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Lower facial reshaping by jaw reduction, also known as v line surgery, is a well known procedure that historically has been mainly used in Asian patients. But its use has expanded and has spread and is now being used in females of many different ethnicities and lower jaw shapes. While it can be a very effective procedure in many patients to create a slimmer and more streamlined lower face.

But it is a procedure that can create ‘too much of a good thing’ where some patients ended up with an over reduced lower face that also has some soft tissue sagging as well. There are multiple reasons why v line surgery patients can end up with an undesired result. One reason, by the nature of way the procedure is done intraorally and the angles needed for the cutting instrumentation, there is no minor amount of vertical ramus and body jawbone removal. It is by definition an angulated amputation of the jaw angles…which can be too much for some facial shapes. 

Second, like many different types of augmentative and reductive facial bone procedures, some patients can exhibit regret in the way their new face looks. I rarely have seen a patient who has had computer imaging of what the predicted outcome would be from v line surgery. Not that this would always prevent such outcomes but looking at other patient results and then seeing on your own face can turn out to be different than what one thought it would be.

The third reason is that loss of jaw bone support and the wide stripping of the soft tissues from the bone to perform the procedure can, and often does, result in some soft tissue sag. While often not of a major consequence it can be an aesthetic tradeoff that some patients do not like.

When contemplating v line surgery reversal the major issue is how to restore posterior jawbone support. (angles and mandibular body) The only way to effectively do so is a custom jawline implant design. To precisely restore the removed bone, whether partially or completely, requires a 3D design process. Re-expanding the bone contours vertically and to do so when some asymmetry of the jawline always exists, can not be done any other way. Achieving smoothness and symmetry has to be preoperatively determined and designed.

The key question is whether the patient wants to partially or fully restore the removed bone. In general, most patients had the procedure for a reason, so may opt to restore some but not all of the lost bone. So the reversal is really a subtotal reversal in most patients.

The chin part of v line surgery is a very different situation than the bone that has been removed behind it. The classic t-shaped bony genioplasty usually narrows the chin and often brings it further forward. Whether chin width needs to be restored and/or brought further forward will vary for each patient. Some may need to have the entire jawline restored while others may not need to have the chin changed at all.

In most cases the small/petite jawline implant can be placed through intraoral incisions, avoiding the need for any external incisions.      

Dr. Barry Eppley

Indianapolis, Indiana

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