Background: One of the common lower facial reshaping procedures done today is that of V line surgery. Originating in the Eastern part of the world where larger and more square shaped lower jaws exist, it is now performed in the Western world as well. It has a prominent role in transfemale surgery to feminize the lower face but can be applied to cis-females as well. While an effective procedure for many female patients with larger jaws it can be a procedure ill-advised for jaws of normal size or those that have a specific jaw shape.
Patients with high jaw angles are at particular risk of an over resected result in which the jaw has the appearance of a complete absence of the jaw angles and resultant loose skin along the jawline. Such a result can occur because traditional V line surgery removes much of the jaw angles through the intraoral bone cuts. Because of the angle of approach and the instrumentation needed to cut the bone only a significant jaw angle bone removal can be done. In the low or even normal jaw angle shape this may be acceptable. But in the high jaw angle patient, which is already vertically short, such resection produces an amputated over resected look.
Such patients may seek some form of V line reversal whether it is subtotal or complete. Most commonly a subtotal reversal is sought as there is a reason the original surgery was done. The only method for V line reversal, anatomically a jaw bone reconstruction, is a custom designed jaw implant replacement.
Case Study: This female had V line surgery in S. Korea which for her resulted in an over resection. It can be seen in her before pictures that she had high jaw angles which can be seen to be virtually missing in the postop 3D CT scan.
While in the front view the 3D CT scan shows a distinct v-shape to the jawline the external appearance shows too small of a lower facial shape.
A subtotal V line reversal implant was designed which still maintained a v-shape of the jawline…just not so radically reduced.
Under general anesthesia the custom jawline implant was placed through a combined external submental incision and bilateral intraoral posterior vestibular incisions.
Key Points:
1) Traditional V line surgery in the high jaw angle patient often leads to an over resection of bone and resultant loose facial tissues.
2) Subtotal or total V line surgery reversal can only be done by a custom jawline implant.
3) A submental incisional approach works best for the complete inferior border elevation that is needed for the jaw implant placement.
Dr. Barry Eppley
World-Renowned Plastic Surgeon