21 year-old female wanted multiple facial reshaping procedures done. One of her main areas of focus was her wide lower face and shorter chin. V-line jaw narrowing surgery was planned.

Jawline Narrowing Surgery result front view Dr Barry Eppley IndianapolisUnder general anesthesia, she initially underwent bilateral jaw angle reduction by outer cortical osteotomies combined with electrocautery of the inner surface of the masseter muscle. A horizontal chin osteotomy was then done with a 5mm midline ostectomy with a horizontal advancement of 7mms.

Jawline Reshaping result oblique viewJawline Reshaping result side view Dr Barry Eppley IndianapolisThree months after her V-line jaw narrowing, she showed a more narrow jawline in the front view and a longer jawline in the side view. Additional Botox injections will be done in the masseter muscle for further thinning in the jaw angle area.

In most V-line jaw narrowing surgeries, the body of the mandible does not need to be reduced to create the effect. Chin and jaw angle changes are enough in most cases to create an adequate jawline narrowing result.

Case Highlights:

1) Jawline reshaping typically strives to make the jawline more narrow and longer in the front view.

2) Most jawline narrowing techniques involve an anterior bony genioplasty and a posterior angle/ramus reduction.

3) As the chin becomes less wide (and sometimes vertically longer) and angles become less wide, the jawline becomes perceptibly more narrow and v-shaped.

Dr. Barry Eppley

Indianapolis, Indiana

Masseter Muscle Changes After Jaw Angle Reduction

Tuesday, September 2nd, 2014

 

Jaw angle reduction surgery, technically known as reduction gonioplasty, is a well known procedure to help reduce a square lower face. It is particularly common in Asians who often have more of a wider face with thicker masseter muscles and greater posterior jaw bone width. It has been practiced for years and is often part of other facial reshaping procedures with the goal of an overall thinner face.

Jaw Angle Reduction (Removal) Surgery Dr Barry Eppley IndianapolisJaw angle reduction surgery can be done by one of two techniques, a oblique ostectomy (amputation) and a sagittal reduction. (outer table ostectomy) Each has their own advantages and disadvantages with an ostectomy being a more aggressive bone reduction method than an ostectomy. But either jaw angle reshaping techniques involves the need to raise the masseter muscle off the bone to perform the surgery. What effect this has on the long-term result has never been studied. Although it has been hypothesized, based on other jaw angle surgeries, that some muscle thinning effect may occur as well due to muscle trauma and disinsertion.

In the September 2014 issue of the Journal of Craniofacial Surgery, an article appeared entitled ‘Long-Term Changes in the Masseter Muscle Following Reduction Gonioplasty’. In this paper, 56 patients were studied before and four years after jaw angle reduction surgery with 3D CT scans. The changes in the volume and shape of the masseter muscle were analyzed. Their results showed that the masseter muscle shrunk an average amount of 21% in the lower part of the masseter muscle in long-term follow-up.

This study confirms what would be suspected with elevating the masseter muscle for any surgery, whether it be jaw angle reduction, jaw angle implants or sagittal split osteotomies. Elevation and disinsertion of the muscle results in some degree of atrophy and loss of muscle bulk afterwards. This can potentially create a skeletonization of the jaw angle area which may account for some of the facial narrowing effect. This could have a positive or negative effect on the jaw angle reduction result depending upon how much bone is removed.

Dr. Barry Eppley

Indianapolis, Indiana

A Comprehensive Approach to Asian Jawline Reshaping

Wednesday, January 15th, 2014

 

Amongst certain Asian subgroups, the face is very wide particularly in its lower third which gives it a square facial contour/shape. Aesthetically this is not a desired facial shape as the lower face should be less wide than the upper face. As a result, reshaping of the jawline/mandible to make it more narrow has become very popular and is an ethnic form of facial bone plastic surgery.

Historically jawline rehaping in Asians was done as a simple jaw angle reduction. Besides loss of the shape of the jaw angle, such an approach does not take into account the entire jawline and does not create the best jawline shape change. It neglects the front two-thirds of the jawline and is not usually a completely satisfying procedure as a stand alone procedure.

A comprehensive article providing a contemporary surgical approach to Asian jawline reshaping appeared in the January 2013 issue of Journal of Plastic, Reconstructive and Aesthetic Surgery entitled ‘How To Achieve A Balanced And Delicate Lower Third Of The Face In Orientals By Mandibular Contouring’. The entire jawline is seen from the perspective of an overall change of the lower third of the face.  The goal is to change the slope of the jawline from the Gonion (jaw angle) to the Gnathion (chin) to form a sloping curve. This involves a three step approach which includes a mandibular outer cortex split ostectomy, the mandibular V-line ostectomy and a narrowing sliding genioplasty.

Mandibular Jaw Angle Ostectomy Dr Barry Eppley IndianapolisThe mandibular outer cortex split ostectomy removes the outer portion of the jaw angle area, very much like a reverse sagittal split osteotomy. This is done by using a reciprocating saw and an osteotome. This thins the bony jaw angle but keeps its shape without creating an amputation effect or severe loss of the jaw angle slope.

Mandibular V Line Surgery Dr Barry Eppley IndianapolisThe mandibular V-line ostectomy is a forward slanting resection from the jaw angle forward to below the mental nerve exit to the chin. The start of the ostectomy at the jaw angle determines the height of the jaw angle from the ear and the line of the ostectomy. As a general rule, the jaw angle point should be about 2 cms below the earlobe.

The chin is narrowed by using a standard sliding genioplasty. The downfractured chin segment is then split, bone removed in the middle and then put back together by plates and screws and fixed to the upper chin bone segment. The vertical height of the chin can be lengthened by the bend of the fixation plates which often is aesthetically necessary. The sides of upper chin segments are then trimmed to avoid an hourglass effect.

This three-step bony reshaping approach to the jaw line is comprehensive and makes the whole jaw more narrow and tapered from the front view. Not every patient will need all three bony areas treated and preoperative assessment by x-rays can be extremely helpful in determining what and how much can and should be done.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study: Lateral Corticotomy Jaw Angle Reduction

Monday, October 21st, 2013

 

Background: The frontal view of the face allows one to see its width from the forehead down to the jawline. This width and its proportion to the length of the face helps create an  overall facial shape. It is generally acknowledged that there are seven basic facial shapes which for women an oval shape is more aesthetically desired while for men a more square shape may be preferred.

But to create a slimmer or more oval-shaped face, narrowing of the lower face is often needed. While Botox can be used to reduce the thickness of the masseter muscle, narrowing the underlying bony jaw requires surgery. Most of the width of the bony jaw  is located in its back half, technically known as the ramus of the mandible. Due to the natural divergence of the jawline from the chin on back, the jaw angles make up the widest part of the lower face.

Reduction of the jaw angles is a well known surgical technique that is used for narrowing a wide lower face, most commonly done for Asian facial reshaping. Historically, jaw angle reduction was an amputation method removing the entire angle in an oblique fashion. While that may be effective in some patients, it is often a technique that is overused and can create undesired aesthetic consequences. (tissue sagging, steepening of the mandibular plane angle) This has led to less aggressive techniques where the angle shape is preserved and its thickness is reduced by a lateral corticotomy.

Case Study: This 33 year-old female was having multiple procedures for facial reshaping. One of the changes she wanted to make was a narrowing of her lower face. But she did not want to lose the shape of her jaw angle and did not want a ‘traditional’ jaw angle amputation technique.

Under general anesthesia an intraoral posterior vestibule incision was made on both sides. The bony angles were exposed. Using a handpiece and burr, the cortical bone was shaved down completely to the marrow space, essentially doing a complete lateral corticotomy on both sides.

The two options for jaw angle reduction are very different in the effects they create. A traditional technique amputates the jaw angle, changing the slope of the mandibular plane as it narrows the bigonial width. Conversely, lateral corticotomy reduction preserves the shape of the jaw angle but has a less significant width reduction.

Case Highlights:

1) Reduction of the posterior lower width of the face involves removal of a portion of the jaw angle…if it has adequate flare or bone thickness.

2) Jaw angles can be narrowed by either a full thickness (amputation) or a partial thickness reduction technique.

3) The width of the posterior lower face is a combination of both bone and soft tissue and bone reduction alone does not always guarantee a very visible narrowing effect.

Dr. Barry Eppley

Indianapolis, Indiana

Chin Narrowing and Lengthening for Slenderizing the Wide Lower Face

Thursday, August 15th, 2013

 

Jaw angle reduction, also known as angoplasty, is one of the most commonly performed procedures for lower facial width reduction particularly in Asians. While it has been touted for years as a mainstay facial bone reduction procedure, it is not as effective as many believe. And when done aggressively through an amputation technique, it can destroy the shape of the jaw angle and lead to a very unnatural slope of the jaw. Even when done well with a more shape-sparing angle reduction by burring or corticotomy, the result may still not be sufficient to make a wide face look significantly more narrow.

When viewed from the frontal view, the width of the jawline (lower face) is more than just the jaw angles but includes all the way front to the chin. Good bigonial angle reduction at the jaw angles will not make a big overall change if the chin is also wide. (which it frequently is) This to slenderize some faces, it is necessary to include chin width reduction and reshaping as well. Chin width reduction and even vertical chin lengthening may be necessary to maximize a facial slendering effect.

In the August 2013 issue of the journal Plastic and Reconstructive Surgery, an article was published on this concept entitled ‘Angloplasty Revision: Importance of Genioplasty for Narrowing of the Lower Face’. Over a two year period, the authors performed over 50 procedures on women who had unsatisfactory jaw angle reduction with a narrowing genioplasty and contouring of the lower border of the mandible back to the jaw angles. All patients had improved aesthetics with a more narrow jawline. No complications were reported other than two patients who had increased submental fullness afterwards. No permanent lip numbness occurred.

A wide lower face is usually caused by increased width of the entire mandible. Thus when considering attempting to change a wide lower face into a more slender one, changes to the entire mandible need to be considered. Jaw angle reduction by corticotomy, body narrowing by burring, a narrowing genioplasty and an inferior border resection reshaping are all elements that can be considered. Changes in the chin for many patients, however, may have the greatest yield because of the effect of its shape on the frontal view. (which is how most people actually see themselves)

Besides narrowing the chin, it frequently is beneficial to length it as well. Because a wide lower face usually has a disproportionate width to height relationship, lengthening the chin as it is narrowed changes that and makes the lower face appear more narrow. Lengthening the chin also creates a more triangular shape which is also beneficial for female facial aesthetics.

Dr. Barry Eppley

Indianapolis, Indiana

Asian Facial Reshaping by Cheek Narrowing and Jaw Angle Reduction

Sunday, August 4th, 2013

 

Reflecting different facial characteristics from distant parts of the world is the difference between Eastern Asian and Caucasian facial bone structures. Prominent cheekbones and a strong jaw angle are common Asian features that are often asked to be reduced as they create a face that is perceived to be wide, square and relatively flat. In the Western world, however, these facial features are highly valued and requests for aesthetic augmentation of the cheeks and jaw angles are common.

Surgical reduction of the cheek and jawline can be done by employing craniofacial bone contouring techniques. But there are limitations as to how much bone reduction can be obtained and the facial changes that will result. Not every Asian face can be made more round, oval or more narrow in width. The thickness of the overlying soft tissues will affect how much reduction of the bone on the outside is seen. In addition it is important for the surgeon to realize that Asians seeking bone contouring surgery are not trying to achieve a Western look but a better shaped face that preserves their ethnicity.

Cheek bone reduction surgery has evolved over the years. Initially simple burring was done on the anterolateral face of the cheekbone through an intraoral approach. This is not only largely ineffective but also can lead to soft tissue sagging from complete periosteal detachment. It is now recognized that an infracture of the zygomatic arch is the only effective method of facial width reduction. (the arch is the culprit not the cheek bone prominence per se) While this can be done very effectively from above under direct vision through a coronal scalp incision, that is a more invasive approach than is necessary. The zygomatic arch can be repositioned by performing a bone cut at the attachment of the front part of the arch to the cheekbone body (zygoma) as well as a second bone cut at the back end of the arch where it attaches to the temporal bone. This moves the convex arch inward, reducing facial width by about 4 to 6mm per side.

Some Asian faces are wider in the upper face not because of the zygomatic arch convexity alone. The width of the temporal area above (bitemporal width) may also be significant and even when zygomatic narrowing is done the results do not make much of a facial change. Bitemporal facial width, contrary to popular perception, is not due to bone but the thickness of the temporalis muscle.  The temporal bone is a very concave bone whose thickness has little influence on the facial width at the side of the eye into the hair-bearing temporal scalp region. This muscle can be reduced by either Botox injections or temporal muscle release and resection through a vertical scalp incision.

Asian faces often have a wider lower face due to a large flare to the jaw angle and thick overlying masseter muscles. To get the best narrowing effect, both muscle and bone must be treated. Resection of the masseter muscle is not a good option and any consideration of that has now been replaced by Botox injections. This requires a series of Botox injections done over a year to produce a sustained muscle shrinking effect.

Contouring of the prominent jaw angle is done from an intraoral approach using several techniques. The traditional approach of a complete amputation of the angle, while , effective, often leaves a high and ill-defined bone shape that may also cause loss of soft tissue support and the development of jowls. The goal is jaw angle narrowing not necessarily jaw angle removal. Burring of the prominent angle, saw reduction in the sagittal plane or an outer cortical bone removal are all better reduction techniques that amputation. Narrowing of the jawline in front of the jaw angle towards the chin can also be done and may be necessary to really show the effects of any jaw angle (bigonial) reduction.

It is very valuable before doing either cheek or jaw angle reduction that presurgical x-rays are obtained. At the minimum panorex and submental digital x-rays are needed. But the drop in cost of 3D facial CT scans and the easy accessibility of them at any outpatient CT center makes their use preferred.

Whether reducing the Asian jaw angle/jawline or the cheek width, it is important to look at how one affects the other. Reduction of a prominent jaw angle can make the cheek prominence look wider and vice versa. This is somewhat similar to the relationship between the nose and the chin. This is why the best Asian facial narrowing effect comes from simultaneous reduction of both cheek and jaw angles in many patients.

Dr. Barry Eppley

Indianapolis, Indiana

Mandibular Gonioplasty – Jaw Angle Removal vs. Jaw Angle Reduction

Wednesday, April 13th, 2011

The shape of the lower jaw has an influence on the appearance of one’s face. Besides the shape and prominence of one’s chin in the front, the other important jaw features are that of the paired angles in the back. The more prominent or square the jaw angles are, they can enhance the masculine features ofa man and can give the impression of strength and confidence in a woman. When the jaw angles are too prominent, however, the jaw can be disproportionately wide as compared to the rest of the face. This may create a very square-shaped face and is the motivation for aesthetic jaw angle modification surgery, also known as a gonioplasty. (jaw angles are also referred to as the gonial angles)

Jaw angle bone modification is done to soften the face and make for a less square or more oval-shaped face. Some may call this creating a more feminine jawline and this is certainly true for a woman considering the procedure. Fewer men undergo gonioplasties because the square jaw is a desired masculine feature but there are some men whose jaw angles are exceptionally prominent who want modification as well.

When considering jaw angle modification, it is extremely important that one understand that there are different techniques for doing it…with different aesthetic outcomes. The traditional and most commonly used method is jaw angle removal surgery. This is always referred to as jaw angle reduction but this is a misnomer. Reduction implies the bony angle is preserved but reduced. In reality, the entire jaw angle is simply cut off or removed. From incisions inside the mouth, the junction of the back part of the jaw and the lower border of the jaw is essentially cut off. This not only softens the jaw angle but also raises the line of the jaw from front to back.

For many women, the elimination of the jaw angle (and raising the height of the back part of the jaw up to a horizontal level of the mouth) is aesthetically advantageous because it is a feminizing procedure. It is also the most effective way to thin the width of the face (jaw angle to jaw angle) because the full-thickness of the jaw bones in this area are removed. Given that that each jaw angle is 1 cm or more thick, one can narrow the lower facial width by up to 2.5 cms. For men, however, the total loss of the jaw angles may be aesthetically advantageous and must be carefully considered. I have consulted more than one man who wanted jaw implants to replace jaw angles that have been cut off.

The other technique for gonioplasty is true jaw angle reduction. In this technique, the jaw angles are not cut off but thinned by burring reduction. The shape of the jaw angle is preserved but the bone is thinned. Its advantage is that the jaw angle is not eliminated or raised but its disadvantage is that it can not achieve as much narrowing. This is because the full thickness of the bone is not removed but thinned. This changes the amount of transfacial width reduction at the jaw angles to maybe 1 to 1.5 cms.

In lower facial gonioplasty, the two available techniques are removal (excisional gonioplasty) and reduction. (reduction gonioplasty) Their effects on the jaw angle and the amount of width reduction are different. The use of the term ‘jaw angle reduction’ is often misunderstood and may lead to undesired jaw shape outcomes if done in a standard fashion for every patient. This may lead to some unhappy patients seeking jaw angle implant reconstruction later.

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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