Homepage Star of June 2015
Mandible reduction is the first surgery that has been used to make the face smaller for cosmetic purpose. However the prototype of this procedure mainly forced on the angle of the mandible bone. This type of surgery has limited effect on facial width reduction except for less than one fourth of the facial reduction candidates whose square face is caused by the eversion of the mandible angle. For the majority of the candidates a combination surgical bone removals on the mandible body, mandible angle, lower edge of the mandible and masseter muscle resection are needed for an effective reduction and a natural post surgery result. According to this Dr. Ma (the author) introduced mandible sculpture technique in facial reduction surgery to insure the reshaped mandible bone resemble those born smaller. The angle of the mandible, serves as an anatomical landmark on the face, is reserved after necessary modification with this technique.
The girl on this page had a square face and her zygomatic bone was not big. The width of the forehead matched the width of the middle face and there was no need of a zygomatic bone reduction. Her face looked bonny and masculine with a lowered facial center of gravity. However her mandible angle had no signs of eversion under CT and physical examinations. A mandible sculpture and a masseter muscle reduction surgeries were the appropriate choices of selection for her square face reduction and center of gravity modification.
After mandible reduction and masseter muscle resectomy the lower face is narrower and the center of gravity of the face moved upwardly.
The angle of mandible is still shown on the post-surgery photo. The reservation of the mandible angle didn’t compromise the facial reduction effect as shown in the above photos.
Angle reserve mandible reduction made the after surgery facial outline looks more natural.
In??the after surgery profile view this girl’s mandible angle still present as a body surface landmark, no trace of surgery at all. No matter under what post there is no sign of any defect in the mandible angle area. In the front view photos, the width of the lower face is narrowed down remarkably, indicating that the mandible sculpture technique reserves the angle of the mandible yet can achieve definite reduction result. After surgery her facial outline looks gentle and smooth, no more signs of masculine, nor bony face. Her facial center of gravity is also lifted.
When reaching adulthood the angle of mandible or “the heel” is formed and remains to old age.
In a normal mandible bone between the mandible ramus and the mandible body there is a angle prominent frontally and downwardly, like the heel of a shoe. So we sometime refer it as the “heel” of the mandible. The above photo shows the mandible bone of an elderly. Though the alveolar bone is atrophic the “heel” is still vivid and no obvious sign of bone absorption. If the angle of mandible is cut according to the holes and marks on the bone in the picture, the bony mark of mandible angle on the face would disappear and the facial figure is also compromised.
An mandible angle over cut can produce a difference like this.
The human mandible is born with the “heel”. If it is removed surgically an unnatural facial figure can be produced, or even “horse face deformity” can be caused. On the right there are two photos from the internet search. Comparing these profile pictures one can have a better understanding of the influence of over done mandible angle reduction on the facial structure. The face on the right side is slimmer. But slim alone doesn’t necessarily mean beauty. The defect of the angle of the mandible may not be able to please most people’s aesthetic standard.
As surgical technique of mandible reduction improves for facial bone reshaping and the candidate’s aesthetic standard becomes more practical, more and more cosmetic surgery candidates start to appreciate the importance of reserving the mandible angle as an body surface landmark and a sign of beauty while planning for their surgery. Most skilled surgeon are very capable of trimming the face slimmer and still left a beautiful angle intact at the corner of the mandible below the earlobe.