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 🌲