What Side Effects Can Occur Due to Excessive Reduction in Facial Contouring Surgery?

Hello, this is Director Jo Hyun-woo of 입체성형외과.

Today, let’s look at what side effects can occur when too much bone is removed during contouring surgery.

From around the early 2010s, contouring surgery started to be performed much more often. At that time, there was a trend of cutting as much as possible. If the theme of contouring surgery used to be removing a lot of bone and creating dramatic changes, recently there seems to be a tendency to pursue safer surgery because of the side effects caused by excessive reduction. So, what side effects can occur due to excessive reduction?

Zygomatic Reduction Surgery

The area of the cheekbone from which bone is removed is the 45-degree cheekbone area. In the early days of cheekbone surgery, the amount of resection of the 45-degree cheekbone was sometimes very large.

When performing an L-shaped osteotomy, I have also seen cases where nearly 1 cm was removed all the way to the red shaded area. The blue circle, as I mentioned in a previous column, refers to the zygomaticotemporal nerve, which is responsible for sensation around the eye area, and there were cases where even that nerve was cut.

Of course, because the bone is cut close to the orbital bone, the width of the cheekbone can be reduced a lot in people whose cheekbones make the eye area look broad. However, side effects such as reduced sensation can occur, and the more bone is removed, the shorter the distance the back part of the cheekbone can be brought together, which often leads to nonunion. If nonunion occurs, sagging of the cheeks naturally follows, and if too much of the cheekbone is removed, the sinus becomes more exposed, increasing the incidence of sinusitis.

Many side effects of cheekbone surgery were caused this way. Another major problem is that the actual amount by which the 45-degree cheekbone is reduced is not very large. Therefore, these days, it seems that surgeons reduce the amount of bone removed from the cheekbone and often perform cheekbone rotation surgery, which pushes it backward.

Jaw Angle Surgery

Among the side effects of jaw angle surgery caused by excessive bone removal, the most serious one seems to be nerve damage.

Red (inferior alveolar nerve) Blue (appropriate resection) Green (over-resection)

In the panoramic X-ray, the red line is the path of the inferior alveolar nerve. In practice, if cutting about as much as the blue area while leaving a margin of 3 to 4 mm below the nerve line is the best approach, there were also cases where surgeons cut all the way to the green area in order to remove as much of the jaw angle bone as possible.

If the nerve is cut while the bone is being removed, this causes nerve damage that can never fully recover. The inferior alveolar nerve is a sensory nerve, so if it is severed, sensation in the lower jaw area is completely lost. Even if food spills out or saliva drips, you would feel nothing. Movement problems can also occur, and the shape of the mouth may become unusual.

Sometimes people say they do not mind losing sensation and ask for as much removal as possible, but it would be good to understand that this can lead to truly terrible results.

Another side effect of jaw angle surgery from excessive reduction is that the bone can take on what is commonly called a "dog jaw" appearance. If the jawbone is cut so that there is no angle left, like a dog’s jawline, the result in a human face looks very unnatural. I will show you by editing a patient’s photo in Photoshop.

Side effect of jaw angle surgery due to over-resection: "dog jaw"

From the front, it may not be obvious at all, but from the side, if too much of the jawbone is removed, the face looks awkward like this. Sometimes, if too much is cut, the bone can even fracture. Therefore, it is always better to cut carefully and safely.

Chin Surgery

If too much is removed during chin surgery, nerve damage can occur, just like in jaw angle surgery.

Red (inferior alveolar nerve) Blue (appropriate resection) Green (over-resection)

The red line is the path of the inferior alveolar nerve. A typical T-shaped osteotomy should be performed below the nerve line, as shown by the blue line. If the osteotomy line is raised in an attempt to reduce the chin too much, the same kind of nerve damage mentioned earlier can occur. Also, if too much bone is removed through T-shaped osteotomy, the remaining bone becomes too small, and in some cases the bone is resorbed and disappears.

In this photo, you can see the panoramic X-ray of a person who had surgery a year ago. At the time of surgery, there would have been bone remaining below the T-shaped osteotomy, but perhaps there was unnecessary dissection, or the bone fragment may have been too small and was resorbed. At present, only the fixation pin remains alone.

I think surgery may sometimes require boldly removing bone in order to achieve a good result. However, if excessive reduction leads to serious side effects that are more harmful than the benefit, I believe that is a bigger problem.

Today, we looked at the side effects of contouring surgery caused by over-resection. Of course, I understand the feelings of patients who want to cut as much as possible and make their faces smaller, but if you think that safer surgery with no side effects may be better for the future, it would be better to reduce a bit of that desire and approach contouring surgery more cautiously. Thank you.