V-line jaw reduction is a lower facial contouring procedure that is popular in Asian patients, although not limited exclusively to them. By the intraoral method through which most of these surgeries are done, it is challenging to get good symmetry and the desired amount of reduction of the entire jawline on both sides. As a result subotimal outcomes due occur and are not rare. Unless one has actually performed this procedure it can be hard to envision the challenges in performing it and why symmetry can be difficult to always obtain.
In the February 2019 Online First Edition of the Aesthetic Plastic Surgery Journal an article was published on this topic entitled ‘A Revision Mandibuloplasty: Causes, Indications, Surgical Methods and Treatment Outcomes’. In this paper the authors categorized dissatisfied V-line jaw contouring patient based on their dissatisfaction types and present methods for revisional jaw contouring. Over a six year period a total of 184 patients underwent secondary jaw contouring surgery for two reasons or types. First some patients had a lack of a desired slender facial shape. (Type 1) The second patient type were those that had either an unnatural or asymmetrical facial appearance due to under- or over resection of bony contours. (Type 2)
They report that the majority of dissatisfied patients were of type 1. (79%) The best improvements in this type were obtained by further reduction of the chin and parasymphyeal regions in those patients that had been undercorrected rather than that of the jaw angle area. The type 2 patients were much less and accounted for 21% of the patients seen. Secondary corrections consisted of further contouring efforts to improve bony asymmetries.
This clinical experience has the authors concluding that great attention needs to be done in preparative planning of the osteotomy lines of the jaw angles and chin. Avoiding over resection of the bone, particularly at the jaw angles, is also cautioned.
Having seen and treated a fair number of unsatisfied v-line jaw reshaping patients, over resection of bone at the jaw angles and residual soft tissue sagging are the two most common problems that I see. Over resection of the jaw angles, particularly when the procedure is performed in Caucasians. is not uncommon. Because most Caucasian bony jaw anatomy is less in size than Asians, many of these patients would have been better off with decortication rather than amputation of the jaw angles.
Dr. Barry Eppley
Indianapolis, Indiana