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 —