Background: V line surgery is popular form of jaw reduction that has its origins in Eastern countries. Because many Asian patients have larger jaw sizes and may desire a smaller/more narrow lower face the removal of some of the jaw bone is needed. Although this facial reduction technique started in Asian countries its popularity has extended around the world where patients of different ethnicities and jaw sizes seek it out as well.In the U.S. a very common patient who seeks out the surgery is in transfemales.
While it is a complete jaw reduction procedure it is divided into two parts which have different bone removal/reshaping procedures. For the jaw angles and body of the mandible an oblique bone cut (ostectomy) is made from the jaw angle up to the chin right underneath the bony course of the inferior alveolar nerve. (vertical height reduction) For the anterior 1/3 of the lower jaw (chin) a sliding genioplasty type procedure is done usually with midline narrowing.
While traditional V line surgery is very effective at lower facial slimming if applied to a jaw of ‘normal’ size over correction can occur. This results in a face that is too V-shaped with a very steep mandibular plane angle that looks abnormal. When this occurs the patient may desire some amount of jaw bone restoration which can only be done by a custom implant design.
Case Study: This female underwent V line with a result that on 3D X-ray created a dramatic V jawline shape but with an external effect that was equally dramatic…in an adverse way. The mandibular plane angle as quite steep at 45 degrees.
A custom jawline implant was designed for partial bony restoration…although there was no way to know what her original jawbone shape was. (No pre V line surgery x-ray)
Under general anesthesia and through an external and bilateral intraoral incisions the custom jawline implant was placed with double screw fixation at the jaw angle areas.
When seen 6 months later for a left jw angle implant adjustment her results could be appreciated that normalized her facial proportion as seen in the front view.
From the side view the steep mandibular plane angle was also corrected. The slope had a less drastic line from the ear to the chin wth a more natural curve to it.
V line surgery is a good technique when applied to the proper jaw size and the angle of the bone cut is not excessive steep. But it is a hard surgery in which to get a low angulated cut through the ramus and body of the mandible…which can become exaggerated in a jaw that does not naturally have a lower jaw angle. When the result becomes an over correction the only method of adding jaw structure back is with a custom implant design. The only decision is whether it should be a partial or full restoration which is the patient’s choice.
Key Points:
- 1) Traditional V line surgery when done in an average jaw size runs the risk of overcorrection with a steep mandibular plane angle and an overly narrow face.
2) Partial or complete V line reversal can only be done with a custom jawline implant.
3) In over resected jaw angles from the angle of the bone cut placements of a custom jawline implant can be challenging.
Dr. Barry Eppley
World-Renowned Plastic Surgeon