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Posts Tagged ‘facial narrowing’

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


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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