Q: Dr. Eppley, I desire a more womanly face. My face is very big and square and is way too masculine looking. I am not sure if my jaw angle needs reducing or if Botox injections will suffice. Can you please advise? I have attached some pictures for you to see my big square face.
A: A square face, by definition, is when the lower jaw width is just as wide as that of the cheekbones. The width of the jaw angle area plays a major role in creating the horizontal dimension of the lower face in the frontal view. The width of the back part of the jaw (jaw angles) is created by three anatomic components; the thickness or flare of the jaw angle bone, the thickness and volume of the masseter muscle and the flare of the jaw from the front (chin) to the back. (posterior border of the ramus) Only the thickness of the masseter muscle by Botox injections and the flare of the jaw angle (ostectomy or jaw angle reduction) can be reduced. The key question is which one of these two is making the greatest contribution to the width of your lower face. While I suspect it is more bony than muscle by your pictures, it is important to make the right diagnosis. I would recommend getting some simple x-rays (frontal, side and submental plain x-rays) where the bony anatomy will be very apparent. A frontal and lateral cephalometric film (orthodontic type x-rays) with a panorex will also suffice for making this diagnosis.
Dr. Barry Eppley