Jaw angle reduction, also known as angloplasty, 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 has both aesthetic advantages and disadvantages. When done aggressively through a bicortical amputation technique, it will remove 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) Thus 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