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V line is a popular lower facial reshaping surgery that removes bone of the lower jaw for a slimming effect. There are different types of V line surgery but, regardless of the type, it requires an extended vestibular incision around the inside of the jawline to perform it.

Given the long intraoral vestibular incision and the retraction of the soft tissues of the bone to perform the reduction, it is not rare to develop scar contractures. These appear as mucosal tissue bands that run perpendicular to the depth of the vestibule which are most pronounced when pulling the cheek outward. They can be associated with tightness, a pulling effect and discomfort.

By definition most scar contractures represent a soft tissue deficiency. Thus simple releasing them (cutting through them) and putting them back together can have a low rate of successful resolution. For assured resolution a release must be associated with adding what is missing…soft supple tissue. This is best done with a small fat graft placed as an interpositional graft into the depth of the release and then the mucosa closed over it.

The intraoral vestibule is the soft flexible lining that exists between the cheek and the teeth of both the upper and lower jaws. It is a common incisional location for a variety of jaw procedures. What makes V line surgery unique for the vestibule is that the incision needed to perform encompasses the entire length of the vestibule since the bone reshaping involves the entire jawline. With such a long incision it is no surprise that some patients at some locations of the incisions may develop adverse scarring. Introducing supple fat as an interpostional graft after release has proven to be an effective treatment strategy.

Dr. Barry Eppley

Indianapolis, Indiana

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