Facial contouring is a generic term for surgery changing the shape of the face by operating on facial bones.
There are broadly two main methods of facial bone surgery. One is reducing bones by cutting or grinding them. Square jaw surgery is a representative surgery reducing bones. Another way is cutting the bones, then repositioning them. Such repositioning method is used for cheekbone or chin surgery.
There is something that must be considered when it comes to changing the face shape by reducing jaw bone. Which is that change in bone responds to a different degree depending on what part of the jaw.
For example, even if you cut the bone in a straight line as though cut with a ruler, unfortunately, the jawline that we see on the exterior does not result in a straight line. This is because each part of the jawline responds to the reduce jawbone to a different degree. So the areas that react well will go in while the areas that react less will appear relatively convex. And the more flesh you have on your jawline, the less elastic your skin is, the worse this gets.
More specifically, the chin responds less due to muscle, and mid-jawline along the mandibular body also responds less due to fat and loose skin. On the other hand, each part is responsive, and the chin and mid-jaw area respond well. If you were to cut a lot of the jawline in a straight line, the area between the chin and mid-mandibular body will appear indented and the mandibular body will likely appear convex in shape. This is similar to the drooping jawline of elderly people.
As such, when planning bone surgery, if the amount cut is planned just looking at the shape of the bone, the actual face resulting will take on a different shape than planned.
I devised REAL (Reverse Estimating Amount of Lessen) which is a new method of jawbone surgery planning that resolves such problem. Firstly, not only is the skeleton observed through X-ray, the actual state of the face is observed closely. In particular, the condition of soft tissues, the degree of skin elasticity, amount of fat along the jawline, how much the skin is sagging at the moment, among other considerations are grasped as accurately as possible.
Then, the amount of change to the actual face is determined. Lastly, where the bone will be reduced as well as the amount of reduction is determined from the resulting amount of change in the actual face. This is called reverse estimation method because the amount of bone reduction is calculated backwards considering how the skin will react.
The major rule of thumb here is to reduce bones less where the skin is responsive to bone changes, and to reduce bones a lot where the skin is less responsive. Specifically, less bone is reduced in the chin and mid-jawline where skin responds well while more bone is reduced along the mandibular body where skin is less responsive.
The bottom line is that cutting in a straight line simply looking at the bone image alone does not result in a good jawline shape, and it is necessary to evaluate the condition of the soft tissue and operate appropriately on each part of the jawline to create a smoother and more attractive jawline.
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