Background: Reshaping of the entire jawline to a more slim or narrowed shape has become known as V line surgery. It is most commonly done in Asians to change a wide and more square jaw to a more narrow and triangular one. It is a bony reshaping surgery which focuses on the chin anteriorly and the jaw angles posteriorly
The cornerstone of V line surgery is what happens in the anterior chin area. As the most projecting point of the lower jaw it must become less wide and often times vertically shorter or longer depending on the patient’s natural chin shape. This is usually done by various of osseous genioplasty concept where the chin bone is downfractured, a midline resection done and then put back together. A horizontal wedge reduction can be done to shorten it if the chin is initially vertically long or the reassembled chin can be put back together and brought forward for a horizontally deficient chin.
The secondary part of V line surgery is a change in the width of the jaw angle. In the past the jaw angle was merely amputated or cut off. While very effective this wipes out any jaw angle shape and can be prone to create soft tissue sag due to loss of ligamentous and muscular attachments. Today it is recogized that preserving the jaw angle shape is important and angle reductions can be done by either a burring reduction or an outer corticotomy.
Case Study: This 22 year Asian female was undergoing a variety of facial reshaping procedures including V line jawline reshaping surgery. She had a naturally short flatter chin and needed more horizontal projection as well as narrowing
Under general anesthesia, she had an intraoral horizontal chin osteotomy done with a midline wedge resection. The bones were put back together with 1.5mm plate and screw fixation and advanced 5mm. The bony stepoffs at the inferior border were trimmed behind the back edge of the osteotomy line. Through different intraoral vestibular incisions the jaw angles were reduced by rotary burring, reducing the outer cortex almost to the marrow space.
At six months after surgery she had a much improved jawline shape. Due to the desire to have further horizontal chin projection, a secondary procedure was done to add a small curvilinear central chin implant of 5mms to create the final jawline shape now seen.
V line jaw reshaping surgery is technically challenging and requires expertise in chin osteotomies as well as mandibular ramus surgery. Secondary revisions are not rare and may need to be done to correct any residual bony asymmetries or projecion deficiencies.
Highlights:
- V line or jawline narrowing surgery is often a combination of chin and jaw angle bony changes.
- The most important element of v line surgery is the anterior chin which must be narrowed and often lengthened to create most of the effect
- Jaw angle width narrowing may also be necessary but it is important to avoid obliterating the shape of the jaw angle in doing so.
Dr. Barry Eppley
Indianapolis, Indiana