Jaw Angle Reduction
Q: Dr. Eppley, I’m wanting to have jaw angle reduction to make the face slimmer.
1.Is it correct that if the jaw angles get cut; then the periosteum that covers the jaw angles will also get detached or cut, correct?
2. The “standard “ jaw reduction surgery would ensure that the periosteum is intact to the jaw bone throughout the procedure. Not to cut the jaw angles which will also result in loss of shape and bone support. Therefore it is best to do a sagittal reduction to make the jaw slimmer?
3. For the sagittal reduction, does it mean that the periosteum does not get detached? I read that a standard procedure would be to keep the periosteum intact and have a sagittal reduction, not cut the jaw angles ? But I don’t understand why the periosteum does not get detached in a sagittal reduction?)
A: The periosteum must be elevated (detached) from the bone in any jaw angle (mandibular ramus) procedure. That is not what is important in preventing soft tissue sag after jaw reduction surgery. The relevant issue is the preservation of the bone angle shape. A traditional jaw angle reduction obliquely removes the full thickness of the angle where various ligaments attach. It will dramatically make the width of the angle less but do so at the loss of angular shape and potentially soft tissue support. The sagittal reduction method preserves the angular shape and soft tissue support although the width reduction will be less.
Either jaw angle reduction technique has its place. It depends on the natural jaw angle shape and thickness of each patien and what one is aesthetically trying to achieve.
Dr. Barry Eppley