What Should Be the Top Priority in Facial Contouring Surgery: Effectiveness or Safety?

Hello, this is Director Jo Hyun-woo of Ibterke Plastic Surgery.

Today, I’d like to talk about the dilemma that comes with facial contouring surgery: “safe surgery” and “effective surgery.”

Most patients who visit the clinic for contouring surgery want to make their face as small as possible.

Of course, I also look at the CT scan and try my best to reduce and remove as much as possible within safe limits so I can create the facial shape the patient wants.

However, after working in plastic surgery for more than 19 years, I have seen far too many side effects caused by excessive bone cutting and pushing-in.

Recently, one patient said, using an expression like “as long as it doesn’t kill me (?)”, “Please cut as much as possible.” I replied, “I’ll do my best within the safest possible limits.”

Let me explain with a few examples.

Zygomatic reduction surgery cut as far as the zygomaticotemporal nerve area

This patient came in because the 45-degree cheek area looked more prominent after cheekbone surgery.

I was shocked when I looked at the CT scan, wondering whether it was really possible to cut that much of the 45-degree cheekbone.

On this patient’s CT, the cut area of the 45-degree cheekbone is the area where the facial zygomaticotemporal nerve exits.

The fixation pin is also secured very close to the orbit.

Of course, the closer you cut to the eye bone, the more the width of the cheekbone is reduced.

But if cutting that close to the eye bone causes partial loss of sensation, can that really be called a good surgery?

Of course, opinions may differ from patient to patient and doctor to doctor, but I do not agree with this kind of surgery.

Zygomatic reduction surgery performed while avoiding the zygomaticotemporal nerve area

As in this patient’s case, I believe that a safe surgery without sensory damage can only be achieved by perfectly preserving the area where the nerve exits.

The same applies to square jaw surgery.

Inferior alveolar nerve (yellow line), safe resection line (blue line)

As shown in this image, when a panoramic X-ray is taken, there is a safe margin for cutting the square jaw bone.

I think that margin is about 3 mm.

When I take X-rays of patients who come in after having square jaw surgery at another clinic, many of them have had the bone cut to within less than 1 mm.

Of course, cutting more may make the result look better.

But if the cut is too close to the nerve line, the nerve can become exposed, and when touching the lower surface of the jawbone, you may feel tingling or pain, along with abnormal sensations.

Square jaw surgery cut close to the inferior alveolar nerve

If you look at this image, you can see how close the margin between the nerve line and the bone cut is.

It is not that I avoid cutting because I cannot cut close enough.

Square jaw surgery performed with a safe margin from the inferior alveolar nerve

If, like this patient, you cut while keeping a minimum safe margin of about 3 mm, the chance of aftereffects can be greatly reduced.

To be honest, when I first started performing surgery, I also cut and pushed in a great deal. But I realized that cutting and pushing in that much does not create an enormous difference in the face, and since then I have pursued safe surgery.

Of course, some patients may still say, “I still want it cut as much as possible,” but in those cases, I usually tell them I’m sorry.

In contouring surgery, if the first operation is done too aggressively, it is virtually impossible to reverse, so I believe that performing surgery within safe limits is the path to becoming naturally beautiful, even if the result is a little less dramatic.

Thank you.