Can Jaw Angle Augmentation Be Done By Osteotomy Or Bone Grafting?

Q: Dr, Eppley, I am writing to inquire about surgical options for modifying the mandibular angle (gonial region), specifically to increase its lateral/outward projection.

Currently, my gonial angles appear to flare slightly inward, which reduces their visibility in profile and contributes to a weaker overall jawline. I am interested in achieving a more laterally prominent, everted gonial morphology, which I associate with a stronger and more defined male jawline.

 I recall having seen a procedure conceptually similar to a chin wing osteotomy, in which a segment of the inferior mandibular border is osteotomized and repositioned to alter lower facial structure. The standard chin wing osteotomy appears to primarily influence the anterior mandible and chin region, with relatively limited direct modification of gonial projection. I would like to know whether any segmental repositioning techniques exist that more directly target the gonial region or the posterior mandibular body/ramus transition.
 Mandibular angle reduction or narrowing procedures (e.g., V-line reduction) typically involve the region I am interested in modifying. My question is whether it would be possible to allow for augmentation or lateral repositioning of the existing gonial angle complex, ideally through bone-preserving osteotomies rather than implant-based augmentation.
 For context, I have attached three illustrative references: 1. The first image shows different mandibular flare patterns. In this diagram, A and B represent female mandibles, characterized by more inward or straighter gonial angulation, while C represents a male mandible with a more outward/everted gonial flare. The latter (C) corresponds more closely with my aesthetic goal. 2. The second image illustrates a chin wing osteotomy. While this demonstrates the principle of segmental osteotomy and repositioning of the inferior mandibular border, it appears to primarily influence the chin and anterior jawline, with limited direct alteration of gonial projection. 3. The third image is based on mandibular angle reduction (V-line), which highlights the specific bony segment typically removed in such procedures. My interest is whether this segment, particularly the portion extending toward the gonial angle and ramus transition, could instead be mobilized and repositioned laterally to increase gonial prominence rather than excised. I am not interested in implant-based approaches. I also understand that non-vascularized onlay grafting in this region may be unpredictable and prone to resorption. I would appreciate your perspective on whether any reliable skeletal techniques exist to achieve this type of modification, or whether implants remain the only predictable option.
 Thank you for your time and consideration.

A: It is very common that the ramus (jaw angle) flares inward rather than outward. There is no osteotomy that can make the jaw angle have an outward flare or prominence. Jaw angle augmentation can only be done by implants.

Dr Barry Eppley

Plastic Surgeon