Facial Contouring Revision Surgery

Facial contouring revision surgery

 

Timing of revision surgery

 

In general, in most cases, revision surgery after a primary operation should be performed only after at least about 6 months have passed, provided there are no acute complications such as inflammation, bleeding, or foreign-body reactions, so that the scar tissue at the surgical site can mature sufficiently and become soft.

 

Timing of revision surgery for square jaw surgery

In the case of square jaw surgery, if there are no acute complications such as postoperative inflammation, it is advisable to perform revision surgery to reshape the jawbone contour about 6 months after the primary operation.

 

Timing of revision surgery for cheekbone surgery

If the cheekbone does not remain properly fixed after surgery and sags, the longer it is left untreated, the greater the risk of unfortunate outcomes such as nonunion of part of the bone or bone resorption. For that reason, it is better to perform revision surgery as early as possible.

 

In particular, if the cheekbone surgery was performed under sedation in a short time, or if cheekbone surgery was done with minimal incisions, and the bone is not fixed in the correct position, the cheekbone may gradually drop downward over time, with part of it resorbing or fusing in the wrong position. In such cases, correction should be done as soon as possible.

 

Of course, in such cases, the first step is to perform a precise analysis of the cheekbone position through three-dimensional tomography, and then establish a surgical plan.

 

 

Square jaw revision surgery

 

 

 

1. Causes that lead to considering revision surgery

 

When there is little change in the contour of the lower face after square jaw surgery

 

• The contour of the face is not determined by the facial bones alone; it is also greatly influenced by the soft tissues covering the facial bones (muscles, subcutaneous fat, and skin).

Therefore, even if the bony contour of the face was not prominent, if the muscles covering the facial bones are well developed or there is a lot of facial fat, reshaping the mandibular bone may not produce a very large change in contour.

 

• On the other hand, the following cases can be considered surgical technical errors.

If only the angular part of the lower jaw was slightly cut or ground down, the contour of the face will not change much, as shown in the figure below (Fig. 1).

 

 

When the facial contour line is unnatural after square jaw surgery

 

• The contour of the face should be connected in a smooth curve. However, if the facial bone contour is reshaped too steeply in a straight line, or if a secondary angle is created at the area connecting to the body of the lower jaw, the facial contour may appear excessively unnatural, or instead of looking softer after square jaw surgery, the face may end up looking only longer and narrower (Fig. 2).

 

 

When there is a large difference between the left and right facial contours after square jaw surgery

 

• Everyone's facial contour has some difference between the two sides. This difference is not only a matter of the facial bones; it is influenced by various complex factors such as the position of the temporomandibular joint, the length of the maxilla, and the condition of the soft tissues.

• However, if the lower jaw contour was shaped unevenly due to a surgical technical error, a large left-right difference in facial contour may also appear after square jaw surgery (Fig. 3).

     

 

 

2. Preparation when considering revision surgery

 

• Surgery that changes the facial contour is performed through the inside of the mouth under limited visibility. In such intraoral procedures, it is advisable for safety to perform the surgery under general anesthesia. Therefore, it is necessary first to check whether the patient is in a health condition suitable for general anesthesia.

• In the case of facial contour revision surgery, because the procedure reshapes the bone contour altered by the previous surgery, it is necessary to carefully review and analyze the deformed facial bone condition in order to establish the surgical plan accurately and fully understand the expected outcome after the second operation.

 

3. Revision surgery method

 

When there is little change in the contour of the lower face after square jaw surgery

 

• After analyzing the deformed bone shape from the previous surgery, checking the location of the nerve running inside the lower jawbone, and reviewing whether there is enough bone left to further contour, the remaining bone can be refined further through the inside of the mouth (Fig. 4).

• The procedure itself is not more complicated than the first operation, nor is it particularly difficult, so you can feel at ease.

 

 

When the facial contour line is unnatural after square jaw surgery

 

• The most common case is when, during the previous surgery, the lower jaw contour was shaved in a straight line and a secondary angle was left at the forward-connected area (Fig. 5).

• In such cases, the area connecting to the anterior body through the inside of the mouth—the newly created secondary angle (figure)—can be smoothed out more gently.

 

 

When there is a large difference between the left and right facial contours after square jaw surgery

 

• Even if square jaw surgery is performed, it is not possible to make both sides of the facial contour exactly the same.

However, it is natural that the result of square jaw surgery should reduce the degree of difference between the left and right jawbones compared with before surgery. If the contour difference between the two jawbones becomes more severe despite the surgery, correction is possible only by reshaping them through revision surgery (Fig. 6).

 

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Cheekbone revision surgery

 

1. Causes that lead to considering revision surgery

 

When the lateral cheekbone contour does not decrease at all after cheekbone reduction surgery

 

• The cheekbone is a structure that determines the contour of the midface, and it is composed of the cheekbone body, which determines the contour of the front cheekbone, and the zygomatic arch, which determines the contour of the lateral cheekbone.

• In surgery to change the contour of the cheekbone, if the zygomatic arch, which determines the contour of the lateral cheekbone, is not precisely moved inward and fixed, and only the front cheekbone area is cut and fixed, the width of the face may not decrease at all, and the front cheekbone may become flat instead (Fig. 7).

 

 

When a line forms in the area connecting the front cheekbone to the lateral cheekbone after cheekbone reduction surgery

 

• If, during cheekbone reduction surgery, part of the front cheekbone is cut and then not fixed accurately in the correct position, the cut area may not unite properly, creating a gap in the bone, or the bone may sag downward (Fig. 8).

 

      

 

When the front cheek appears to sag significantly after cheekbone reduction surgery

 

• In general, after cheekbone reduction surgery, between 3 and 6 months, swelling may make the front cheek look a bit fuller or the nasolabial folds may appear more pronounced, but between 6 months and 1 year it returns to normal.

• The following is the case when a technical problem causes a bone issue during cheekbone reduction surgery.

If, during cheekbone reduction surgery, part of the front cheekbone is cut and the posterior zygomatic arch is also cut, and then it is not securely fixed in the correct position, the masseter muscle may pull the cheekbone downward, causing it to sag and making the cheek appear drooped (Fig. 9).

 

 

2. Preparation when considering revision surgery Cheekbone revision surgery

 

Cheekbone reduction surgery, like square jaw surgery, is mainly performed through the inside of the mouth, so performing the operation under general anesthesia is essential for safety.

Because the cheekbone has a much more three-dimensional structure than the mandible, it is difficult to assess the bone's exact three-dimensional shape with ordinary plain X-ray examinations.

Therefore, three-dimensional tomography (three-dimensional reconstruction of CT) is essential to determine how the previously operated cheekbone position has changed.

 

 

3. Revision surgery method

 

When the lateral cheekbone contour does not decrease at all after cheekbone reduction surgery

 

• First, through three-dimensional tomography, it is necessary to check whether the front cheekbone area is properly united or whether there is no bone defect (an area where the bone is not connected) in the zygomatic arch area.

If there is no problem with the front cheekbone area, the most posterior part of the zygomatic arch (the part connected to the skull) can be cut and moved inward, reducing the width of the face by up to about one finger's width on one side (Fig. 10).

 

 

When a line forms in the area connecting the front cheekbone to the lateral cheekbone after cheekbone reduction surgery

 

• After checking the extent of the bone defect in part of the front cheekbone (where the bone did not unite and was resorbed, leaving a gap) through three-dimensional tomography, it is necessary to cut the posterior part of the zygomatic arch and fix the anterior cheekbone body in a stable position using wire fixation or metal fixation (Fig. 11).

 

 

When the front cheek appears to sag significantly after cheekbone reduction surgery

 

• If, after cheekbone reduction surgery, the nasolabial folds merely look deeper or the front cheeks seem fuller due to soft-tissue swelling, then simply waiting for time to pass will improve it, at the latest within 1 year.

• However, if the cheekbone body and the posterior part of the arch are cut at two points and not fixed, the masseter muscle pulls the cheekbone complex downward, causing the bone as a whole to sag downward and making the face appear drooped.

• In such cases, through an intraoral incision and an incision at the sideburn area, the sagging cheekbone must be lifted upward and fixed so that the bone can unite properly (Fig. 12).