Are There People Who Can’t Have Cortical Ostectomy Surgery for a Frontal Square Jaw Effect?

Hello, I’m Director Cho Hyun-woo of Uply Plastic Surgery.

These days, compared to 10 or 15 years ago, there don’t seem to be many people whose square jaw angle reaches 90 degrees.

Instead, there are many people who want a slimmer face from the front.

In fact, unless there is no square jaw angle that needs to be removed, or the jawbone is not extending outward, cutting the bone does not noticeably improve the frontal effect.

In such cases, I have said that cortical ostectomy and masseter reduction surgery can improve the frontal effect.

Then, can anyone undergo cortical ostectomy surgery?

I have performed cortical ostectomy for nearly 20 years, and I have encountered many risky situations where the nerve was too close. Recently, I have been using just one criterion when deciding whether to perform cortical ostectomy.

This is the coronal view of the CT that I mentioned in my explanation of how to read CT scans. In this coronal view, you can see the location of the nerve canal. The red circle I marked is the nerve canal, and by looking at the CT from front to back, you can trace the position of the nerve canal.

I trace it this way and perform cortical ostectomy only until the nerve canal comes out to more than half of the bone. In fact, even when cortical ostectomy is performed, it does not mean that only the cortical portion of the bone is precisely removed. The outer cancellous bone is also removed together.

When the nerve canal runs toward the outer side of the bone, the nerve canal may become exposed. Of course, the nerve remains attached to the remaining bone, but if the nerve canal becomes exposed, you may feel tingling and may complain of discomfort.

Therefore, if the nerve canal is on the outer side, I do not perform cortical ostectomy and instead do cortical shaving. If a lot is shaved, it can remove as much as cortical ostectomy.

If you look at photos like this, for someone whose left side protrudes a lot, if more cortical shaving is done, the cortex becomes almost invisible.

This is a CT taken on postoperative day 3. It looks as if there is a complete hole, but in fact the cancellous bone is present in that hollow area, so it will be covered well over time. When cortical shaving is done like this, the effect is good and there is no concern about nerve damage, so if the nerve line is in a risky position, I recommend shaving rather than cortical ostectomy.

If the square jaw is severe from the front, many people feel a dramatic effect when square jaw surgery is performed together with cortical ostectomy and masseter reduction surgery.

A patient who underwent square jaw surgery, cortical ostectomy, and masseter reduction surgery together

A patient who underwent square jaw surgery, cortical ostectomy (right side), and masseter reduction surgery together to improve the frontal effect and jaw asymmetry

A patient who underwent square jaw surgery, cortical ostectomy, and masseter reduction surgery together for a frontal effect

However, safety is more important than dramatic results. If the nerve canal is exposed or cut, truly irreversible side effects can occur, so before surgery, I think it is important to check your own nerve line position in relation to cortical ostectomy to avoid choosing surgery unconditionally.

Thank you.