Total Facial Plastic Surgery

 

700. Total Facial Plastic Surgery
Facial plastic surgery refers to all surgical and non-surgical procedures related to the face. While most people may think only of eye, nose, contour, or lifting procedures, true facial surgery encompasses a much wider spectrum.

From front to back (surface to deep), it includes:
– Skin surgery,
– Fat surgery,
– Fascial surgery,
– Muscle surgery, and
– Bone surgery.

From top to bottom, we divide the face into:
– Upper face (e.g., forehead surgery – see 660mm),
– Midface (e.g., cheekbone surgery – 670mm),
– Lower face (e.g., jaw surgery – 680mm).

By anatomical region:
– Eye surgery (620mm),
– Nose surgery (630mm),
– Mouth surgery (640mm),
– Ear surgery (650mm).

Choosing the right procedure shouldn't rely solely on the patient’s request, but must be based on objective analysis by the surgeon, then matched with the patient's goals.

For example, if a patient wants deeper, symmetrical double eyelids due to asymmetry, but has protruding eyes causing the imbalance, and this isn’t acknowledged or understood, the eyelid surgery alone will likely fail. The crease may loosen or become asymmetrical. In this case, the surgeon must first correct the eye protrusion and asymmetry, then perform double eyelid surgery 3 months later for stable, symmetrical results.

Another case:
If a patient wants a facelift to look younger due to sagging skin, but has prominent cheekbones and angular, asymmetrical jawbones, lifting alone won’t be effective. In such cases, combining facial contouring surgery (to reduce cheekbones and jaw size) with the facelift maximizes the effect—allowing more excess skin to be removed and enhancing the lifting vector, especially since facial ligaments are already detached during contouring.

Without this insight, performing a facelift alone based on the patient’s wish could result in poor outcomes and low satisfaction.

Another example:
A patient with mandibular prognathism comes for jaw surgery but wants only a single-jaw (mandibular-only) surgery to save cost. If the surgeon follows this without checking the airway on CT, the patient may suffer sleep apnea post-op. An expert should analyze airway width and recommend double jaw surgery if needed. Also, since double jaw surgery can widen the nose, patients should be informed of possible changes and consider simultaneous rhinoplasty.

Using submental intubation, both procedures can be done together. Instead of synthetic implants, rib cartilage particles can be used to shape the nose and stored for future touch-ups like cartilage fillers. This prevents nasal collapse, addresses sleep apnea, and allows for future refinement, improving both safety and satisfaction.

Facial plastic surgery is not just about the outer layer—it requires understanding the anatomy from bone to skin, from upper to lower face, across eyes, nose, mouth, ears. A truly complete approach requires knowledge of ophthalmology, ENT, and dentistry to ensure precise results and proper management of any side effects.

[Facial plastic surgery is total surgery—from the inside out, top to bottom, with comprehensive anatomical and interdisciplinary knowledge.]
– 700 mm Growing Pine Tree 🌲

Oro-Facial Plastic Surgery

 

699. Oro-Facial Plastic Surgery
Oro-facial plastic surgery is not simply about reshaping the lips—it’s a comprehensive approach that considers the harmony of the lower face structure and the overall facial proportions when correcting issues around the mouth.

For subtle correction of protruding lips, TADs (Temporary Anchorage Devices) can be fixed to the alveolar bone to precisely move teeth in the desired direction—allowing retraction of front teeth even without extractions. In more pronounced cases, anterior segmental osteotomy (ASO) may be performed, instead of or in addition to orthodontics.

For open bites, orthodontics alone is often insufficient, and orthognathic (jaw) surgery may be necessary. In severe cases, triple jaw surgery (maxilla, mandible, and ASO) is needed to achieve proper alignment.

When there is facial asymmetry due to one-sided mouth corner elevation, orthognathic surgery helps align the upper and lower jaws. In mandibular prognathism (prominent lower lip or chin), correction may involve mandibular setback or rotation jaw surgery (rotational orthognathics). For receding chins with protrusive upper lips, options include orthodontic retraction of the upper teeth, chin advancement surgery, or counterclockwise jaw rotation, which can also improve sleep apnea by advancing the airway space.

When the gums are overly exposed while smiling, and the midface is long enough to show the upper teeth even at rest, severe cases may require maxillary impaction (upper jaw elevation) via jaw surgery. Milder cases can be treated with botulinum toxin injections targeting the elevator muscles of the upper lip and depressor muscles of the nasal tip.

For retruded mouths, the angle of the upper teeth may be corrected with orthodontics, but if the maxilla is recessed, maxillary advancement through jaw rotation surgery is required to correct midface depression.

Factors such as:
– Whether the mouth is protruding or sunken,
– Whether the lip corners are symmetrical,
– The relationship between upper and lower teeth,
– The presence of overbite, underbite, or misalignment,
– Whether the dental axis is tilted—
all determine the right treatment plan. This may include orthodontics, TADs, ASO, orthognathic surgery, or even triple jaw surgery.

These decisions are made after analyzing medical facial photos, dental models, and 3D facial CT scans.

Oro-facial surgery is not just about changing the shape of the lips—it’s about correcting the relationship between the upper (maxilla) and lower (mandible) facial structures.

[Oro-facial surgery is about analyzing and correcting both mouth-related and mid-lower facial issues together.]
– 699 mm Growing Pine Tree 🌲

Oto-Facial Plastic Surgery

 

698. Oto-Facial Plastic Surgery
Oto-facial plastic surgery is not just about correcting the ears—it’s a comprehensive facial surgery concept that considers the harmony of the midfacial side profile and overall facial proportions.

The ears significantly influence the side view of the face. While they’re barely seen from the front, they complete the facial image when viewed at a 45-degree angle. Folded ears may appear youthful but can lack maturity. Protruding ears make the face look inward or narrower from the side. The ears’ size, position, and angle are closely linked not only with the eyes, nose, and mouth, but also with the skull contour and jawline.

Uneven ear height can make wearing glasses or sunglasses difficult. Ear asymmetry can further highlight facial asymmetry. In flat-head syndrome (plagiocephaly), one ear may be more forward and the other more backward, exaggerating imbalance.

The ears are closely related to the jaw. Smaller ears often accompany smaller jaws because both originate from the first pharyngeal arch during embryonic development. That’s why people with microtia often also have a recessed chin.

For example:

• Treacher-Collins syndrome features bilateral microtia, receding chin, and underdeveloped cheekbones.

• Goldenhar syndrome shows unilateral microtia with one-sided chin deficiency and facial asymmetry.

• Nager syndrome presents with microtia, chin and cheekbone deficiencies, and limb deformities.

• CHARGE syndrome can involve microtia with mandibular hypoplasia, heart defects, coloboma, choanal atresia, and genital abnormalities.

Underdeveloped ears often correlate with smaller temporomandibular joints (TMJ), which play a vital role in chewing. If TMJs are small or dysfunctional, chewing becomes inefficient—affecting digestion and energy intake.

Thus, oto-facial surgery may include:

• Chin advancement surgery for recessed chins,

• Orthognathic surgery for facial asymmetry,

• Ear reconstruction with rib cartilage for microtia,

• and fat grafting for facial volume enhancement.

In summary, smaller or painful ears tend to be associated with smaller jaws and more convex facial profiles, while larger, healthy ears are often linked with larger jaws and concave profiles. Ear development directly affects facial volume and shape, forming one of the two structural axes of the side profile along with the jaw.

[Oto-facial surgery is about correcting ear-related and side-profile facial issues together.]
– 698 mm Growing Pine Tree 🌲

Rhino-Facial Plastic Surgery

 

697. Rhino-Facial Plastic Surgery

Rhino-facial plastic surgery is not just simple nose surgery. It is a comprehensive facial surgery that considers the harmony of the midface structure and overall facial proportions. While rhinoplasty focuses on improving the nose—raising a low bridge, lowering a high one, or straightening a crooked nose—rhino-facial surgery also examines surrounding features. Is the nose sunken? Are the areas around it flat? Is the midface lacking projection, making the face appear long or flat depending on the nose height?

Orthognathic (jaw) surgery often causes nostrils to widen. Also, in cases of dorsal humps, jaw surgery alone sometimes corrects them. Therefore, patients considering jaw surgery should always think about rhinoplasty, either simultaneously or afterward.
For drooping noses (so-called “arrow noses”), maxillary advancement during jaw surgery naturally rotates the tip upward. At the same time, rib cartilage can be grafted to refine the tip and bridge.

When the midface is sunken, rotational jaw surgery can make it fuller. Using submental intubation helps avoid nasal widening and enables simultaneous rhinoplasty. Maxillary advancement ultimately creates a more convex, balanced profile.

In patients without occlusal issues but with a sunken midface, micro-rib cartilage grafts around the nose (nasal base augmentation) and rhinoplasty can be done together to transform a hollow appearance into a more projected one.

Smiling habitually on one side can deepen nasolabial folds and hollow the nasal base on that side. Over time, this causes the nasal tip to collapse asymmetrically, leading to a deviated nose. Continuous unilateral muscle use (levator muscles, zygomatic muscles) gradually bends the nose—twisted expressions creating a twisted nose. Rhinoplasty in such cases is often motivated by a desire to correct not just appearance, but the emotional distortion reflected in it. However, unless the smiling habit is also corrected, recurrence is possible.

If the brow bone is overly prominent, the nasal root may appear too low. One might wish to match the nose to the high brow bone, but this can result in an avatar-like, oversized nose. Rather than augmenting the nose to cover the issue, it’s better to surgically reduce the brow bone directly.

Rhino-facial plastic surgery, therefore, spans from the brow bone to the upper teeth. It involves not only rhinoplasty, but also brow bone surgery, cheek lifting, perinasal augmentation, and jaw surgery—all of which influence the nose and midface. It is crucial to analyze the whole face to determine what underlying issues are causing nasal problems, and to correct them first or simultaneously to prevent recurrence.

[Rhino-facial surgery is about correcting the facial causes behind nasal problems.]
– 697 mm Growing Pine Tree 🌲

Eye-Face Surgery

 

696. <Eye-Face Surgery>

Eye-face surgery goes beyond basic eye procedures—it's a comprehensive approach that considers the entire facial structure and proportions when correcting or enhancing the eye area.

Double eyelid surgery simply creates creases, and canthoplasty (epicanthoplasty, lateral, and lower) enlarges the eye. However, these can affect facial harmony—for instance, inner corner surgery can make the eyes look too close together, unintentionally making the nose look taller and the midface appear wider. Eye-face surgery offers proportion-based solutions, not just desired changes.

For patients with protruding eyes, it’s essential to first correct the asymmetry and wait for swelling to subside before performing eyelid surgery. This reduces the risk of asymmetry or relapse.

In cases of ptosis (droopy eyelid) with facial asymmetry, correcting eye protrusion first allows for more accurate and balanced ptosis correction.

A prominent brow bone can make the eyes look deep-set and the nose flatter. Reducing the brow bone can reveal the actual eye depth, helping plan the most suitable eyelid design through 3D CT and photo analysis.

If the forehead is asymmetric, correcting it with fat grafting or implants first helps assess true eye symmetry.

Ultimately, eyelid surgery should follow careful analysis—and, if necessary, correction—of the forehead, brow bone, and orbital bone asymmetry. Otherwise, repeat surgeries are more likely.

Many patients seek under-eye fat repositioning, but if the eye is protruded, correcting the protrusion alone often improves the bulge without touching the fat.

The best eye surgery is not needing one—but if you're going to do it, do it right. Analyze the full face, understand what caused the eye issue, and fix the underlying cause first to avoid recurrence.

[Eye-face surgery means correcting facial causes behind eye problems.]
– 696 mm Growth Pine Tree –

Facial Fat Grafting

 

695. Facial Fat Grafting

Facial fat grafting adds volume and shape by injecting your own fat into hollow or flat areas. Common areas include the forehead, front cheeks, and chin—where fat is placed near bone for better stability. Areas like the lower cheeks (deep buccal fat) are usually avoided, as fat there can sag over time.

Sunken temples or upper eyelids can also be treated. In people who overuse their eyelid muscles, fat tends to burn away faster, making grafts reabsorb quickly. These patients often need a second or third graft.

Forehead grafts should subtly recreate the brow bone to look natural. A too-round forehead can appear artificial. Fat between muscles and skin also reduces forehead wrinkles by increasing the skin-muscle distance.

Under-eye fat grafting helps smooth uneven bulges when muscle tone is weak. But areas like the nasolabial folds move constantly, so fat there doesn’t last long and may disappear within weeks.

Fat is energy. It’s harvested from low-activity areas like the abdomen or thighs and placed in high-activity areas like the face, where it may get used up. That’s why some reabsorption is natural.

To improve fat survival: limit facial movement, avoid stimulation, and sleep early—growth hormone released at night supports healing. If needed, preserved or fresh fat can be used for touch-ups.

Facial fat grafting is the art of transferring body energy to the face—to restore and reshape.

– 695mm Growth Pine 🌲

Facial Wrinkle Surgery

 

694. Facial Wrinkle Surgery

Facial wrinkle surgery includes various treatments to improve wrinkles and sagging skin due to aging.

At the early stage of aging, non-surgical methods are often enough:

• Botox reduces forehead, frown, and crow’s feet lines by relaxing overused muscles.

• Fillers restore volume to deep wrinkles like nasolabial folds.

• Thread lifting helps with sagging in the jawline and lower face.

When sagging becomes more obvious, surgical facelifts are more effective. Depending on the area, techniques include:

• Upper face: forehead or brow lift, upper eyelid surgery

• Midface: cheek lift, mini-lift, lower eyelid surgery

• Lower face: lower facelift, neck lift

Mini facelift uses short incisions in front of the ear, lifting the SMAS layer at a 45° angle. It's less invasive, good for the lower face, with low nerve risk.
Extended SMAS facelift lifts the SMAS flap to improve the lower face but is less effective for the midface.
Deep plane facelift lifts skin and muscle together below the SMAS, offering excellent improvement in both mid and lower face. It heals fast and is more durable, but requires advanced surgical skill.

Intraoral dissection can release key ligaments (zygomatic, mandibular, masseteric) from the bone, helping with facial lifting, especially when combined with facial contouring surgery.

But why do faces sag again over time? It’s not just skin — facial bone loss plays a major role.

To maintain long-lasting results:
✔ Do facial blood flow exercises
✔ Sleep deeply to support bone regeneration
✔ Eat whole, natural foods to slow bone loss

Facial wrinkle surgery is about remodeling the skin and fascia over a shrinking bone structure.
– 694mm Growth Pine Tree 🌲

Facial Paralysis Surgery

 

693. Facial Paralysis Surgery

Facial paralysis surgery refers to procedures that restore balance and expression to the face after facial nerve damage, often affecting one side. The facial nerve (7th cranial nerve) controls facial muscles, so when it is injured, facial asymmetry or loss of movement can occur.

There are two main approaches:
Static reconstruction improves symmetry by lifting sagging tissue, inserting weights into the upper eyelid to help it close, reshaping drooping eyes (canthoplasty), and lifting a drooping mouth corner using materials like threads or fascia. These methods restore balance but not movement.

Dynamic reconstruction restores movement. It includes:

• Nerve grafting: Connecting branches from the healthy facial nerve to the paralyzed side (cross-facial nerve graft), or using nerves like the hypoglossal (tongue) or masseter (chewing) nerve to help regain a smile.

• Free muscle transfer: Transplanting muscles like the gracilis to the face, connecting them to nerves and vessels, allowing them to move again.

• Muscle transfer: Transposing nearby muscles like the temporalis to the mouth area, enabling a smile by clenching teeth. This is useful for older patients or when microvascular surgery isn’t possible.

But what causes facial paralysis?
Often it's a mix of factors: weakened muscles from one-sided habits, poor sleep, processed food, chronic lymphatic congestion, viral infections, or even sudden weather changes affecting facial nerve blood flow.

When negativity lingers too long and meets the right (or wrong) conditions, facial paralysis may result.
But if we shift our mindset—see life more positively and fill each day with happiness—we can protect our expressions and spirit.

Facial paralysis surgery: restoring expressions lost from a twisted mind and tense life.
– 693mm Growth Pine Tree 🌲

Facial Resurfacing Surgery

 692. Facial Resurfacing Surgery

Facial resurfacing is a procedure that removes the outer layers of skin to stimulate regeneration and reveal smoother, healthier skin beneath. There are three main types: chemical peeling, mechanical peeling, and laser resurfacing—with laser being the most commonly performed today.

Chemical peels use acids to dissolve and remove damaged skin:

• AHA (Alpha Hydroxy Acids) like glycolic acid target the epidermis, while lactic acid is gentler—great for sensitive skin.

• BHA (Beta Hydroxy Acid) such as salicylic acid is oil-soluble and effective for acne-prone skin.

• TCA (Trichloroacetic Acid) can reach deeper layers and is used for scar treatment depending on its concentration.

• Phenol peels go deepest, offering dramatic results but with higher risk and longer downtime.

Mechanical peeling involves physically sanding the skin using a high-speed rotating device. It’s often used for deep acne scars or raised moles, but comes with more bleeding, longer recovery, and high dependence on the practitioner's skill.

Laser resurfacing precisely removes skin using laser energy and promotes collagen regeneration:

• CO₂ lasers (10600nm wavelength) target water in tissues, reaching the upper dermis—ideal for deep wrinkles and acne scars.

• Er:YAG lasers are more water-absorbent, allowing gentler, more precise peeling for fine lines or mild scars with fewer pigment risks.

• Fractional lasers treat only tiny portions of the skin in columns, speeding recovery while improving scars, pigmentation, and fine lines.

• Non-ablative lasers don’t peel the skin but deliver heat to stimulate collagen. They’re safe for pigment issues and fine lines but require multiple sessions.

Since skin regeneration mainly occurs during sleep, proper sleep habits—especially before and after treatment—are essential. Late nights or insomnia can delay recovery.

Facial resurfacing is a form of skin rejuvenation where intentional exfoliation leads to purposeful renewal.

Facial resurfacing is a sculpted renewal through controlled exfoliation.
- 692mm Growing Pine Tree 🌲

Facial Scar Revision Surgery

 

691. Facial Scar Revision Surgery

Facial scar revision aims to reduce the visibility of various types of scars—raised, sunken, pigmented, pale, or contracted—to enhance appearance. Why do scars form differently even with the same incision? It’s not just about your “skin type,” but more about your lymphatic system. When lymph vessels are well-developed and clean, cellular waste drains efficiently, minimizing inflammation and scarring. However, if lymph flow is blocked or polluted—often due to processed foods—the buildup of toxins irritates tissues, leading to hypertrophic scars, keloids, or atrophic scars depending on blood supply and damage level.

To treat scars surgically, local flap techniques such as Z-plasty and W-plasty realign scars along natural skin tension lines, making them less noticeable. For deep sunken scars, dermal grafts or fat grafting can be used. Since fat graft survival may be low in scar tissue, we combine treatments like subcision, PRP (Platelet-Rich Plasma), ADSC (Adipose-Derived Stem Cells), SVF (Stromal Vascular Fraction), and hyperbaric oxygen therapy.

Non-surgical treatments also play a key role. Radiofrequency (RF) helps remodel collagen by gently heating the dermis. Laser therapy breaks down scar tissue and promotes regeneration. Low-Level Light Therapy (LLLT) stimulates mitochondria to boost cellular repair and speed up scar healing. Advanced micro-optic devices now allow ultra-fine skin grafting for even more precision. For raised scars, silicone gel pressure therapy can also be effective.

Ultimately, scar outcomes improve not just with procedures but with lifestyle: eat clean (avoid food additives), exercise to detox lymph fluid, and sleep deeply from 10 PM to 5 AM—the prime time for skin repair.

Facial scar revision is the art of making what remains... beautifully unnoticeable.
- 691mm Growing Pine Tree 🌲

Facial Bone Surgery

690. <Facial Bone Surgery>
Facial bone surgery reshapes the facial skeleton for aesthetic and functional improvements. The face is made up of 15 bones, and most are involved in facial bone surgery, excluding the sphenoid, lacrimal, and palatine bones.

Forehead bones can be reduced or filled using shaved bone or implants. Brow bones may be contoured by pushing in the frontal sinus or shaving thick bone. Temporal bones can be reduced by grinding muscle attachments and weakening the temporalis muscle for a slimmer side profile.

Orbital bone surgery adjusts the eye socket. Protruding eyes are corrected by expanding the orbital space (medial, inferior, lateral walls). Sunken eyes are corrected by filling the orbit with implants or autologous grafts like rib cartilage or bone particles.

Nasal bone surgery includes narrowing wide nasal bones and correcting hump noses via preservation rhinoplasty. A deviated septum is straightened, and inferior turbinate bone may be repositioned outward to improve airflow in cases of rhinitis.

Zygoma surgery includes reduction (moving the arch and body inward) and augmentation (enhancing the flat cheek area with implants, fat grafts, or rib cartilage).

Maxillary surgery (Le Fort osteotomy) repositions the upper jaw with the dental arch. Sunken areas around the nose can be enhanced with grafts for a fuller midface.

Mandibular surgery includes sagittal or vertical osteotomy to reposition the lower jaw. When both upper and lower jaws are corrected, it's called two-jaw surgery (orthognathic). Jawline contouring, cheekbone reduction, and chin surgery can be done independently or with two-jaw surgery.

Facial bones protect sensory organs and also shape facial appearance. Whether for trauma, congenital reasons, or beauty, facial bone surgery can be tailored to each patient.

[Facial bone surgery reshapes the bones that protect your senses into a face you want to reveal.]
– 690mm Growing Pine Tree –

 

Facial Contouring Surgery

 689. <Facial Contouring Surgery>

Facial contouring surgery aims to create a balanced, harmonious, and attractive facial shape by adjusting the contours of the face. It can be divided into upper, mid, and lower facial contouring.

Upper face contouring includes forehead or temporal contouring using fat grafts or implants to add volume. Autologous bone grafts can also be used—often by crushing bone from jaw or cheek surgeries and grafting it onto the forehead.

Midface contouring typically involves zygoma (cheekbone) surgery. Zygoma reduction reduces protruding cheekbones for a slimmer midface, while augmentation enhances flat anterior zygoma for a more dimensional look.

Lower face contouring includes square jaw reduction and chin surgery. Chin contouring can involve reducing, elongating, advancing, or setting back the chin. Combining jaw angle reduction with chin contouring helps create a slimmer, V-line facial profile—popular in modern aesthetics.

1:1 facial photos and 3D-CT scans are essential. These help analyze bone and soft tissue to determine the amount of reduction needed while avoiding nerve damage. If maxillary sinus inflammation is present, it must be treated before zygoma surgery to prevent complications.

Since zygoma reduction involves separating and fixing parts of the bone, habits like teeth grinding or prolonged chewing may affect bone healing. Botox or other treatments may help prevent nonunion in such cases.

V-line jaw surgery reduces the jaw angle and width while refining the chin. In cases with sleep apnea, genioglossus advancement moves both the chin and tongue forward to widen the airway and improve breathing.

If the skin is significantly loose—especially in patients over 40—facelift surgery may be combined. When done together, the same incision in front of the ear can be used to fix the zygomatic arch, eliminating the need for a separate sideburn incision. The detachment during bone exposure also severs ligaments between skin and bone, making skin lifting easier and more effective—even with a minimal incision. Especially for chin advancement in older patients, the lifting effect can be more pronounced.

Facial contouring surgery thus reshapes the facial bones to create a slimmer and more harmonious appearance.

[Facial contouring shapes facial balance through bone refinement]
– 689mm Growing Pine Tree –

Orthognathic Surgery

 

688. <Orthognathic Surgery>
Orthognathic surgery, or double jaw surgery, involves cutting and repositioning the upper (maxilla) and lower jaw (mandible) to correct misalignment. Ideally, the jaws align in a perfect bite, but varying degrees of discrepancy can require surgery.

The most common method for repositioning the upper jaw is the Le Fort I osteotomy. If the upper jaw is retruded (flat face), it's moved forward; for protruding mouths, it is set back. In long midface cases, especially when gums show while smiling, the maxilla is reduced to balance the distance between the eyes and teeth.

Those who chew hard food often have overgrown back maxillae, flattening the occlusal plane. By reducing the posterior part and rotating the jaw clockwise, volume in the midface increases, creating a youthful appearance and a natural smile arc.

When the lower jaw is overly developed (prognathism), it’s often due to genetics or strong chewing habits. The Sagittal Split Ramal Osteotomy (SSRO) is the typical method to reposition the mandible, while the Intraoral Vertical Ramus Osteotomy (IVRO) separates the jaw vertically.

SSRO offers wide bone contact for stable healing but carries a higher risk of inferior alveolar nerve damage, depending on nerve canal anatomy. IVRO minimizes nerve risk and is often used for TMJ disorders or severe facial asymmetry, though it may require non-fixed healing, causing patient discomfort.

In cases with a narrow airway or asymmetry, lower jaw surgery alone isn't enough—both jaws must be addressed. Severe bimaxillary protrusion may also require an Anterior Segmental Osteotomy to reduce the premolar region.

Orthognathic surgery can correct underbites, protrusions, asymmetry, long face, and sleep apnea by restoring jaw harmony. Braces may be needed before (pre-surgical orthodontics) or after surgery (surgery-first approach), so dental evaluation is essential.

[Orthognathic surgery harmonizes upper and lower jaw imbalance]
– 688mm Growing Pine Tree –

Mandibular Surgery

 

687. Mandibular Surgery

Mandibular surgery reshapes the lower jaw to improve facial harmony, occlusion, and function. It starts by evaluating the chin’s position. In cases of a recessed chin, genioplasty (chin advancement) is performed through horizontal osteotomy. If the chin is blunt or wide, a T-shaped osteotomy can advance and refine it. For severe retrusion affecting breathing (like sleep apnea), genioglossus advancement surgery may be added for functional improvement.

Asymmetric chins are corrected with wedge osteotomy, followed by long curved mandibular angle contouring and cortical shaving to create a slimmer “V-line.” In cases where a T-osteotomy is not suitable due to a wide midline, surgery is done in two stages—initial contouring followed by chin advancement after 6 months.

For patients with protruding “witch chin,” chin reduction is combined with V-line contouring to soften the look. When the entire lower jaw is overly forward and misaligned, sagittal split ramus osteotomy (SSRO) moves the jaw backward using a wafer to properly align the bite. In cases of severe asymmetry, vertical ramus osteotomy is preferred for better nerve protection and jaw correction.

Advanced techniques now allow 3D simulation and custom surgical guides to minimize errors and match surgical results with pre-op plans. Endoscopic-assisted surgery reduces swelling, and navigation systems help confirm accurate jaw positioning during surgery.

In older patients, jaw contouring may lead to loose skin. A facelift can be done simultaneously to lift and tighten the jawline, ensuring youthful results.

Post-op, jaw joint (TMJ) rehabilitation is critical. Without proper exercises, the joint can stiffen, so guided movement and recovery protocols are essential to prevent long-term dysfunction.

Mandibular surgery is a key part of facial contouring and orthognathic surgery, shaping the foundation of the lower face.

[Mandibular surgery is the foundation of lower facial sculpting.]
– 687mm Growing Pine Tree –

Maxillary Surgery

 

686. Maxillary Surgery

Maxillary surgery corrects the position and shape of the upper jaw to enhance facial harmony, occlusion, and aesthetics. The maxilla connects to the cheekbones laterally, surrounds the nasal area at the front, and is bordered internally by the maxillary sinus, which helps regulate temperature through ventilation.

When the upper jaw is underdeveloped, Le Fort I osteotomy is performed to advance the maxilla. This horizontal osteotomy enables forward or backward movement of the maxillary segment depending on the patient’s needs—whether to correct sunken midface or a protruding upper jaw. If the occlusal plane is tilted, the jaw can be rotated and fixed to align with the interpupillary line using wedge-shaped adjustments.

In cases where the protrusion is localized to the anterior maxilla (such as mild bimaxillary protrusion), anterior segmental osteotomy (ASO) may be performed instead. This involves extracting premolars and moving the front maxillary segment backward. Sometimes both Le Fort I and ASO are combined, dividing the maxilla into two or three segments for precise repositioning.

When the maxilla is too narrow—often seen in patients with cleft lip and palate and a history of multiple childhood surgeries—SARPE (Surgically Assisted Rapid Palatal Expansion) is used to widen the palate.

For congenital conditions like Crouzon or Treacher Collins syndrome with severely hypoplastic maxilla, Maxillary Distraction Osteogenesis helps lengthen the bone gradually.

Since repositioning the maxilla affects the bite, it’s often combined with mandibular surgeries like sagittal split or vertical ramus osteotomies to properly align the upper and lower jaws—this is known as bimaxillary surgery.

For patients with long midfaces or excessive gum show while smiling, upper jaw repositioning can involve upward movement and rotation to reduce gum exposure and improve smile aesthetics.

In older patients with short maxilla and missing teeth, titanium supports can be placed to hold dental implants, restoring bite function and facial volume for a more youthful appearance.

Maxillary surgery corrects jaws that are too long, short, forward, recessed, or rotated, bringing balance to the midface and alignment to the bite.

[Maxillary surgery sculpts the upper jaw for ideal proportion and harmony.]

– 686mm Growing Pine Tree –

Zygoma (Cheekbone) Contouring

 

685. <Zygoma (Cheekbone) Contouring>
Zygoma contouring is a facial bone surgery that reshapes the cheekbones to improve midface balance. It can involve reduction, augmentation, or asymmetry correction.

Zygoma reduction is done in two ways:

1. Non-fixation: The zygomatic arch is cut but not fixed. This avoids external scars but may lead to instability due to jaw habits like clenching or grinding.

2. Fixation: Both the zygomatic body (via intraoral incision) and arch (through a small cut near the sideburn) are cut and securely fixed. Though it leaves a minor scar, it offers better stability.

For older patients, zygoma reduction can be combined with facelift surgery. In these cases, the arch can be accessed beneath the SMAS flap during the facelift, eliminating the need for a separate incision at the sideburn.

When the midface appears flat or saggy due to weak cheekbones, zygomatic augmentation can help. A custom 3D-printed implant (based on facial CT scans) can be inserted through the mouth. For a natural alternative, midface lift (see post 664) and fat grafting can add volume without implants.

If the cheekbones are misaligned due to past trauma, they may cause eye asymmetry or enophthalmos (sunken eyes). In such cases, zygomatic repositioning is done. A 3D skull model and navigation system may be used for precise correction and symmetry.

Zygoma surgery is not just about making the cheekbones smaller—it's about reshaping and repositioning them to create a balanced and dimensional midface.

🦴 [Zygoma contouring restores volume and structure to the midface.]

—685mm Growing Pine—

Orbital Bone Contouring

 

684. <Orbital Bone Contouring>
Orbital bone contouring is a surgical procedure that adjusts the bones surrounding the eyes to move the eyeball forward, backward, or correct its position for aesthetic or functional improvement.

A common case is protruding eye correction (Exophthalmos Correction). This is often related to Graves’ disease, where overactivity leads to muscle and fat expansion behind the eye, pushing it forward. In serious cases, it may compress the optic nerve and affect vision. To relieve pressure, a procedure called orbital decompression surgery is performed, reducing the volume within the orbit.

Even without thyroid issues, some people naturally have prominent eyes due to narrow orbital cavities. For these cases, a cosmetic orbital expansion surgery is done by accessing the orbit through the conjunctiva and gently expanding the medial, inferior, or lateral orbital walls to create more space, allowing the eye to settle deeper.

On the other hand, if the eye is sunken (Enophthalmos), correction involves adding volume behind the eye. Causes include genetics, past trauma like a blowout fracture, or previous orbital surgery. Depending on the case, the sunken eye is corrected using implants—either artificial bone, autologous bone, or rib cartilage—inserted through a conjunctival incision. In revision cases, previous implants may need removal before recontouring.

When orbital trauma also involves zygoma (cheekbone) fractures, the orbital floor may drop, causing one eye to sit lower. In these cases, both zygomatic reconstruction and orbital repositioning are needed.

In essence, orbital bone contouring aims to move one or both eyes forward, backward, or upward to enhance balance and symmetry around the eyes.

🧠 [Orbital bone contouring adjusts the bone housing the eyeball to refine the periorbital area.]

—684mm Growing Pine—

Brow Bone Contouring

 

683. <Brow Bone Contouring>
Brow bone contouring refers to reshaping the brow ridge—either reducing a prominent brow bone or augmenting a flat one. If the brow bone protrudes, it can be shaved down or pushed inward. Whether shaving or repositioning is appropriate depends on the size of the frontal sinus and the bone thickness, which must be evaluated through a facial CT scan.

We refer to shaving the bone as PBBS (Prominent Brow Bone Shaving), and pushing the bone inward as PBBR (Prominent Brow Bone Reduction).

🔧 How is it done?
In PBBS, the bone is accessed through an incision at the eyelid crease or just below the eyebrow. A surgical burr is used to shave the bone, and bone dust is flushed out before suturing. If a visible scar is a concern, a hairline incision is preferred. The forehead skin is lifted to expose the brow bone, shaved down, and then the incision is closed at the hairline.
While endoscopic shaving is possible, it tends to flatten the brow rather than give it a natural curve, so it’s usually not recommended.

In PBBR, the forehead is accessed either directly through the hairline or 2cm behind it. If the patient has a long forehead, we use the hairline incision to reduce forehead height as well. The brow bone is then exposed, and based on the size of the frontal sinus, a portion of the bone is cut and carefully pushed inward, ensuring the sinus lining is not damaged. The repositioned bone is secured with micro-fixation pins, and if needed, the outer parts of the brow bone are also refined for aesthetic balance.

✨ For brow augmentation, especially in cases of over-reduction or naturally flat brows, rather than using implants (which carry infection risks), we prefer using autologous rib cartilage. The cartilage is finely ground into a paste-like filler and inserted above the brow bone via a hairline incision. This method allows for precise volume control, and stored cartilage can be used for touch-ups later.

In summary, brow bone contouring is a procedure that can reduce, augment, or reshape the brow area, giving you the exact degree of projection you desire—while always considering the anatomy of the frontal sinus.

🧠 [Brow bone contouring is brow reshaping with respect to the frontal sinus.]

—683mm Growing Pine—

Temporal Bone Contouring

 682. <Temporal Bone Contouring>

Temporal bone contouring refers to reshaping the side of the head. This procedure includes both temporal augmentation and temporal bone reduction.

If your temples are sunken in, it can make your cheekbones appear more prominent or give you a harsher look. In this case, you may want to add volume. On the other hand, if you're concerned about having a wide head—especially due to broad sides—you might want to reduce the width. However, not everyone is a candidate for bone reduction. A CT scan is required to assess the thickness of the temporal bone and whether it allows for safe shaving.

Temporal augmentation is safest when performed with fat grafting, rather than implants. Although some absorption of fat can occur, this is usually addressed through a secondary graft. To improve fat survival, botulinum toxin can be injected into the masseter and temporalis muscles to reduce muscle movement that leads to fat resorption.

Temporal bone reduction surgery involves making an incision behind the side hairline and dissecting along the temporal ridge to shave the outer part of the temporal bone. The procedure also includes temporal fascia decompression and detachment or weakening of the temporalis muscle’s origin, which reduces both bone and muscle bulk, resulting in a smaller, flatter head contour. Botox injections into the temporalis muscle further help optimize the reduction effect.

Temporal bone contouring aims to either reduce or enhance the lateral head width, depending on the individual's needs. It's crucial to carefully assess the temporal bone's thickness on CT beforehand to ensure only the safely reducible amount is shaved, thus avoiding any risk to the underlying temporal lobe.

🧠 [Temporal bone contouring is the art of adjusting the thickness of the side of the head.]

—682mm Growing Pine—

Forehead Bone Contouring Surgery

 

681. Forehead Bone Contouring Surgery

Forehead bone contouring enhances the aesthetic contour of the upper face. It includes forehead augmentation, which adds volume to flat or sunken areas to create a smooth, curved profile—and forehead reduction, which reshapes overly prominent, asymmetric, or uneven forehead bones.

For augmentation, both autologous (your own tissue) and artificial materials can be used. The most common autologous option is fat grafting, while artificial options include PEEK (PolyEtherEtherKetone) implants. These are strong, biocompatible materials created using 3D printing and sterilized before being inserted through a scalp incision as a customized implant.

For reduction, a CT scan checks bone thickness to assess if safe reshaping is possible. If the frontal bone is too thin or brain protection could be compromised, surgery may not be viable.

Incisions are usually made along or 2cm behind the hairline, allowing access to the frontal bone while keeping scars hidden. However, inserting implants or reducing bone can stretch or affect nerves (like the supraorbital and supratrochlear), leading to temporary or permanent sensory changes in the forehead or scalp.

Forehead reduction may also lead to skin sagging or eyebrow drooping due to reduced skin elasticity—making the face look older. To counter this, forehead shortening techniques similar to a lift may be combined for a more youthful appearance.

To reduce the risk of infection from implants:

• Sleep deeply and regularly (10PM–3AM is critical for melatonin & detox).

• Avoid shift work if possible before and after surgery.

• Eat clean—limit processed foods and additives that may trigger chronic inflammation.

• Sweat regularly through exercise to help the body eliminate waste.

A healthy lifestyle = longer-lasting, more stable results.

Forehead bone contouring refines the upper facial structure both aesthetically and harmoniously.

🌲 - 681mm Growing Pine Tree -

Jaw Surgery

 

680. <Jaw Surgery>

Jaw surgery refers to procedures and surgeries that aim to aesthetically improve or functionally correct the shape or position of the jaw. Non-surgical treatments for the jaw include jaw Botox and jaw fillers. Jaw Botox includes masseter Botox to reduce the square jaw and mentalis Botox to reduce chin dimpling (commonly known as "pebble chin"). Jaw fillers are used to address jaw asymmetry or to temporarily correct underdeveloped chins (also known as "recessed chins").

An underdeveloped chin can lead to the formation of a double chin, sagging chin fat, and the appearance of protruding lips. Therefore, chin advancement surgery may be necessary to correct double chins, sagging chin fat, or protruding lips. Especially in cases of underdeveloped chins, medical facial photography and 3D CT analysis are conducted to plan for chin advancement surgery.

The causes of recessed chins can be congenital—passed down through generations—or acquired through lifestyle habits such as eating quickly, chewing inadequately, or sleeping with the mouth open due to nasal congestion. In order to correct recessed chins, inserting artificial implants can lead to complications such as bone resorption, inflammation, or fluid accumulation. Therefore, it's better to correct the structure through bone-cutting techniques like osteotomy or bone resection.

To advance the chin, various surgical techniques such as horizontal osteotomy, vertical osteotomy, and inverted V-shaped osteotomy are performed. If the patient also has a narrow airway, a genioglossus advancement may be included in the surgery. This involves advancing the root of the tongue along with the chin, helping to widen the airway behind the tongue—resulting in functional improvement as well.

In severe cases of mandibular retrusion with obstructive sleep apnea, chin advancement alone may not be sufficient. In such cases, double jaw surgery may be required, where the upper jaw is reduced, and the lower jaw is rotated counterclockwise to advance the chin, often combined with genioplasty.

Conversely, if the chin is overly protruded, a reduction genioplasty, sometimes referred to as a "witch chin" correction, is performed. If the entire lower jaw is protruded and causes malocclusion, a sagittal split osteotomy (SSO) is used to reposition only the lower jaw. In some cases, the upper and lower jaws are repositioned separately—moving the upper jaw forward and the lower jaw backward—requiring double jaw surgery. A CT scan is used to evaluate the airway length to determine whether single or double jaw surgery is appropriate.

In cases of square jaw, both cortical bone resection and mandibular angle reduction (angle ostectomy) are performed simultaneously. If the chin is underdeveloped, chin advancement may also be performed. On the other hand, if the chin is overdeveloped, it can be reduced and reshaped, similar to contouring. Based on aesthetic preferences, V-line square jaw surgery can be performed to slim the chin and jawline.

Over the past decade, advancements in craniofacial surgical techniques in plastic surgery have made jaw reconstructive surgery easier with the help of 3D printing, and navigation systems now allow for more precise jaw positioning. Jaw surgery has evolved into a more comprehensive facial surgery that not only focuses on cosmetic improvements but also emphasizes functional enhancements from a scientific and holistic perspective.

[Jaw surgery is a type of facial surgery aimed at both cosmetic and functional (chewing, airway, TMJ) improvements of the lower face.]

– 680mm Growing Pine Tree –

Mandibular Reconstruction Surgery

 

679. <Mandibular Reconstruction Surgery>
Jaw reconstruction surgery restores the structure and function of the lower jaw damaged by trauma, tumors, congenital defects, infection, or osteonecrosis.

Depending on the type of tissue lost, reconstruction may involve skin, soft tissue, bone, or a combination.
In early life, conditions like Treacher Collins syndrome or hemifacial microsomia may require correction. In adulthood, jaw injuries from trauma, tumors like oral or mandibular cancer, or complications from radiation or medications can lead to jaw defects needing reconstruction.

Skin loss is treated with primary closure, local or distant flaps, or free flap techniques. For soft tissue atrophy, fat grafting is commonly used, but severe cases may need flap surgery.
When bone (hard tissue) is lost, the most reliable method is the fibular free flap, which transplants leg bone and soft tissue with microvascular anastomosis. If autologous bone is not an option, custom 3D-printed implants made of titanium or PEEK can be designed using mirrored imaging and virtual surgery planning.

These 3D-guided methods reduce surgery time and improve symmetry. If jawbone loss results in missing teeth, dental implants restore chewing function. In cases of tongue defects, free flaps are used followed by speech therapy for functional recovery.

Milder reconstructions often involve fat grafting, especially when only volume correction is needed. In asymmetry cases where one side underdevelops, instead of enlarging the smaller side, the healthy side can be reduced with jaw contouring to balance the face with less surgical burden.

Similarly, underdeveloped upper jaws or cheekbones may not need augmentation if the larger side can be reduced or softened with contouring and fat grafts. Every plan is tailored to the patient's anatomy, symmetry, and needs.

Jaw reconstruction aims to restore function, improve aesthetics, and support full rehabilitation. Each treatment plan is carefully designed with respect to the patient’s medical needs, financial resources, and surgical timeline.

[Mandibular reconstruction is a complex surgery combining aesthetics, function, and rehabilitation.]
– 679mm Growing Pine Tree 🌲

V-Line Jaw Surgery

 

678. <V-Line Jaw Surgery>
V-Line jaw surgery refers to reshaping the jaw to form a slim, V-shaped contour — a look popularized by celebrities in the 2000s and still a beauty standard in 2025.

It combines square jaw reduction (lateral cortectomy) and chin surgery (genioplasty). There are two main chin techniques:
1️⃣ Shaving the outer chin (mental tubercles) to smooth the shape
2️⃣ Performing a T-osteotomy: cutting the chin vertically and horizontally, then narrowing the shape by bringing two triangular bone pieces together — creating a sharp V-line.

After shaping the chin, the lower jawbone is trimmed to match — reducing its lower edge and width.

This is all done through intraoral incisions (no visible scars). To protect the inferior alveolar nerve, we use ultrasonic saws that cut bone but not soft tissue. This also helps smooth out the “second angle” between the jaw and chin, avoiding any step-like contour.

For patients over 40, bone shaping alone may lead to sagging skin. In those cases, simultaneous facelift surgery is recommended. If skin laxity isn’t addressed early, later facelifts may be less effective as the skin anchors lower. Doing both surgeries together tightens the skin and defines the jawline more clearly.

Since the intraoral approach fully exposes the jaw, it detaches ligaments and fascia — making facelift lifting easier and more effective. In older patients with weak chins and wide jaws, combining chin advancement with a facelift pulls the skin both forward and backward, maximizing lift and definition.

The small plate used for fixing the chin after a T-osteotomy can stay, but many patients choose to remove it after 1–1.5 years for peace of mind.

V-Line surgery offers a slimmer jawline and stronger profile — especially when paired with a facelift.

– 678mm Growing Pine Tree 🌲