Can Jaw Angle Reduction Be Done To Look Natural?

Q: Dr. Eppley, I am a woman with square jaw who just wants to have her angles rounded off, nothing extreme…so far, the people I’ve seen who have had jaw angle reduction/resection were left with no angles at all and I found it unnatural and unattractive. I saw a professor who talked to me about bone decortication, removing a little bit the angles without touching the bone or touching the muscle and that it can be done under local anesthesia with little risks and would give a natural result. But he said that asymmetries are common with that type of method. Is that all correct?

A: Jaw angle reduction/recontouring can be done by two basic methods, bicortical (amputation) or monocortical. (decortication) While the historic and still most commonly used technique is bicortical removal, you are correct in that such amount of bone removal can make the jaw angle ‘hollow’ and create a soft tissue sag or indentation over the jaw angles. For many patients, a monocortical approach may be better as it lessens jaw angle width but without losing jaw angle shape. The best candidates for this type of jaw angle reduction surgery are those that have radiographic comfirmation of an angle flare that sticks out beyond the external oblique ridge of the mandibular ramus. This makes it technically possible to reduce the jaw angle flare with the instruments that are available to do it.

But no jaw angle recontouring method can really be effectively done under local anesthesia. (nor can I imagine who would want to) It is necessary to lift the masseter muscle off the bone to provide visualization for the bone reduction. Any method of jaw angle manipulation (augmentation or reduction) run the risk of asymmetry because they can not be seen as a ‘pair’ surgically and most people do not have perfect jaw angle symmetry beforehand.

Dr. Barry Eppley

Indianapolis, Indiana