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 🌲

Square Jaw Reduction Surgery

 

677. <Square Jaw Reduction Surgery>
Square jaw surgery reduces the width of the lower jaw (mandibular body) to create a slimmer, more defined jawline. There are two main approaches:
1️⃣ External incision behind the ear to remove the jaw angle (preauricular square jaw surgery)
2️⃣ Intraoral incision inside the mouth to shave down part of the mandibular body (oral square jaw surgery)

The external method avoids an incision inside the mouth, but it mainly targets the jaw angle, offering side-view improvement only. It often fails to reduce the front view width because the mandibular body isn’t properly addressed. Also, if the patient has a receding chin along with a square jaw, a chin procedure (which requires an intraoral incision anyway) becomes necessary — negating the original advantage.

More importantly, external incisions risk damaging facial nerves located near the ear. If injured, permanent facial paralysis could result. So, in trying to avoid intraoral incisions for a quicker recovery or lower cost, one might risk severe complications.

In contrast, oral square jaw surgery safely exposes the bone through a cut inside the mouth. We then perform a lateral cortectomy, removing the outer bone layer. CT scans help map the inferior alveolar nerve, and if the nerve runs close to the bone surface, we use an ultrasonic saw, which cuts bone but not soft tissue — minimizing nerve injury risk.

Because bone cutting can cause bleeding, we use hypotensive anesthesia to lower blood pressure and reduce bleeding during surgery.

If chin surgery is also needed, the intraoral approach allows full access to the jawbone. This makes it easier to correct asymmetry, advance the chin, or reshape it with precision — unlike the limited visibility in external methods.

In short, square jaw surgery is safest and most effective when done through the mouth using ultrasonic tools and hypotensive anesthesia. This approach allows both functional safety and faster recovery.

Square jaw reduction sculpts the overgrown lower jaw to enhance balance and aesthetics.

– 677mm Growing Pine Tree 🌲

Prognathism Surgery

 

676. <Prognathism Surgery>
Prognathism surgery corrects a protruded or overly developed lower jaw. If only the chin sticks out and the bite is normal, it’s called a witch chin. When the entire lower jaw protrudes and causes a misaligned bite, it’s true prognathism. Some have a retruded chin but forward lower teeth, or simply a long jaw without protrusion.

For long jaws, a horizontal ostectomy genioplasty reduces the chin’s length. If the chin is also retruded, it's slightly advanced. If the whole lower jaw is long, a long linear ostectomy trims the lower edge of the jaw.

For witch chins, we contour the jawline and perform a curved chin reduction to improve balance. In cases with a double chin due to bone, we trim the lower border to refine the chin shape.

If there’s a bite issue (malocclusion), orthodontic treatment comes first, followed by orthognathic surgery. If immediate correction is possible, surgery-first orthognathic surgery is performed. A BSSO (bilateral sagittal split osteotomy) moves the lower jaw back, while a Le Fort I osteotomy may bring the upper jaw forward if needed.

Whether one-jaw or two-jaw surgery is done depends on airway width. If one-jaw surgery risks narrowing the airway and causing sleep apnea, we do rotational two-jaw surgery to preserve breathing function. If the airway stays sufficient, one-jaw surgery can be safely done.

In retruded-chin prognathism, chin advancement is often combined with two-jaw surgery for better profile harmony.

Prognathism surgery isn’t just cosmetic—it balances function and aesthetics.

– 676mm Growing Pine Tree 🌲

Chin Augmentation Surgery (Correction of a Receding Chin)

 

675. <Chin Augmentation Surgery (Correction of a Receding Chin)>

Chin augmentation surgery is a procedure to improve the shape of the chin, especially in cases where the chin is short or retruded. But what causes a receding chin?

One of the main reasons is nasal issues such as chronic rhinitis. When nasal passages are blocked—especially during sleep—mouth breathing becomes habitual. This leads to sleeping with the mouth open, which affects facial development. Specifically, the upper jaw grows vertically downward due to the lack of occlusion with the lower jaw. As a result, the mandible rotates in a clockwise direction, causing the chin to appear retruded.

Additionally, habitual mouth opening leads to efforts to keep the mouth closed, causing the mentalis muscle to overwork. This results in a puckered chin and the formation of “pebble chin” or “orange peel” dimpling. In this way, an issue that starts in the respiratory system can lead to structural changes in the chin.

So how do we correct a receding chin?

The surgical method varies greatly depending on the chin's shape. Many clinics use artificial implants such as silicone, but there are important reasons to avoid this approach. First, there’s always a risk of infection. Second, even without infection, long-term pressure from a silicone implant can cause resorption of the cortical bone of the chin, which may lead to functional problems such as compression of the mental nerve or resorption around the canine teeth.

Instead, we use the patient’s own bone for natural and safe correction. If the chin is simply retruded, we perform a horizontal osteotomy and advance the chin segment forward (horizontal advancement osteotomy). When the chin is also vertically long, a portion of the bone is removed (horizontal reduction osteotomy) before advancing it. If the chin appears broad or "double-chinned," a vertical reduction of bone is done in addition to the advancement, in a procedure known as T-osteotomy.

In cases where the gap between the two sides of the chin is too wide, a T-osteotomy may not be feasible. Instead, the chin is narrowed by shaving the bone, and advancement is postponed to a second-stage surgery performed about six months later.

It’s also important to assess for sleep apnea in patients with a retruded chin. If severe snoring is observed during sleep and a polysomnography confirms sleep apnea, we must consider not only aesthetic improvement but also functional correction. In such cases, we perform a "D-shaped osteotomy" to advance both the chin and the genioglossus muscle (which is connected to the tongue), thereby enlarging the airway behind the tongue and improving airflow in the pharynx and larynx.

Other techniques include:

• Elevator osteotomy: to vertically elongate a short chin.

• "S"-shaped osteotomy: to avoid the mental nerve more safely during cutting.

Ultimately, the appropriate surgical plan is developed through both functional and aesthetic analysis of the chin.

Chin augmentation surgery corrects an underdeveloped chin by surgically enhancing its shape.

— 675 mm Growing Pine Tree 🌲

Submental Lifting Surgery

 

674. <Submental Lifting Surgery>

Submental lifting (submental platysmaplasty) is a procedure that removes and tightens the sagging skin under the chin to create a defined jawline. With age, skin loses elasticity, and decades of fast eating habits can weaken the tongue and platysma muscles, leading to a drooping submental triangle blending into the neck.

If excess fat is present, liposuction is done first to refine the jawline. Then a submental incision is made to expose the platysma. A midline platysmaplasty is performed to tighten the loosened muscles by suturing them together in the center, enhancing neck contour. If there’s significant skin laxity, excess skin is removed and tightened through the same incision.

In cases with vertical neck bands (platysma bands), an incision along a natural crease is made to access both platysma muscles. If deep subplatysmal fat is excessive, it is also removed. The platysma edges are sutured together centrally, sometimes shortened or resected for better tension. Using the Advanced Corset Technique, deep fascia layers are tightly secured like a corset.

If submental sagging is severe, we assess for a recessed chin. Underdeveloped chin structure often worsens the droop. In such cases, advanced genioplasty pulls soft tissue forward, improving tension. When combined with a facelift, submental correction may require less tissue removal, but surgical complexity may vary—this is discussed during consultation.

When paired with facelift surgery, lateral tension from the lift may reduce the need for skin or muscle removal, with platysma tightening alone often sufficient.

Submental sagging depends on jaw structure, aging, and habits. To prevent it: chew slowly, swallow without water, use low pillows, and avoid looking down for prolonged periods.

[Submental lifting corrects habits that cause sagging under the chin—through surgery.]

—674mm Growing Pine Tree 🌲

Double Chin Correction

 

673mm | Double Chin Correction

Double chin surgery addresses the accumulation of fat, loose skin, or a recessed jawline beneath the chin. It’s most effective when approached from three angles: fat removal, skin tightening, and structural correction of the chin.

Why does a double chin form?

1. Excess fat under the chin.
   This often results from poor tongue movement and overeating. The tongue’s role is to deliver food to the teeth for proper chewing. When we eat quickly without chewing well, the tongue becomes inactive, weakening the base muscles under it. Fat tends to accumulate where muscles are underused—leading to a double chin. This is why fast eaters are more prone to developing one.

2. Loss of skin elasticity.
   Again, due to weak tongue and swallowing muscles. Chewing activates tongue muscles, and proper swallowing engages submental muscles. If food is swallowed more like a drink, these muscles weaken, and the skin begins to sag. Eating slowly, chewing thoroughly, and avoiding soup or drinks during meals helps train these muscles using only saliva to swallow.

3. Underdeveloped or recessed chin bone.
   The chin bone is the core structure that supports overlying soft tissues. When it's short or retruded, the skin and fat around it lose support and sag easily, creating a double chin. People with weak chin projection or a protruded mouth often experience this more noticeably.

How is a double chin corrected?

If the patient agrees to structural improvement, the best solution is chin advancement surgery (see 675mm). Moving the chin bone forward lifts sagging tissue and smooths fat deposits.

If bone correction isn't desired, options include:

• Chin liposuction to physically remove fat.

• Neck lift surgery to tighten sagging skin.

• Non-surgical treatments like fat-dissolving injections, HIFU (High Intensity Focused Ultrasound), RF (radiofrequency), thread lifting, and lipolytic injections.

Although habits can be corrected over time, those wanting quick results may opt for double chin correction procedures.

🌀 Double chin surgery is a rapid correction of chin fat caused by the habit of swallowing food like a drink.
—673mm 성장 소나무 🌲

Chin Filler

 

672mm | Chin Filler

Chin filler is a non-surgical procedure where filler material is injected to enhance the chin’s shape and projection. It’s chosen when the chin is short or recessed—making the face appear more balanced without surgery. It can also improve the appearance of a protruding mouth or create a slimmer V-line when surgery feels too burdensome.

Common filler types include:

• Hyaluronic acid (HA) fillers: Soft and naturally absorbed in under a year.

• Calcium hydroxyapatite (CaHA) fillers: Firmer, longer-lasting, ideal for bone-like projection.

• Autologous cartilage filler: Made by harvesting rib cartilage, processed into ultra-fine particles and injected. It’s biocompatible and natural.

Precise technique is key. Anatomical landmarks like the pogonion, gnathion, and menton must be understood, and care taken to avoid arteries like the inferior labial artery and mental artery. The ideal injection plane is beneath the mentalis muscle to minimize movement and ensure stability. For short chins, focus is placed on the gnathion area; for retruded chins, on the pogonion.

In some cases, Botox is used to relax the mentalis muscle and help cartilage filler stay fixed while it stabilizes during the first 3 weeks.

Chin filler is an alternative to genioplasty, helping with mild to moderate chin retrusion. However, it has limitations—especially with severe deformities or protrusions. As it involves injecting liquid or microparticle material over the bone, consultation with a facial bone specialist is key to determining if filler or surgery is more appropriate.

—672mm 성장 소나무 🌲

Jaw Botox (Masseter & Mentalis Toxin Treatment)

 

671. Jaw Botox (Masseter & Mentalis Toxin Treatment)

Jaw Botox involves injecting botulinum toxin into the masseter or mentalis muscles to reduce overdeveloped or hyperactive jaw muscles. In Korea, this is often called “square jaw Botox” (masseter) or “chin tip Botox” (mentalis).

▶ Indications for Masseter Botox:

• Enlarged jaw from chewing hard foods

• Bruxism or jaw clenching habits

• Overdeveloped salivary glands from long chewing habits or chronic stimulation (e.g. spicy/salty food, gum, jerky, alcohol)

Masseter overuse leads to muscular-type square jaws. If prolonged from childhood, it may also affect bone growth, resulting in skeletal square jaws. Long-term chewing can enlarge the parotid gland, while alcohol stimulates the parasympathetic system, further enlarging salivary glands and potentially causing alcoholic parotitis.

▶ Therapeutic effects:

• Jawline contouring

• Bruxism prevention

• Relieves TMJ pressure

• Reduces gummy smile (via mentalis Botox)

• Smooths "orange peel" chin wrinkles caused by mentalis overuse (e.g. frequent pouting, retruded chin, or lip-sealing effort)

▶ Treatment details:

• 3-point injections on the lower masseter

• Dosage varies: low (first-timers), medium (bruxism), high (jaw slimming)

• Adjust dosage for asymmetry; evaluate chewing side habit

• Lasts ~3–6 months depending on muscle activity

• Chewing gum or tough food shortens effect duration

• Softer foods help maintain results

• Repeated early injections may cause antibody resistance, so spacing out sessions is key for long-term use

✨ Jaw Botox reduces overworked facial muscles, reshapes the lower face, and corrects habits like clenching or pouting.

— 671mm Seongjang Sonamu —

Zygomaplasty (Cheekbone Surgery)

 

670. Zygomaplasty (Cheekbone Surgery)

Zygomaplasty is a midface contouring procedure that adjusts the cheekbones to refine facial balance. It includes surgical options like zygomatic reduction, augmentation, and reconstruction, as well as non-surgical treatments like fillers, fat grafting, buccal fat removal, and cheek lifting.

Several anatomical considerations are crucial:

1. Infraorbital nerve – Though rarely cut, pressure from swelling or fat repositioning can cause numbness in the upper lip or nasal wing.

2. Sinus complications – In patients with sinusitis, cutting near the maxillary sinus can risk infection, especially with implants.

3. Facial nerve – During zygomatic arch osteotomy, incisions near the temple risk injury to the frontal branch, which can cause eyebrow droop.

4. Orbital concerns – In cases of old fractures or enophthalmos (sunken eye), implanting material to correct the defect may cause double vision or impaired eye movement if soft tissue is caught between the implant and orbital wall.

In some cases, patients undergo “quick zygoma” surgery only to later feel their cheekbones appear larger. Revisional surgery may require repositioning the bone and redoing the reduction properly, often making the second surgery more complex than the first.

As we age, fat compartments in the midface shrink and spread apart, deepening lines like under-eye wrinkles, tear troughs, and nasolabial folds. Therefore, cheekbone surgery is often combined with procedures like lower eyelid fat repositioning, cheek lifting, and nasolabial fold correction to restore both contour and volume.

✨ Zygomaplasty is not just bone work — it's midface rejuvenation from structure to softness.

— 670mm Seongjang Sonamu —

Paranasal Augmentation (Gwijok Surgery)

 669. Paranasal Augmentation (Gwijok Surgery)

Paranasal augmentation enhances the area beside the nose to correct a sunken midface and create a fuller, more refined appearance—hence the nickname “gwijok surgery,” meaning “aristocrat surgery” in Korean.

It differs from nasolabial fold correction. While it may slightly improve deep smile lines by volumizing the base of the folds, it doesn’t treat lines that extend to the mouth.

There are two main methods: artificial implants (like silicone or Gore-Tex), and autologous grafts using your own tissue. Artificial implants are inserted through an incision in the mouth and fixed with screws, but they may move or cause inflammation.

For a safer, more natural option, we prefer ultrafine rib cartilage grafting. A small incision (about 2cm) is made under the breast to harvest rib cartilage. It's ground into fine particles and injected through a nostril incision to sculpt the area, avoiding oral incisions and improving post-op comfort.

If the entire midface is recessed, grafts can be extended upward. For sharp nasolabial angles, grafting near the anterior nasal spine helps support the central face. Often, this is combined with fat grafting or cheek lift for balanced volume correction.

✨ Paranasal augmentation enhances the zone where the mid- and lower face meet, helping restore a youthful, elegant contour.

— 669mm Plastic Surgery —

Zygoma Reconstruction Surgery

 668. <Zygoma Reconstruction Surgery>

Zygoma reconstruction is performed when the cheekbone (zygoma) is deformed due to trauma, tumor removal, congenital conditions, or previous surgeries. Severe cases may require repositioning the bone or placing an artificial implant to restore symmetry and structure.

Since the zygoma supports the orbit, its collapse can lead to enophthalmos (sunken eye). Therefore, correcting both the bone and the orbit is often necessary. Advanced techniques like 3D-printed implants, mirroring of the unaffected side, and navigation systems help ensure precision. Surgical guides may also be used for accurate implant placement.

When synthetic implants aren't preferred, autologous tissues like jawbone (from mandibular contouring), rib, or skull can be used. In milder cases, microparticulated costal cartilage mixed with fibrin glue can reconstruct the area like sculpting clay.

Zygoma reconstruction is more than cosmetic—it restores facial structure and function. Preoperative checks, especially for sinus health, are essential to avoid complications.

[It’s a reconstructive surgery to restore midface depression.]

— 668mm Growing Pine Tree —

Zygoma Augmentation Surgery

 

667. <Zygoma Augmentation Surgery>

Zygoma augmentation surgery is a cosmetic surgery performed to increase the volume of the zygomatic (cheekbone) area when the midface region is underdeveloped. It is mainly found among Westerners, where the zygomatic bone area is less developed, making the midface appear flat and lacking volume, prompting the surgery to add dimensionality.

The zygomatic bone is a structure that extends from the center of the face to the side, playing an important role in determining the contour and three-dimensionality of the face. In East Asians, it is relatively more developed, while in Westerners, it is relatively less developed. There are various reasons for this, but one explanation is that East Asians tend to have a brachycephalic (short-headed) skull shape, while Westerners tend to have a dolichocephalic (long-headed) skull shape. Evolutionarily, due to a more collectivist development, East Asians tend to follow commands more and prioritize the species' standpoint, leading to temporal lobe development and suppression, activating a psychological mechanism to seek pleasure through habits like teeth clenching. This results in more developed zygomatic bones and lateral skull areas. On the other hand, Westerners, due to individualistic development, tend to think more, talk more, and behave more freely, which leads to frontal lobe development and thus more developed forehead regions with less developed zygomas.

To undergo zygoma augmentation surgery, preoperative planning is necessary. Through a 3D CT scan, the facial bone structure, asymmetry, presence of maxillary sinus abnormalities, and zygoma protrusion direction are carefully examined. Using a 3D printer, a customized implant is created to enlarge the zygomatic bone. At this time, care must be taken to ensure that the infraorbital nerve is not compressed when inserting the implant, by leaving a gap to prevent nerve pressure. The implant is inserted above the bone through an incision inside the mouth, thereby making the midface more three-dimensional.

Zygoma augmentation may also be considered due to age-related midface volume loss, or when the zygomatic bone is depressed due to trauma. In such cases, the zygoma can be osteotomized and elevated, and both the frontal and temporal limbs of the zygoma are osteotomized and fixed with titanium.

If the depressed bone is too difficult to elevate through osteotomy, artificial implants can be inserted over the maxilla and zygoma. Especially in trauma-related cases, if the maxillary sinus is fractured and sinusitis is present, inflammation could spread to the implant, so preoperative management and control of rhinitis or sinusitis are required. If one wants to avoid complications like infection from artificial implants, autologous tissue grafts can be used as an alternative. However, since there are size limitations with autologous implants, they may not be suitable for significantly augmenting the zygoma. One method involves grafting the mandibular bone (obtained while slimming the jaw) onto the zygoma. For a more ergonomic bone graft, bone particle grafting can be performed by grinding the bone. However, in the case of bone particle grafts, the absorption rate can exceed 30%, and inflammation may occur in some cases, so the physical condition must be carefully checked before surgery.

Fat grafting is the best way to minimize inflammation risk while using autologous tissue, and can be used as an alternative to elevate the zygoma. If only a slight augmentation is needed, costal cartilage can be harvested and cartilage particle grafting can be partially injected to slightly enhance the zygoma.

Thus, zygoma augmentation can be performed using either artificial or autologous tissue to provide volume to the midface.

[Zygoma augmentation surgery is a cosmetic surgery that enhances the three-dimensional appearance of the midface.]

– 667mm Growing Pine Tree –

Zygoma Reduction Surgery

 666. <Zygoma Reduction Surgery>

Zygoma reduction surgery reduces prominent cheekbones for a softer contour and slimmer mid-face. The procedure involves intraoral incisions and L-shaped osteotomy to push and fix the zygoma inward, adjusting both position and size.

There are two types: incision and non-incision for the zygomatic arch. The non-incision method avoids sideburn scars but skips arch fixation, which can cause bone nonunion — especially in patients with teeth grinding or clenching habits. For them, dual fixation via incision is safer, though a small scar remains near the sideburn.

In patients over 40, reduced bone volume without skin reduction can lead to sagging. A facelift performed together can prevent this, using one incision for both surgeries and leaving no additional scars.

Facial asymmetry from chewing or smiling habits requires custom planning. Arch incisions must also avoid facial nerve damage that may affect eyebrow movement.

Post-op, jaw stiffness may occur. Mouth-opening exercises are important. Non-surgical methods like thread lifts or fat removal rarely reduce actual bone. For real contour change, bone surgery is necessary.

Zygoma reduction improves both side and 45° angles but may create a visible second curve. It can also make the jawline appear more prominent, so considering jaw surgery together may be ideal.

[Zygoma reduction narrows the mid-face width.]
— 666 mm Growth Pine Tree

Quick Zygoma Reduction Surgery

 665. <Quick Zygoma Reduction Surgery>

Quick zygoma surgery is promoted as a less invasive, faster-healing alternative to traditional cheekbone reduction. It replaces general anesthesia with sedation, reduces surgical time, and minimizes scarring — leading to the perception that it's an “easier” option.

One common method involves fracturing and pushing in only the zygomatic arch, without cutting into the main zygoma body. This can be done through incisions inside the mouth, in front of the sideburn, or hidden in the hairline. While this narrows the face from the side, it doesn’t reduce the 45-degree angle (the front-side cheekbone), which can lead to disappointment for those with both prominent side and 45° cheekbones. In such cases, the 45° cheekbone may appear even more pronounced after surgery.

Issues like nonunion, over- or under-correction, and bone relapse are not uncommon, especially when fixation is skipped. If revision is needed, the zygomatic arch must often be restored before performing full reduction again — turning a “simple” surgery into two major ones.

Quick methods may seem convenient but often have limited effects and apply to only a narrow group of patients. If done without precise planning and post-op care, they can become a source of dissatisfaction.

New doesn’t always mean better. If cheekbone reduction is truly needed, a full and properly planned surgery by an experienced surgeon — not just a faster one — is the best route.

[Quick zygoma surgery is just a quick partial cheekbone reduction.]

— 665 mm Growth Pine Tree

Buccal Fat Removal: What Are You Really Removing?

 663.Buccal Fat Removal: What Are You Really Removing?

Buccal fat removal is a cosmetic surgery designed to slim the face by removing the buccal fat pad — a deep fat compartment located between the cheek and the upper jaw muscles. This pad stretches in four directions, divided into three lobes, reaching from the parotid gland in the front to the temporalis muscle and mandibular ramus in the back.

But why does buccal fat exist?

Fat is our body’s form of energy storage. We store and use energy through three main pathways: sensory, cognitive, and motor.

Motor energy is stored in abdominal fat — our belly reflects our movement energy.

Sensory energy is stored in facial fat, especially buccal fat.

The brain (hippocampus, frontal lobe) processes cognitive energy.

Think of the buccal fat pad as a storage unit for sensory energy.

When you overuse your senses or are mentally stressed, your cheeks hollow out — you look tired or gaunt. But when you feel safe, calm, and less stimulated, your cheeks fill out naturally.

Trying to gain buccal fat by just eating more? You'll only gain belly fat instead. Want to lose cheek fat? Increase sensory input and anxiety — though that's not advisable.

The point is: Buccal fat changes naturally depending on how you live and feel.

So what happens when you surgically remove it?

You’re permanently discarding a reservoir of sensory energy. Over time, this may lead to faster eye fatigue, earlier onset of tinnitus, and even reduced alertness. As we age, we naturally use more sensory energy — removing the storage when you’re young could leave you drained later in life. Once it’s gone, it’s nearly impossible to restore.

Before choosing this surgery, consider:

Are you paying to destroy your own sensory reserve — your deep emotional storage — with trauma disguised as beauty?

This isn’t just a cosmetic decision. It’s an energetic one.

[Buccal Fat Removal = Cutting Away Your Sensory Energy Bank]

— 663mm Growth Pine Tree 🌲

#buccalfatremoval #facecontouring #innerhealth #aesthetictruth #deepbeauty

Buccal Fat Removal Surgery

663. <Buccal Fat Removal Surgery>

Buccal fat removal is a cosmetic procedure that removes or reduces the buccal fat pad—located deep between the cheek and the upper jaw—to create a slimmer facial contour. The buccal fat pad lies between the buccinator and zygomatic muscles and extends in four directions, with its front near the parotid gland and rear toward the temporalis muscle and mandible.

Why does this fat exist? Fat tissue stores energy, and our body uses energy in three ways: through movement, thinking, and sensory activities. Belly fat stores energy for movement, especially leg use. Cheek fat—specifically buccal fat—stores energy for sensory functions such as sight, hearing, smell, taste, and touch. Visual energy is stored in the orbital fat around the eyes, while general sensory energy is stored in the cheeks.

This means when you overuse your senses or feel stressed, your cheek fat may reduce, making your face look slimmer. If you're mentally relaxed and use fewer sensory functions, cheek fat tends to increase. While belly fat increases from overeating and inactivity, cheek fat increases from emotional comfort—not food. Trying to gain cheek fat by eating more often just increases belly fat. To add cheek volume, calm your mind. To reduce it, stress alone may work—no surgery needed.

So what happens if you surgically remove buccal fat? You're cutting out your sensory energy storage. Over time, this can lead to faster eye fatigue, early tinnitus, and reduced alertness. As we age, we naturally rely more on sensory input, depleting these reserves. Removing buccal fat while young erases what might be hard to restore later. Even though the surgery is relatively simple—done through an incision inside the mouth—it’s important to weigh the long-term effects before proceeding.

Consider whether it’s truly worth paying to destroy such a meaningful energy reservoir. Reflect deeply on the true purpose and impact of buccal fat removal.

[Buccal fat removal is the removal of your sensory energy reservoir.]
— 663mm Growing Pine Tree

#BuccalFatRemoval #SlimFaceSurgery #CheekFatReduction #YouthfulLook #FacialContouring #MidFaceLifting #PreventSagging #EnergizedFace #EpillPlasticSurgery

Cheek Fat Grafting

 

662. <Cheek Fat Grafting>

Cheek fat grafting is a cosmetic procedure that involves transplanting fat into the cheek area to improve sunken cheeks and enhance the volume and three-dimensional contour of the midface.

There are two types of cheek fat: superficial and deep. First, the superficial fat, known as the malar fat pad, is located above the orbicularis oculi muscle, sitting atop the zygomatic bone under the eyes. It plays a key role in shaping the midface. The malar fat pad is divided into compartments, including the infraorbital compartment, medial cheek compartment, and nasolabial compartment. These compartments are separated by the medial cheek septum and the nasolabial septum, respectively.

Second, the deep fat, called the buccal fat pad, lies between the buccinator and zygomaticus muscles. It consists of three lobes that extend in four directions. The anterior lobe surrounds the parotid gland, the intermediate lobe lies between the anterior and posterior lobes, and the posterior lobe extends toward the temporalis muscle and mandibular ramus.

The buccal fat pad serves as a reservoir for sensory energy. While the orbital fat inside the orbicularis oculi within the orbital cavity acts as an energy reservoir for vision, the buccal fat pad in the oral cavity stores energy for general sensory functions. When we eat a lot, we use the buccinator muscle, reducing the buccal fat above it; similarly, frequent chewing activates the temporalis muscle, depleting the deep fat overlying it. However, during periods of rest, when these muscles are not in use, energy is replenished and stored in the cheek fat.

On the other hand, if a person experiences high levels of stress, overuses visual and auditory senses, speaks excessively, loses appetite, and avoids eating due to aversion to smells, energy is continuously depleted without being replenished. This can lead to progressive fat loss in the cheeks, resulting in a gaunt, skeletal appearance over time.

Conversely, if someone eats well and feels relaxed, cheek fat tends to increase. Another deep fat layer is the suborbicularis oculi fat (SOOF), located beneath the orbicularis oculi muscle in the lower eyelid. It acts as a cushion and maintains the soft contour and volume around the eyes, contributing to a youthful and healthy look. When SOOF diminishes or sags, the under-eye area may appear hollow, highlighting dark circles and forming tear troughs—common signs of aging.

Thus, if a patient has prominent tear troughs, fat is grafted into the SOOF area. If the area in front of the cheekbone looks flat, and the zygomatic bone itself is under-projected, fat is evenly injected into the periosteum, muscle, and subcutaneous fat layers of the cheekbone region.

Fat for grafting is usually harvested from the abdomen or thighs. It is then refined using a centrifuge and loaded into a fat injector. For precision, a micro-fat injection device is used, allowing for injections as small as 1/240cc. Typically, amounts between 1/120cc and 1/60cc are injected to balance cheek volume symmetrically. For example, if one has a habit of smiling more on one side, the buccinator muscle on that side may be slightly thicker. Therefore, more fat is injected on the side with the lower mouth corner, and less on the lifted side, to achieve better symmetry. Rather than injecting equal amounts, the procedure accounts for bone recession, muscle thickness, and soft tissue depth for meticulous adjustment.

For secondary grafts, patients may opt for cryopreserved fat that can be thawed and reinjected 2–3 months later. However, the fat's freshness declines, leading to a slightly higher absorption rate. This factor should be considered when planning a second fat graft.

Most patients seeking cheek fat grafting tend not to smile often, so practicing smiling to engage and lift the buccinator muscle is recommended.

[Cheek fat grafting replenishes the energy reservoir of the senses and restores aesthetic volume.]

—662mm Growth Pine Tree—

Cheek Fillers: More Than Just Volume

 

Cheek Fillers: More Than Just Volume

Cheek filler treatment adds volume to sunken or flat midface areas, creating a more defined, youthful, and lively look. When we stop smiling, our cheek muscles weaken, skin starts to sag, and facial expressions tend to fade. Over time, this can lead to a tired or aged appearance — not just physically, but emotionally too.

People who seek cheek fillers often do so because they’ve unconsciously stopped using key facial muscles like the zygomatic and levator muscles — muscles we naturally engage when we smile. A lack of positive expression can cause fat and muscle tone in the cheeks to disappear, leading to sagging and hollowness.

Most cheek fillers use hyaluronic acid (HA), which can be dissolved later if needed, making the treatment relatively safe and reversible. However, repeated filler injections over time may lead to artificial material mixing with natural tissue, so it’s worth considering both aesthetic and functional effects.

The true reason cheeks lose volume? It’s not just aging — it's underused facial muscles, especially the buccinator, which helps with eating and facial movement. As we age, smaller food intake and less facial motion reduce this muscle’s activity, leading to loss of volume.

Filling the cheek with artificial volume may restore shape temporarily, but it doesn’t restore function. Smiling more often and activating your facial muscles can help build natural, healthy cheek volume from within.

Cheek filler doesn’t create happiness — it shapes the space where happiness can return.

—661mm Growing Pine Tree—

Forehead Plastic Surgery

 660. <Forehead Plastic Surgery>

Forehead plastic surgery is a procedure aimed at improving the shape, volume, and proportions of the forehead to enhance the harmony of the overall face and correct the upper facial region. When wrinkles appear on the forehead, Botox can be injected to block the neurotransmitter acetylcholine, preventing it from transmitting signals from the frontal nerves to the muscles. As a result, muscle contraction is inhibited, and wrinkles caused by muscle contraction do not form—effectively treating the wrinkles.

However, if wrinkle grooves have already formed due to frequent use of forehead muscles, Botox alone cannot resolve them. In these cases, filler injections are used to artificially fill the grooves caused by the repeated folding of the skin, smoothing out the dermis and resolving the wrinkle depressions. Thus, fillers address current wrinkles, while Botox helps prevent future wrinkles.

When the wrinkles are too deep to be corrected even with fillers, fat grafting can be used to support the area from beneath. Since fat grafting can also adjust the thickness of the skin, it can improve the overall shape of the forehead—making it suitable for sunken foreheads, depressed areas from past fractures, or asymmetric foreheads caused by scaphocephaly.

If the forehead is too wide or long, the forehead line can be reduced through hair transplantation. However, because the transplanted hair is typically less dense than natural hair, a sparse appearance may be bothersome. In such cases, forehead reduction surgery can be performed by making a zigzag incision along the hairline, dissecting the scalp from the skull bone, and advancing the scalp forward to reduce the visible forehead length. This procedure results in denser-looking hair, as baby hairs are trimmed, and the scar can be hidden behind the hairline if the incision is made diagonally. However, if concerns about scarring or scalp sensory changes are greater, hairline shaping through transplantation may be a better option.

If the forehead is narrow, fat grafting can be used to make it appear wider. In cases of brow ptosis, an incision can be made within the hair to perform a forehead lift, thus widening the narrow forehead and lifting the brows simultaneously. If the brows are drooping and the forehead is also long, an incision can be made along the hairline to perform a forehead lift while excising a portion of the forehead skin, thereby shortening the forehead and improving facial proportions.

If the entire brow has drooped, a forehead lift can address the issue, but if only the outer brow or tail of the brow is drooping, a temporal lift through an incision along the temporal hairline can effectively lift the outer corner of the eyes.

If the side of the head is too wide due to hypertrophic temporal muscles, Botox can temporarily reduce the size of the muscles. For more permanent results, temporal fascia decompression surgery can reduce the pressure in the muscle and gradually decrease its size. When the temporal bone is thick, temporal bone shaving can be considered. However, if CT imaging shows a thin temporal muscle and thin temporal bone, the issue may be due to a large brain size, in which case surgery or procedures may not be feasible, and a CT scan is essential for judgment.

If the forehead is overly protruding, the forehead bone can be exposed via a hairline incision and shaved down. If the brow bones are overly prominent, they can be shaved or pushed inward to correct their shape. When the forehead is too flat, it can be corrected with fat grafting, and when the brows appear flat, they can be augmented with costal cartilage filler.

In this way, the three-dimensional structure of the forehead, both front-to-back and side-to-side or top-to-bottom, can be treated with a customized plan depending on the individual case. However, the forehead bone is a result of ancestral thinking, and the forehead itself is the window of one’s thoughts, being the vessel that connects ancestral insight with personal thought (refer to 552mm). Thus, one should carefully consider whether to undergo forehead plastic surgery.

[Forehead plastic surgery is a procedure that alters the shape of the vessel that connects the thoughts of my ancestors with my own thinking.]
–660mm Growing Pine Tree–

Frontal Bone Contouring Surgery

 

659. <Frontal Bone Contouring Surgery>

Frontal bone contouring surgery is performed when the forehead is excessively protruding, too flat, or sunken; to correct deformities following trauma or brain surgery; or during gender transition—such as reducing or pushing in prominent brow ridges when transitioning from male to female, or augmenting the brow area when transitioning from female to male. This surgery redefines the contour of the forehead.

First, frontal bone reduction surgery involves exposing the forehead bone via a coronal incision through the scalp. The thickness of the frontal bone, previously measured with a facial CT scan, guides the shaving down of protruding areas. If the brow bone is also protruding, it can be shaved or pushed inward. When the brow bone is thicker than the frontal sinus as seen on CT, it can be shaved down. In cases where only the brow bone needs reduction—known as brow bone shaving surgery—a coronal incision is unnecessary; instead, a sub-brow incision can expose and allow shaving of the brow bone. For patients planning to undergo double eyelid surgery, the brow bone can be shaved through the eyelid incision line.

When the brow bone is thin, with minimal bone to shave, and the frontal sinus is well-developed, it is not shaved but pushed inward—this is referred to as brow bone reduction surgery. This procedure involves peeling back the forehead skin via a coronal incision, observing the brow bone directly, and performing osteotomy to push it in. To prevent frontal sinusitis, it's best to preserve the mucosa of the frontal sinus. Additionally, the outer parts of the brow bone can be shaved to address bulging upper eyelids.

Frontal bone augmentation surgery is suitable for individuals with sunken or flat foreheads. Using artificial bones or silicone increases the risk of infection. Recently, 3D-printed custom implants have allowed for more precise shaping to the patient’s preference, but since they are still artificial materials, the risk of inflammation remains. Using autologous tissue is a way to reduce inflammation risks. Options include autologous bone graft and autologous fat graft.

When performing an autologous bone graft to the forehead, bone removed during other facial contouring surgeries—such as jaw or cheekbone reduction—can be ground and particleized, then grafted to the forehead to add volume. Therefore, autologous bone grafting is recommended for patients already undergoing facial bone reduction, rather than harvesting bone from the skull or iliac crest unnecessarily. For those not undergoing facial bone procedures, fat grafting can be used to shape the forehead.

Forehead asymmetry can result from past injuries or from asymmetrical brow bones, making the forehead appear uneven. In cases of brow bone asymmetry, the bones can be asymmetrically pushed in or shaved to improve balance. If necessary, the final adjustments can be made using fat grafting.

Thus, forehead bone can be shaved or filled, and brow bones can be shaved, pushed in, or augmented to improve the shape of the forehead. If the asymmetry or depression is due to a past fracture, particulate bone grafting or fat grafting can help restore the contour. However, since the frontal sinus plays a role in ventilating the heat from the frontal lobe, special care must be taken during frontal bone contouring surgery to avoid compromising it.

[Frontal bone contouring surgery is a procedure that improves the contour lines of the upper facial area.]
–659mm Growing Pine Tree–