Can My Overreduced Jaw Angles Be Fixed?
Q: Dr. Eppley, I am unhappy with what was done to my jaw angles. The procedure was done using a saw-like tool that was used to cut off bone from my jaw angles. I think they took too much bone. I don’t want to go back to exactly the way my jaw angle was before, however, I would like to get some prominence back. I think too much was shaved down and it looks too weak now. Also, both sides are uneven so my left and right profiles do not match which just shows how much my last surgeon was lacking in skill and technique. What can be done now to fix it?
A: Jaw angle reduction is done for prominent or flaring jaw angles which make the lower face too square. This is most commonly done in Asian populations due to their ethnically more square facial shapes. From inside the mouth, am oscillating saw is used to remove the tip of the jaw angle in an angulated bone. How much bone to remove and how steep to make the angle of the cut is a matter of intraoperative judgment and experience.
Restoring a now too obtuse and short jaw angle can be done with jaw angle implants. Placed from inside the mouth, the implants are inserted under the muscle back over where the bone had been cut out. The implant’s size and shape, like the original bone cut, is a matter of aesthetic judgment. While the jaw angle implant’s size should be small, positioning them to correct jaw angle asymmetry requires precise and secure placement. Using a panorex x-ray before surgery, measurements can be taken to get a good idea about the differences in bone shape around the jaw angle. This can be useful to appreciate when placing the implants as both sides can not be seen at the same time.
Dr. Barry Eppley