After Facial Contouring Surgery: Asymmetry, When Can Revision Surgery Be Performed?

Hello. I’m Dr. Jo Hyun-woo of Inhyeong Plastic Surgery.

Today’s topic is when revision surgery can be performed after facial contouring surgery.

In fact, compared to eye and nose surgery, facial contouring surgery is not a procedure that frequently requires revision surgery.

It is not the kind of surgery where a difference of 1–2 mm appears, like a double-eyelid line, and if the surgery was not significantly problematic, revision surgery is rarely necessary.

However, because facial contouring surgery involves cutting bone, it is also a procedure that must be done well the first time.

Of course, there are surgeries to reconstruct an excessively shaved mandibular angle and surgeries to reconstruct the cheekbone, but

it is most important to perform the first surgery accurately, and for that, you should decide how much bone to remove and how much to reduce the width of the cheekbones through sufficient consultation before surgery.

Then, let’s take a look at the timing of revision surgery for each area.

First, let’s look at zygoma reduction surgery.

The biggest cause of revision surgery after zygoma reduction is nonunion of the cheekbone.

Nonunion can occur for several reasons.

First, the fixation pin that was used for fixation may break.

As you can see on the CT, this is a case where the fixation pin that had been secured broke. If the fixation pin breaks, it must be fixed again right away.

If the pin breaks after the bone has already hardened to some extent, the bone does not move, so there is no need to replace the pin.

However, in most cases, these issues occur before the bone has fully hardened.

The muscle force may be strong, and there can be various causes, but in such cases, it is important to fix both the front and back parts of the cheekbone to distribute the force placed on the pin.

If you perform revision surgery like this and refix it, the bone should heal properly without any problems, right?

Another cause is when the fixation pin comes out of the bone.

Usually, if there is inflammation such as sinusitis, the bone can begin to dissolve. In such cases, revision surgery is truly difficult.

When going back in to refix it, the bone around it has already dissolved and crumbles apart.

In these cases, the bone must be preserved and fixed as much as possible.

In this patient’s case, they visited our hospital with chronic sinusitis, and when we took a CT scan, the bone appeared separated, and you can see that the fixation pin is not properly attached and is floating in the air.

In such cases, we perform surgery again, thoroughly clean the sinus, remove all the dissolved bone, and fix it with new pins.

Depending on the case, it may be possible to stabilize it well, but if the bone has dissolved significantly, a second surgery may be needed for cheekbone reconstruction.

Therefore, if there is inflammation such as sinusitis, it is best to have surgery immediately.

Another common revision surgery is when the side cheekbone has rotated back.

This patient had surgery about 10 years ago, but the side cheekbone arch has not reduced at all and remains in its original position.

In such cases, the timing of revision surgery is actually not very important.

That is because the bone must be cut again after it has hardened.

If the bone is cut again through revision surgery and securely fixed with pins, you can see that the side cheekbone is tucked in better than after the first surgery.

Other cheekbone revision surgeries are not especially urgent, and in most cases, revision surgery for dissatisfaction that the cheekbones were not reduced enough can be done whenever you want.

Next, I will talk about square jaw surgery.

Square jaw surgery is not a procedure that often requires immediate revision surgery like cheekbone surgery does.

If you understand exactly how much can be removed when consulting for the first surgery, revision surgery can be prevented.

A common reason for revision surgery is when the square jaw bone is cut asymmetrically, making one side look larger.

If only one side looks too large, the other side can be shaved more to correct the asymmetry.

In fact, because the location of the nerve line is often different on the left and right, this is not a surgery that can always be done, but if the CT is carefully analyzed, good results can be achieved.

Another commonly performed revision is when a secondary angle (step deformity) develops.

It is a simple surgery in which only the area where the secondary angle formed is shaved, and this surgery can also be done whenever you want, regardless of timing.

This is a patient in whom the secondary angle is visible in the photo.

They wanted the secondary angle removed and the chin narrowed further through T-osteotomy.

This is the post-operative photo.

You can see that the secondary angle visible before surgery has been resolved, and the chin appears slimmer.

Another square jaw revision surgery is for people who feel that the face did not become slimmer from the front.

This patient came in after having behind-the-ear square jaw surgery, saying that only the angle near the ear had been removed and the front had not become slimmer at all.

This procedure can be dramatically improved by performing front chin surgery together with cortical bone reduction to reduce the front width.

If you look at the post-operative photo, you can see a slimmer appearance.

In addition, some people feel that there is still a slight deficiency if cortical bone reduction was not performed during square jaw surgery, or if masseter muscle reduction was not performed.

In such cases, I do not recommend revision surgery unless the case is severe.

So, it is always best to have a careful consultation before surgery and think it through.

Lastly, revision surgery for chin surgery.

Because surgeries such as T-osteotomy involve cutting the bone and fixing it with pins, side effects related to the fixation pins can occur, just like in cheekbone surgery.

If there is inflammation in the chin, the pin may come out and the bone may dissolve, so if these symptoms occur, revision surgery should definitely be performed quickly.

In cases where the front chin simply did not come forward enough, or came forward too much, it is best to wait until the bone has fully healed.

After 6 to 12 months, revision surgery can be performed accurately without bone loss.

So far, we have looked at the timing of revision surgery after facial contouring surgery.

As mentioned earlier, facial contouring surgery is not a procedure that often requires revision surgery if there is sufficient preoperative consultation and the surgery is performed by an experienced specialist.

With the exception of a few urgent cases, the timing of revision surgery can be considered slowly, so rather than rushing, it is best to make your decision after consulting carefully.

Thank you.