Surgical modification of the lower third of the face

Mandibular bone reshaping and facial oval surgery

Mandibular bone reshaping surgery is the cornerstone of the lower facial modification, after hair removal by laser and/or electrolysis for light-colored hair.

The angle of the lower jaw is more pronounced, associated with a wider, less rounded jaw and chin shape in men, giving a square face appearance.

It is possible to reduce this angle, but the effect is often limited because it does not act on the volume of the masseter muscle which forms the essential contour, especially in subjects who brux or clench their jaws at night. In these conditions, botulinum toxin is the most effective treatment.

It's easier to reduce or refine the chin. Projection of the chin can be achieved with a silicone prosthesis, and the square aspect reduced by bone modelling and muscle plasty of the chin tuft muscles. 

It is also possible to reduce the rounded side of the mandible to obtain a V-shaped appearance of the lower third of the face.

              

It is therefore necessary to carry out a precise pre-operative clinical and radiological study to determine the area to be reduced; this reduction does not involve muscle or skin structures.

Surgical technique :

- under general anaesthetic

- vestibular incision (between cheek and mandible) to approach the bone directly and reduce it by direct milling

- endo-buccal closure with absorbable stitches, transcutaneous drainage sometimes necessary

Operative sequences :

- outpatient surgery is possible, but a 24-hour hospital stay is more comfortable

- moderate pain, food remains mushy for a week

- antibiotics and mouthwash are prescribed

- a compression bandage should be worn for a few days to limit swelling and the risk of haematomas

- the definitive result should not be assessed before 3 months, as swelling takes a long time to disappear and structures must be allowed to settle back into place

Operating risks :

- endo-buccal haematomas and bleeding

- bone infection (exceptional)

- lower labial and dental anesthesia (usually transient)

- facial nerve damage, unlikely in the mouth

 

preoperative and postoperative appearance of mandibular remodeling (+rhinoplasty)

  

                 

 

pre- and post-operative chin reshaping (reaming + muscle plasty)

              

pre- and post-operative chin reshaping (advancement osteotomy) + lip-lift revision

  

  

pre- and post-operative chin and mandible remodelling, V-shaped appearance

 

pre- and post-operative chin reshaping (plastic + prosthesis)

  

        

 

Facial oval surgery is performed with a cervical mini-lift, possibly combined with submental liposuction or liposculpture of the face. It harmonizes contours and restores volume without modifying the face in depth.

preoperative appearance before rhinoplasty and mini-lift for facial oval

  

post-operative appearance

  

 

 

This surgery can also be proposed for rejuvenation/feminization combining a cervical lift and lipofilling for aesthetic purposes, combined with rhinoplasty in this example.

  

post-operative appearance

  

 

 

Liposculpture or Lipofilling

This simple and rapid complementary procedure involves removing fat from the patient's inner knees, thighs or abdomen and reinjecting it into the hollow areas of the face after centrifuging. The result is more youthful contours and improved skin quality.

Preoperative appearance before rhinoplasty, genioplasty, liposculpture

  

Post-operative appearance

  

Preoperative appearance before rhinoplasty, genioplasty

 

Preoperative appearance before genioplasty, liposculpture and minilifting of the oval of the face

 

Post-operative appearance 

 

Preoperative appearance before rhinoplasty, liposculpture and minilifting of the facial oval