Combination Cheekbone and Jaw Reduction with Facial Rejuvenation is Safe and Effective
Goals/Purpose: Cheekbone and jaw angle reduction are procedures often requested in a subset of Asian patients to achieve a more desirable oval facial shape. Some of these patients require concomitant facial rejuvenation to achieve appropriate contours. Combining facelift, malar and jaw reduction can be performed safely.
Bony facial contouring is more popular in the Asian community than in the Caucasian population. While Caucasians desire to have more prominent cheekbones and jaw angle, Asians covet oval facial contour because prominent cheekbones or jaw angles are considered masculine features; these are more prevalent in Korean and Japanese patients.
Options to reduce prominent jaw angle or square jaws range from non-surgical treatments such as Botox® in the muscle, to the masseter muscle, to direct mandibular angle ostectomy. The surgical option is the direct reduction of the sometimes outward flaring mandibular angles. When the cheekbone and jaw angle reduction is performed concomitantly with a facelift, the approach and surgical maneuver for the cheek bone reduction is relatively unchanged, but the jaw reduction can be performed under direct vision which affords the surgeon a greater ability to control the size of the bone resection as well as the ability to avoid injury to the inferior alveolar nerve.
Methods/Technique: Over the period of 5 years, among the patients who presented for cheekbone and jaw angle reduction, 6 patients were candidates for the combined cheekbone, jaw angle reduction and facial rejuvenation. All the patients were Asian females from Vietnam or Korea. The procedures were performed under general anesthesia. The cheekbone reduction was done first via the transoral approach using a reciprocating saw to perform the osteotomy at the junction of the zygoma body and the zygomatic arch. Multiple green stick fractures was then performed on the zygomatic arch. A single green stick fracture is usually not sufficient to re contour the zygomatic arch from a curved shape to a flatter contour. After the bone reduction, a standard SMAS facelift is performed. The mandebular angle reduction is performed after the SMAS is elevated.
Results/Complications: All 6 of the patients who underwent the combined surgery were very satisfied with the surgical outcome. Only one patient required fat grafting of the cheek region due to mild contour irregularities of the cheek region. No patient had any problem with skin flap ischemia or viability. Minor post-op complication such as small localized hematoma is not significantly different from the standard facial rejuvenation alone.
It is clear that a segment of the patients requesting cheek bone reduction and jaw reduction would also benefit from facial rejuvenation. Due to the fear of vascularity issue some have opted for delayed facial rejuvenation after the bone contouring procedure. We have found that when performed appropriately, the bone contouring can be safely performed in conjunction with facial rejuvenation. The facelift incision also affords the surgeon direct visualization of the area of planned resection. A more accurate and a greater amount of mandibular angle can be resected due to the greater exposure of the angle and a more direct alignment of the saw. We recommend at least a panorex x-ray to determine the safe range of bone resection. We find that 3-D cone beam CT to be very helpful in the analysis and planning of the surgery. The ability to explain the surgery to the patient using their 3-D image can facilitate patient's understanding and acceptance of the surgery.
Conclusion: We have demonstrated that combining facial rejuvenation and significant facial bone contouring can be done safely with precision and a high degree of patient satisfaction. With the appropriate pre-operative work-up and precise execution of the surgery, we believe that combination surgery including cheek bone reduction, jaw angle reduction and facelift can be performed together with no additional morbidity.
