V-Line Square Jaw Surgery - The Truth and Reality of T-Osteotomy

 

Surgery that changes the contour of a large, angular lower jaw bone into a softer, more refined shape is commonly called square jaw surgery. In this type of surgery, when the front chin area appears somewhat wide and blunt, surgery that trims the overall contour of the front chin into a sleeker shape is often referred to, for convenience, as V-line square jaw surgery.

 

Let us look at the accurate and practical aspects of surgery that goes beyond ordinary square jaw surgery and reduces the contour of the front chin into a smaller, sleeker shape.

 

Surgical methods for reducing the wide, blunt-looking contour of the front chin into a smaller, sharper shape can be considered in several ways.

 

Figure 1 - Schematic diagram

1.     When the chin length is neither long nor short, but appropriate - contour shaving or T-osteotomy

2.     When the chin length is short - lengthening of the chin bone

3.     When the chin length is long - shortening of the chin bone by sandwich osteotomy

  

The two points that must be considered in these surgeries are as follows.

Figure 2. – Nerve pathway on 3D CT

First, the path and location of the inferior alveolar nerve

Second, the overall harmony of the jawline that connects laterally from the front chin

 

Recently, during consultations, many plastic surgery clinics recommend T-osteotomy for the front chin unconditionally, and from my point of view, I find this truly baffling.

 

As shown in the schematic below, when T-osteotomy is performed, step deformities inevitably occur in the surrounding connected areas. If the surrounding lower jaw bone is then shaved to eliminate these step deformities, the risk of injuring the path of the inferior alveolar nerve increases. 



Figure 3. – T-osteotomy simulation schematic

Therefore, if the width of bone removed in T-osteotomy is reduced, it becomes difficult to make the chin contour sleek.

Figure 4. – T-osteotomy simulation schematic

  

The 3D CT below compares the 3D CT of a patient who underwent V-line square jaw surgery with T-osteotomy at a clinic that performs T-osteotomy frequently, but visited our clinic due to dissatisfaction with the results, and the case in which I refined the front chin area. 

Appearance of the front chin after T-osteotomy 

 

Appearance of the front chin after T-osteotomy

Appearance of the front chin after contour shaving

 

 

Of course, I also perform T-osteotomy in appropriate cases when the indications are suitable, but I would like to emphasize that applying the proper surgical method according to the shape of the chin can ensure better results.