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–

Temporal Lift

 658. <Temporal Lift>

A temporal lift is a cosmetic surgery performed to improve the aged appearance caused by sagging of the outer corners of the eyes or outer eyebrows. It is primarily aimed at improving sagging on the outer part of the forehead, lifting the outer part of the eyebrows, and correcting crow's feet and droopy eyes.

The main reason for performing a temporal lift is that it offers faster recovery and less burden compared to a full forehead lift, while still effectively improving sagging around the eyes and sides of the forehead. It also lifts drooping outer eye corners and eyebrows, resulting in a clearer eye shape.

The incision is made 3–5 cm above the outer eye corner, within the hairline of the temporal area, between the hairs of the temple. The incision is typically 2–4 cm long, and the resulting scar is hidden by the hair and is thus barely visible. Dissection is carried out down to the temporalis fascia (SMAS layer) and the deep temporal fascia, lifting the outer eyebrow and fixing it to the fascia, followed by suturing the incision site.

From an anatomical cross-sectional perspective during a temporal lift, beneath the skin lies the subcutaneous fat layer, under which is the temporoparietal fascia—also called the superficial temporal fascia—which corresponds to the SMAS layer. Below this lies the deep temporal fascia, and between these fascial layers, neural structures are embedded. The deep temporal fascia surrounds the temporalis muscle and splits into two layers as it approaches the zygomatic arch: the superficial layer of the deep temporal fascia and the deep layer of the deep temporal fascia. Between these two layers lies the superficial temporal fat pad. Posterior to the arch and anterior to the temporalis muscle lies the deep temporal fat.

During a temporal lift, dissection is performed between the superficial and deep temporal fascia layers, as this area involves less bleeding and is relatively easy to dissect. After elevating the temporal flap, the superficial temporal fascia is anchored to the deep temporal fascia for lifting.

Temporal lift is typically suitable for relatively younger patients who are just beginning to experience sagging of the outer eye corners. For moderate to severe facial sagging, it is often performed together with a facelift. It is difficult to correct sagging of the inner eyebrows or glabella (the area between the eyebrows) with a temporal lift alone. Therefore, the temporal lift is mainly used when the outer corners of the eyes are sagging.

While a forehead lift mainly targets lifting the central forehead, a temporal lift focuses on the lateral forehead. It is a lighter procedure, suitable for correcting drooping outer eye corners, and may even improve the nasolabial folds to some extent. In this way, a temporal lift can help correct sagging on the outer areas of the face.

[The temporal lift is a cosmetic surgery that improves the lateral proportion and aging of the upper face.]
–658mm Growing Pine Tree–

Temporal Reduction Surgery

 

657. <Temporal Reduction Surgery>

This procedure slims the sides of the head by reducing the size of the temples, creating a narrower and more balanced facial contour. A wide temporal area can be caused by thick temporal muscles, excess temporal fat, or prominent temporal bone. A facial bone CT is often used to assess the cause.

If the temporal muscle is thick, we may partially release it from the bone or perform temporal fasciotomy—loosening the fascia to reduce muscle tension over time. Botox can also be used for a non-surgical reduction.

In cases where the temporal bone itself is thick, part of the bone can be shaved, often combined with muscle reduction, for a more dramatic and visible result.

Why does the temporal region thicken? It's often linked to chronic stress, anxiety, or clenching habits—grinding teeth or chewing hard food as a way of tension release. Over generations, a highly obedient or rigid lifestyle can lead to increased activity in the temporal lobe, possibly influencing skull development. This makes the head wider in shape, especially in cultures with vertical, top-down social structures.

Temporal reduction is not brain surgery—but it does involve the bone that protects your brain, so the decision should be made with care and self-understanding.

[Temporal reduction reshapes the bone and muscle surrounding your temporal lobe.]

—657mm Growing Pine—

#temporalreduction #headshaping #epilpsurgery

#slimhead #skullreshaping

Forehead Lift (Brow Lift)

656. <Forehead Lift (Brow Lift)>

Forehead lift surgery is designed to improve drooping eyebrows and upper eyelid heaviness by lifting the forehead skin and underlying tissues. Over time, repeated facial muscle contractions (frontalis, corrugator, procerus, orbicularis oculi) and skin laxity cause forehead wrinkles and sagging.

As we age, facial bones—including the frontal bone—gradually shrink due to mineral loss. However, the overlying soft tissue doesn’t shrink, so the skin begins to droop with gravity, leading to lowered brows and a tired eye appearance.

For those wanting to lift the brows without visible facial scars, endoscopic forehead lift is an option. Small incisions are made behind the hairline, and using a camera, muscles like the corrugator may be partially removed to soften frown lines. The forehead tissue is lifted and fixed to the bone, sometimes with dissolvable implants. However, certain implants may cause tingling or discomfort when touched later, so material choice matters.

Unlike open lifts, the endoscopic method doesn’t remove excess skin—it repositions and anchors the tissues, so its longevity may be shorter.

In open forehead lift, the incision placement depends on forehead size:

Wide forehead: incision along the hairline; lifts brows and shortens the forehead.

Narrow forehead: incision 2 cm behind the hairline; lifts brows while increasing forehead height slightly.

In both methods, the frown muscles can be trimmed and the periosteum modified to reduce lines and secure the lift.

Ultimately, this surgery improves upper-face balance and aging signs. Knowing your facial bone structure is key, and keeping up circulation through aerobic activity may help preserve a youthful look longer.

[Forehead lift enhances facial proportion and counters upper-face aging.]

—656mm Growing Pine Tree—

Forehead Reduction Surgery (Frontal Hairline Advancement)

 655. <Forehead Reduction Surgery (Frontal Hairline Advancement)>

This procedure reduces the vertical height of the forehead, but the actual surgical dissection happens at the scalp, not the forehead itself. The scalp is lifted from the crown toward the back of the head and then advanced forward, allowing the forehead skin to be removed without undermining the forehead itself.

Depending on scalp elasticity and thickness, around 1–2 cm of reduction is possible, with an average of 1.5 cm. However, this is not recommended for patients with crown hair loss, as it may worsen thinning due to reduced blood supply.

To keep the hairline natural, the incision is made in a zigzag pattern, angling backward to preserve more hair follicles. During the process, some nerves like the supratrochlear and supraorbital nerves may be cut or stretched, causing temporary or permanent numbness on the scalp—which is a common side effect.

If you can’t accept numbness, hair transplantation may be a better option—but this comes with its own tradeoffs, like lower density. There’s no zero-risk procedure. A good surgery begins with a full understanding and acceptance of its pros and cons.

The surgery takes about 1 hour under sedation. Sometimes, you may notice a subtle brow lift effect afterward, and it can also be combined with forehead fat grafting. This surgery is ideal for people with a long or wide forehead, helping create a better facial balance by adjusting the upper third of the face.

[Forehead reduction is a surgery that reshapes the upper face.]

—655mm Growing Pine Tree—

Forehead Wrinkles – Filler

 652. <Forehead Wrinkles – Filler>

Filler treatment for forehead wrinkles involves injecting filler beneath the wrinkle groove to lift and smooth the area with volume and pressure. Unlike Botox, which prevents wrinkle formation, filler corrects existing static wrinkles.

Shallow lines require a delicate technique. If the wrinkle only appears with facial movement, Botox may suffice. But if it’s visible at rest, even if shallow, low-viscosity filler is injected superficially to avoid uneven texture.

For slightly deeper lines, low-viscosity filler can be placed in the lower dermis.

Medium to high-viscosity fillers are used for deep wrinkles, injected in deeper planes such as above the muscle or periosteum.

If a sunken scar is causing the depression, it may be necessary to release fibrotic bands underneath using a V-shaped cannula before filling.

Hyaluronic acid fillers are preferred as they are reversible if complications occur. Other types like calcium, PCL, or PLA fillers may be too rigid and are less ideal for fine wrinkles. (See 604mm)

Vascular complications are a serious risk. If filler enters a vessel, it can block blood flow—leading to pain, pale skin, and even necrosis. In severe cases, high-pressure injections into glabellar arteries can backflow into the ophthalmic artery and cause blindness by blocking the retinal or posterior ciliary arteries.

To minimize these risks, fillers should focus on shallow lines, not general forehead volume. If visual symptoms occur, immediate injection of 150–300U hyaluronidase, warm compresses, massage, and anticoagulants are critical.

Though rare, delayed allergic or immune reactions can cause nodules or inflammation. These too can be reversed with enzyme injection.

Ultimately, while filler can conceal wrinkles externally, it's vital to understand the risks. Reducing overuse of the frontalis muscle, which is activated by fear or surprise, is a proactive way to prevent wrinkles. Inner calm can help protect your face. (See 552mm)

[Filler for forehead wrinkles is a treatment that corrects current wrinkles by filling the base of the crease.]

– 652mm Growth Pine Tree–

#ForeheadFiller #WrinkleCorrection #EFILPlastic

Forehead Wrinkle – Botox

 651. <Forehead Wrinkle – Botox>

Forehead wrinkle correction with Botox works by relaxing the frontalis muscle, preventing it from contracting and forming lines. It blocks acetylcholine at the nerve-muscle junction, and the effect usually lasts 3–6 months.

However, repeated and frequent treatments may trigger your immune system to develop neutralizing antibodies, leading to Botox resistance. Using purified toxins without accessory proteins can help reduce this risk.

Placing Botox too low on the forehead can weaken the frontalis’ ability to lift the brows, causing heaviness or a droopy look—especially in patients who rely on their forehead to open their eyes due to ptosis.

If only the central forehead is treated while leaving the outer parts active, it may result in an unnatural "samurai brow." A balanced injection pattern that includes the lateral frontalis is essential for natural results.

Also, since the frontalis lifts the eyebrows and the glabellar muscles pull them down, treating both the forehead and frown lines together helps maintain a harmonious brow line.

To achieve optimal and natural results, dosage, depth, and injection distribution must be carefully planned.

[Forehead Botox is a wrinkle-smoothing treatment that adjusts muscle activity with precision.]

—651mm Growing Pine Tree—

Aesthetic & Functional Ear Surgery

650.<Aesthetic & Functional Ear Surgery>

The ear is not merely a decorative edge of the face—it is a gatekeeper of sound, balance, and even the body’s subtle energetics.

Ear reshaping surgery, or auricular reconstruction, varies widely depending on the shape and condition of the ear.

Protruding ears may be folded back through cartilage suturing; constricted ears are released using skin flaps; buried ears are uncovered via local flap or skin grafting. When ears are underdeveloped or absent (microtia), we harvest rib cartilage to sculpt a new auricular frame, often followed by tissue expansion and skin grafting for a natural appearance.

Even the tiniest structures matter:

A missing tragus may be rebuilt with cartilage grafts; large or torn earlobes can be reduced or repaired; and in keloid-prone ears, excision must be followed by radiation or steroid therapy to prevent recurrence.

Yet cosmetic form isn’t the whole story.

The auricle collects and funnels sound—its curvature, protrusion angle, and features like the antihelix or tragus all affect how we perceive pitch, direction, and spatial quality.

A reduced tragus weakens sound capture; small lobes reduce acoustic absorption, altering sound balance. The earlobe also connects to the autonomic nervous system, making ear surgery not only aesthetic but subtly neurological.

And so: ear surgery is not a decision to take lightly. As a sensory terminal linked to the kidneys and time-perception centers (520mm), it should follow careful evaluation of the body’s condition—not just appearance.

Ear surgery is the art of honoring hearing by refining its form.

– 650mm Growing Pine Tree

#EarSurgery #AuricularReconstruction #MicrotiaRepair #CartilageGrafting #SoundAnatomy

#EFILPlasticSurgery

Traumatic Ear Reconstruction

 

649. <Traumatic Ear Reconstruction>

The ear, though often overlooked, is a delicate structure. When trauma strikes—through accidents, piercings, or contact sports—its form and function can be irreversibly altered.

From minor lacerations to severe cartilage loss, traumatic ear reconstruction involves precise suturing, local flaps, skin grafts, or even costal cartilage grafting to restore the ear’s shape.

Contact sports like wrestling or rugby can lead to repeated hematomas between the cartilage and skin. When untreated, this causes fibrosis and deformation—commonly known as cauliflower ear. If addressed early (within 2–3 days), simple drainage and compression can prevent long-term damage. But once hardened and chronically deformed, only surgical reconstruction remains.

Some athletes embrace cauliflower ear as a badge of honor. Yet many, later in life, wish to return to their original ear shape—requiring removal of fibrotic tissue, and at times, full reconstruction using rib cartilage, fascia, and scalp tissue.

Beyond aesthetics, trauma to the auricle affects how we perceive sound.

Ear reconstruction isn’t just about restoring form—it’s about honoring the ear’s quiet role in how we hear and are heard.

Traumatic ear reconstruction is the art of reawakening our respect for something we rarely notice—until it’s lost.

– 649mm Growing Pine Tree-

#TraumaticEarReconstruction #CauliflowerEar #CartilageRepair #ReconstructiveSurgery #EarInjury#EFILplasticsurgery

Keloid Ear Surgery

 648. <Keloid Ear Surgery>

Keloid scars on the ear often form after piercings, injuries, or surgery, when fibrous tissue grows excessively during healing. This leads to raised, hard, reddish scars.
Keloid ear correction involves surgically removing the scar tissue and combining multiple methods—magnetic earrings, steroid injections, or radiation therapy—to prevent recurrence.

Why does the ear develop keloids so easily?
The ear has poor blood flow and underdeveloped lymph drainage. If lymph is already "polluted" by a lifetime of processed food or inherited toxicity, wounds on the ear (where there's little fat between skin and cartilage) can provoke aggressive fibrous overgrowth.

Prevention?
It takes a lifetime:

Sweat it out daily with exercise

Sleep early—melatonin detoxes lymph

Go plant-based and avoid processed food

Do it consistently for 10+ years

Keloid treatment isn’t just about cutting it out—it's about changing your body's terrain.
Let’s stop passing on toxic habits to the next generation. It starts with us.

Keloid ear surgery treats abnormal tissue caused by lymph leakage in an already polluted lymph system.
– 648mm Growing Pine Tree

Earlobe Aesthetic Surgery

 647. <Earlobe Aesthetic Surgery>

Earlobe surgery (earlobe otoplasty) refines the shape, volume, and symmetry of the lobe through procedures like reduction, augmentation, asymmetry correction, and torn earlobe repair.
Oversized or stretched lobes are reduced with delicate wedge excisions.
Deflated lobes are volumized through autologous fat grafting—harvested, purified, and evenly injected to restore natural fullness.
Dermal-fat grafts are also an option, avoiding the risks linked to artificial implants.

When correcting asymmetry, one lobe may be reduced while the other is enhanced, depending on the cause—whether from heavy earring use or natural imbalance.
A torn earlobe, where the skin edges have epithelialized, is repaired by excising the margins in a reverse V-shape or interdigitated pattern for a finer scar.
Closing old piercing holes involves precise elliptical excision and fine suturing, ensuring balance before any re-piercing.

Beyond aesthetics, the earlobe holds profound physiological significance.
It is richly supplied with parasympathetic fibers from the auricular branch of the vagus nerve.
Thus, gentle earlobe stimulation can activate vagal reflexes—slowing heart rate, easing tension, aiding digestion.
The earlobe is an external gateway to autonomic balance.

A thick, full lobe reflects vitality, strong kidney essence, and fertility.
A thin, wrinkled lobe may hint at declining energy, aging, or cognitive vulnerability, as shown in the link between earlobe creases and dementia.

The ear’s inner lymphatic health connects to kidney function; tinnitus may arise when renal detoxification weakens.
A supple, radiant earlobe mirrors robust kidney qi and abundant life force.

Thus, earlobe surgery is not merely cosmetic.
It is an act of honoring the vessel of vitality, life force, and unconscious regulation.
Before altering the earlobe—through surgery or adornment—we must reflect deeply on its sacred role.

[ Honor the earlobe. Protect vitality. Heal with reverence]
— 647mm, Growth Pine Tree

#EarlobeSurgery #Otoplasty #EarlobeRepair #AutonomicNervousSystem #HolisticHealing

Tragus Reconstruction

 

646. <Tragus Reconstruction>

The tragus is the small cartilage projection located at the front of the ear. Tragus reconstruction is performed when the tragus is absent, underdeveloped, or overly prominent.

But what role does the tragus play?
Evolved through mammalian development, the tragus helps collect sounds coming from the front and distinguishes them from those coming from behind, sharpening our ability to detect sound direction. It’s particularly important for recognizing the direction of high-frequency sounds and acts like a protective lid for the ear canal against dust and debris. In some cases, the tragus may be naturally missing or can be damaged, especially in women due to earrings or infections, leading to the need for surgery.

How is tragus reconstruction performed?
Cartilage—typically harvested from the ear or rib—is sculpted into the shape of a tragus and fixed into place. If there is insufficient skin, adjacent skin flaps or grafts are used.
For cases where the tragus is excessively prominent, a reduction is performed by trimming and reshaping it harmoniously with the ear.

Sometimes, abnormal tissue growths near the tragus (accessory tragus) or deformities (tragus malformation) occur. These may involve reconstructing the tragus’ natural curve and prominence through cartilage reshaping or grafting.
When the tragus is underdeveloped (hypoplasia), volume enhancement using nearby cartilage or harvesting cartilage from behind the ear can recreate a natural-looking tragus.

Complete absence of the tragus (aplasia) often accompanies microtia or ear canal anomalies. In these cases, a full ear reconstruction using rib cartilage is performed, including tragus creation, with skin rotated or grafted from the scalp or temple area.

The tragus is an essential functional and aesthetic structure — when necessary, it should be reconstructed to restore both beauty and precision in hearing.

"Tragus surgery is the art of rebuilding the protective pillar at the front of the ear that sharpens the directionality of sound."
- 646mm growing pine tree-

Otoplasty for Constricted Ear

 

645. [Otoplasty for Constricted Ear]

– Unfolding the Ear, Restoring Confidence –

A constricted ear is a congenital deformity in which the upper part of the ear folds inward due to underdeveloped cartilage. While it may seem subtle, this small fold can cause significant emotional impact—especially in children, who may face teasing or develop a negative self-image.

Constricted ears range from mild to severe:

In mild cases, a simple antihelical fold creation can restore the shape.

In moderate forms, additional cartilage sutures are required to unfold the ear.

In more complex cases, cartilage grafts—or even rib cartilage—may be needed to reconstruct the upper ear.

Why does it happen?

During fetal development, the ear forms from six small hillocks. If blood flow to the cartilage is reduced, or if pressure is applied in the womb due to tight space or fetal position, the ear’s natural curve may not form properly, resulting in a folded upper ear.

You may have heard of Lop ear, where the upper helix bends downward, or Stahl’s ear, where an extra ridge causes the ear to look pointed. When the ear is small and curled upward, it’s called a Cup ear. All are part of the same family of deformities—subtle yet impactful.

The best time for correction?

While newborns can often be treated non-surgically with molding devices in the first 2–3 weeks of life, older children may require surgery. Around age 11, ear cartilage becomes thick and fully grown, making it an ideal time for long-lasting results.

More than just an ear

Children with constricted ears may quietly carry emotional burdens—avoiding mirrors, shying away from photos, and struggling with self-esteem. By correcting the ear, we don’t just restore its shape—we restore confidence, dignity, and the freedom to face the world fully.

Let us not allow a folded ear to fold the spirit.

Early treatment unfolds not just the ear, but also the future.

[Constricted Ear Surgery – Where form meets self-worth.]

— 645mm Growing Pine Tree —