Q: Dr. Eppley, I am at a stage where I am set on receiving a frontal jaw width reduction procedure, but the question really comes down to which procedure. I thought jaw reduction surgery will be the answer to my problems, but I know that I also have quite large masseter muscles. Will jaw reduction surgery alone slim down my jawline? I know that Botox is an option, but I am looking for a more permanent solution. I have heard of masseter muscle excision. What do you think about this procedure?
A: In looking at your pictures, I can see that your very wide jaw angles are most likely a result of a combination of bony angle protrusion and masseter muscle thickness. How much the bony angle contributes to your jaw width can really only be determined by an x-ray (frontal cephalometric x-ray or 3D CT scan). This would be of particular relevance if an angle thinning procedure is to be done as opposed to an angle amputation procedure. Particularly with an angle thinning procedure, the masseter muscle must be managed (reduced) in some fashion of a real posterior jaw width reduction is to be achieved. Subtotal excision of the masseter muscle is never a good idea and that is prone to intraoeperative bleeding and postoperative facial irregularities. This is why most masseter muscle reductions are done by Botox injection since it is far safer…albeit temporary in many cases. I have evolved to a different approach to master muscle reduction with bony angle reductions and that is electrocautery. By cauterizing the inside of the muscle where the bony is lifted off of the bone, this causes a natural shrinking of the muscle due to fiber injury. This takes months to see the final outcome as the muscle shrinks down as it heals. But it can produce up to 25% to 33% reduction of the muscle width.
Dr. Barry Eppley