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Face contouring procedures consists of cosmetic surgeries that enhances the facial appearance aesthetically, and improves the aesthetic image by reshaping and balancing the facial contours. In other words, it is a procedure to make the face contours pleasing and beautiful by sculpting and grinding, or building up the bones which are inharmonious in relation to other facial features.
Face contours for the surgery are composed of the front view, profile view, and diagonal view which is a 45 degree angle.
Face contours can vary when viewed from different angles, and each patient does possess a different silhouette. Procedures will be decided after an overall evaluation.
Square Jaw Reduction (Mandibular Angle Reduction) |
A square jaw which is due to a protruding mandibular angle, gives a tough and stubborn masculine look. The correction of a square jaw can have a double effect; facial contours soften and the neck appears beautifully elongated.
For the square jaw correction procedure, incisions are made inside the mouth with the use of an endoscope and an operating saw. Not only will the angular jawbone be resected, but the operated area as well will be resected to create a natural looking curve. It is important to remove the bone in a crescent shape, for it produces the best contours, and it also helps to reduce bleeding after surgery. Since the degree of protrusion varies with each person, X-ray and CT scans are required to estimate the shape and size of the bone to be resected.
 Procedures
• One-Stage Long Curved Mandibular Contouring by Mirror Technique
 This is a surgical procedure where a smooth curve from the back mandibular angle to near the front chin is resected with one sweep. This is a highly difficult surgery with the use of saws constructed of different sizes and angles. Our surgeons have designed these instruments themselves. The use of these customized instruments have many advantages; the procedure is performed by using a special mirror, it has more accuracy and takes less time than other procedures. It can also prevent swelling or temporary sagging after surgery.
Long curved madibular angle resection helps to improve the contours with a natural profile and a feminine front view.
• Botox
- Pre-operative Botox
Botox injection is not to reduce the size of the bone, but the masseter muscles covering the square shaped jaw. If a patient has severely overgrown masseter muscles, the Botox injection will shrink the muscles before surgery. Thus, the surgery will be much easier to perform and it will ensure better results.
- Post-operative Botox
Square jaw resection itself has the effect of reducing the size of masseter muscles considerably. However, if the size of the muscles do not reduce sufficiently, which is a rare case, Botox injection 4 months to the post operative date will significantly help to reduce the volume of the masseter muscles.
• Chin and Jaw Contouring by BK
When a patient’s chin is to wide or long, and has a square jaw as well, long curved mandibular contouring will be extended to the front chin by resecting the lower part of the chinbone. |
Which procedure is right for me?
* If I have jaw muscles of normal size, but jutting angular jawbone with V shaped front chin,
We recommend angular bone contouring with a suctional saw through a small incision of 5 mm under the chin.
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If I have overdeveloped jaw muscles and jutting angular jawbone with V shaped front chin,
We recommend short resection of angular area through an incision inside mouth before reducing muscles.
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We recommend long curved mandibular contouring down to the front of the chin from the angular square jawbone, which makes a V shaped face, and an appearance of a longer neck when viewed from the front.
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If you have jaw muscles of normal size jaw, but wide flat chin which makes the face look larger,
You probably look like you have a square jaw from the front profile even though your jaw muscles are not overdeveloped. We strongly recommend long curved mandibular contouring for this case. Just a short resection of the angular bone will create a secondary angle, and will make you appear as if you are holding a piece of candy in your mouth.
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If you have wide flat chin and U shaped masculine jawbone,
To correct an overdeveloped chinbone and a U shaped masculine jawbone, we recommend a high leveled operation of bone resection which avoids nerves in the front portion.
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If you have only overdeveloped jaw muscles (masseter muscle hypertrophy),
Congenital or acquired hypertrophy of masseter muscles formulates a square jaw. To reduce the size of masseter muscles, we recommend cortex ostectomy, grid incision, or Botox injections.
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If you have an asymmetric square jaw,
Most patients with a square jaw have asymmetry in the bones, muscles, or fatty tissues. An exact evaluation of asymmetry is required before surgery, and a proper procedure will be elected accordingly. |
• Frequent Questions
Q.
I want to improve my front appearance. Which procedure is right for me?
A. For improvement of your facial contours from the front profile, it is important to reshape the thickness of masseter muscles, the thickness and angle of jawbone, and the fat volume in the cheeks. In general, masseter muscles cover 60 to 80 % of the thickness of the face for the entire front profile. Therefore, the face contouring effect from the front profile depends on how much masseter muscle is reduced. In this regard, mandibular angle reduction surgery will be more effective if an additional procedure is performed. Whether it be cortex ostectomy or grid incision, the surgery may be followed in accordance to the patient’s condition.
Q.
What is a secondary angle?
A. If the jawbone is cut in a simple straight line for the mandibular angle reduction surgery, the natural angle under the ears disappears. This natural angle which our jaws possess is the Secondary angle. When a simple straight line is resected on one’s jaw, a highly unnatural jaw line and a more aged appearance is constructed. Our hospital is well known for creating the natural secondary angle with the mandible reduction procedure.
Q.
Will the operated area feel cold and discomfort?
A. After the normal procedure of mandibular angle reduction, you may experience temporary numbness or insensibility, but it will disappear soon after the procedure during the healing phase. If this symptom lasts, it is quite plausible that your nerves may have been damaged during the operation. This is why many years of experience and skills with face contouring, and X-ray scans of the actual size are essential.
Q.
Will the bone grow again?
A. In principle, the jawbone won’t grow again after an angle resection. However, masseter muscles can redevelop due to the patient’s bad habits; such as chewing gum or dried cuttlefish too much. With this in mind, the patient should religiously abide to the instructions provided by the surgeon for the successful recovery and optimal results. If unfortunate aesthetic problems occur due to the patient’s habits, they can be corrected by a simple Botox injection.
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Cheekbone Reduction (Zygoma Reduction)
Protruding cheekbones consist of front protrusion, side protrusion, and a combination of front and side protrusions of the cheekbones. The majority of Asian people have side protrusions, with a rather flat profile on the front part of the cheeks, this characteristic makes the face look larger and also lacking in volume.
In the past, large incisions were made inside the mouth or on the temporal. But, these days, a tiny 3 mm incision is made inside the mouth, and the procedure is performed with use of an endoscope. This is a safer and more efficient procedure with only a few side effects, including less pain and a faster recovery.
It is important to use X-rays and CT scans to evaluate how much of the cheekbone should be sculpted and removed, with the consideration of size and shape. These evaluations will help bring the bones to a harmonious balance with the rest of the facial features. This is all obviously accomplished before the procedure is performed.
Procedures
• Three-dimensional cheekbone reduction without sagging cheeks by BK
 Cheekbones adjacent to other facial bones have a three-dimensional structure which determines the width of the face. Accurate examination and exact evaluation are essential for successful surgery.
Cheekbone reduction surgery is performed through intraoral (inside the mouth) incision and scalp incision. As for the scalp incision, 1.5cm incision is made on the side of the scalp to remove some cheekbone on the whiskered area using a burring saw. This procedure is very effective, leaving no visible scars, but requires a very high degree of skill as the area of operation is far from the incision area.
On the other hand, the intraoral incision is used to cut the front part of cheekbones.
The cheekbone reduction of BK , is based on a wealth of experience and proven techniques, brings a balanced structure to the face according to the patient’s condition by performing the most effective procedure and achieving accurate operative results without sagging cheek skin.
4 steps to prevent sagging cheeks
1. Perform diaphysis fixation
2. Make a small rise to prevent the fixed cheekbone from drooping
3. Detach partially the front masseter muscle which is pulling the bone
4. Minimize the periosteum separation by minimal detachment to prevent sagging cheeks
=In case of large front cheekbone, additional surgery is required to move the resected bone further backward.
=In case of large side cheekbone, small size of implant can be inserted into the front cheekbone area at the same time of side cheekbone reduction surgery. |
• Side cheekbone reduction by minimal scalp incision
The side cheekbone which is prominently placed next to ears and over the whiskers will be reduced by minimal scalp incision of 1cm long.
This procedure is used to correct protruding side cheekbones as well as unpleasing uneven cheekbone contours due to previous cheek surgery.
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• Frequent Questions
Q. Is fixation necessary?
A. Most procedures of cheek surgery involve moving the front and side cheekbones backward after resecting them. Therefore operated cheekbones can move after surgery. Fixation is not a requirement, but if they are not properly fixed, the results would not persist with side effects like sagging cheeks, asymmetric cheeks, or unstable bones. In this regard, we strongly recommend fixation.
Q. Will the cheekbones move a little after surgery?
A. Despite fixation, cheekbones will move slightly as they are settled while swelling subsides. You don’t need to worry because this is normal. |
+Caution before and after surgery+
• Pre-Operative Care
1. You must refrain from eating 8 hours before surgery.
2. You should report any medical history (high blood pressure, diabetes, etc.) or medications to your surgeon.
3. You must stop smoking 2 weeks before surgery.
4. You must stop drinking alcohol 1 week before surgery.
5. Please come to the hospital 30 minutes in advance of the appointment on the day of surgery.
6. Do not wear nail polish, makeup, accessories, or contact lenses. You don’t need to accompany a guardian, but please avoid driving home afterward.
• Post-Operative Care
1. BK provides professional and family-like inpatient treatment with careful nursing for the patient’s comfort on the days of surgery.
2. Liquid and soft food diet is required for 2 to 3 days after surgery and then you may eat any kind of foods except very hard tough foods.
3. Swelling peaks on the 2nd or 3rd day after surgery and will subside within 2 weeks. You can enjoy the results of your final facial contours 6 to 8 months after surgery.
4. Use a cold pack for the first 5 days and afterward a warm pack is when there is no warmth in the affected area.
5. It is better to be sitting or walking a little than just lying down.
6. You have to take antibiotics for a week to prevent infection. This surgery is performed inside the mouth, so it is important to keep inside the mouth clean. Please always take care of dental and oral hygiene by washing out with water and gargle immediately after eating food.
7. Avoid being jarred or bumped in the face.
8. You can wash your hair 2 to 3 days after surgery and brush your teeth with a toothbrush of small head 4 to 5 days after surgery.
9. Drinking alcohol and smoking prevents heeling. Please avoid smoking for at least 2 weeks and drinking for 1 month after surgery.
10. You may rarely experience numbness which will disappear within 1 to 2 months after surgery. You may also feel discomfortable on the movement of your facial muscles due to repositioning. This will gradually subside as well.
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Protruding Mouth Correction
The correction of protruding mouth which is called bimaxillary prognathism refers to a surgical procedure to move backward all teeth and gum tissue and fix them up by maxillary and mandibular osteotomy through an incised space made after pulling out 2 upper and 2 lower teeth. The results of successful surgery are magical in the change of appearance. Since the correction of bimaxillary prognathism is a very difficult operation, much experience and expertise as well as accurate and safe procedure are required for successful surgery together with the precise analysis on the extent of protrusion.
Procedures
Horizontal minimal incision is used for the correction of protruding mouth in BK. This new method is completely different from the usual incision performed elsewhere which refers to an incision on the gums in a big ‘ㄷ’ shape. Our method has an advantage of leaving invisible scars on the gums when smiling or laughing.
• Do I need orthodontia after surgery?
 Half of patients who had their protruding mouth corrected end up with orthodontic treatment. Aesthetic expectations of pleasing contours can be achieved by the correction of protruding mouth, but extraction of teeth is prerequisite for the surgery, and teeth and gums will move accordingly after bone resection. Thus, there will be a change in alignment of teeth.
For this reason, orthodontic treatment is necessary as finishing touches to make up the space produced due to extraction and occlude the teeth. In some cases, only dental prosthesis is sufficient without orthodontia. Orthodontic treatment is available 2 months after surgery and it takes 3 to 12 months to complete the treatment.
• Who needs protruding mouth correction?
 Protruding mouth refers to a projecting mouth that gives a blunt look when viewed in profile. Lips are usually open and when you close the lips yourself, your mouth looks inharmonious with the tip of the chin. When you smile, too much gum tissue is seen and the lips look very thick.
This surgery is generally recommended for over age 17 with individual difference. If you have false teeth put in after extraction of 6 front teeth, or you have receding chin surgery, or even if you’ve already finished having orthodontic treatment, but you are not satisfied with your looks, you are allowed to have protruding mouth surgery.
• Difference from orthodontia
In general, orthodontia refers to a treatment for correcting the alignment of teeth. When you get only the orthodontic treatment after pulling out 2 upper and 2 lower teeth in order to correct protruding mouth, which means both maxillar and mandible are jutting, you have to wear a brace on the teeth at least 2 to 4 years. Plus, you may not have satisfactory results even after the long painful period of treatment.
So to speak, it is the right way to correct the bones if you have a problem with bones and to correct the tooth alignment if you have a problem with the tooth alignment.
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Receding Chin Correction (Genioplasty/Mentoplasty)
To achieve facial balance and harmony, contours of chin are very important, especially when viewed in profile. A well defined chin makes a major difference.
Procedures and Implants
• Autologous tissue
-Chinbone osteotomy and moving: It refers to a procedure whereby the surgeon cuts the chinbone of the patient’s own and moves it forward or downward. It rarely has side effects, but if it needs to lengthen the size of chin, bone graft is essential, which costs a great deal. Aesthetical demerits may occur such as sagging jowls or layered skin when the bone is moved in a large range.
-Micro fibro-fat grafting: Recently coming into the spotlight, this procedure refers to a delicate injection of the fat extracted from the patient’s lower abdomen into the receding short chin area. It rarely has side effects as well, but once or twice additional injection should be done for optimal results. Incision is made inside the mouth, so scars are invisible.
• Implant Insertion
- Silicon: This is the simplest and safest method for chin augmentation.
Through intraoral incision the implant is inserted on the chin. This procedure makes only a little swelling and the patients need very short recovery period and get dramatic improvement of profile.
It is not necessary to remove the stitches and this leaves no scar at all.
- Gore-Tex: It makes a well-shaped implant, but can be contracted to 40%. Compression tested Gore-Tex should be used for satisfactory results of the surgery.
-MedPore: Its shape is good, but the patient can feel discomfortable in the movement of the mouth after surgery. |
Protruding Chin Correction
Mandibular prognathism refers to a protruding chin which makes the face look longer with jutting lower jaw. In the past, the protrusion of chin was corrected and treated only when a person had masticatory disorder, malocclusion of the teeth, or temporomandibular joint syndrome.
Procedures
 Protruding chin surgery is often regarded as a procedure to move just lower jawbone backward, but in fact, it needs to correct the upper jaw which is relatively receding in addition to correct the jutting lower jawbone for most cases. Therefore, bimaxillary orthognathic surgery (correction of both upper and lower jawbone) is very common and accordingly, the position of upper and lower jaw changes after surgery. For this reason, orthodontic treatment is required before or after surgery in consultation with orthodontists.
Orthodontic treatment before surgery generally takes months, but it varies with the individual case. That is to say, it takes a long while to be under the knife after you decided to have surgery. Considering the duration of the whole procedure, you’d better prepare yourself with enough time to spare.
What to expect after surgery
Swelling will be mostly gone 2 weeks after surgery, but a dressing will be applied and remained in place for a week to fix the maxilla and the mandible. During the healing stage, you should take a liquid and soft food diet as your ability to move the mouth will be limited. Chewing will be also restricted.
You will experience some temporary difficulty with breathing through the nose because of significant swelling inside the mouth and nose immediately after orthognathic surgery. In addition, since the nerves in the teeth are cut while upper jaw is moved, you may feel temporary numbness in upper teeth until the nerves are recovered. On the contrary, the nerves in lower jaw are remained uncut, but temporary numbness may occur in the lower jaw and lips due to the shock of osteotomy. Sensation will be recovered within several days or months at longest.
Post-operative orthodontic treatment will be available as soon as the incision is healed, but we recommend the consultations with orthodontists.
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Forehead Contouring
• Forehead Augmentation
Forehead augmentation refers to a procedure to correct broad and flat or sunken forehead by giving contours with fat injection or implant insertion in order to create round and voluminous shape. The fat extracted from the patient’s abdomen or thighs will be grafted into the forehead. Autologous fat grafting has few side effects and helps to make natural and pleasingly prominent forehead as some fat graft will be gradually absorbed into the skin tissue.
Procedures
Autologous fat grafting which is performed under local anesthesia takes 30 minutes to an hour. To minimize swelling, the forehead will be bandaged for 3 to 7days and shampooing will be allowed 3 or 4 days after surgery. Autologous fat is extracted from fleshy body parts of the patient such as lower abdomen or outer thighs, which makes the troubled spot look slimmer. Extracted fat will be refined through centrifugal separator and then grafted into the forehead. Injection is used for fat grafting without incision, so no scars leave.
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Paranasal Augmentation
Paranasal augmentation refers to a procedure to correct the sunken area around the nose. This procedure is often labeled as noble face surgery as it makes the face look elegant and classy as noblesse.
Asian face is relatively wide lacking in distinct facial contours which can catch the eye. Especially, this procedure is effective for the patients whose nose looks flat and mouth protruding, or who have deepening nasolabial folds due to sagging cheeks while aging.
Procedures
For paranasal augmentation, implants are inserted such as Silastic (solid Silicon) or MedPore.
Incision is made inside the mouth or on the natural crease around the nose under local anesthesia. Significant swelling will subside a week after surgery and most swelling will be gone one or two months afterwards so that you can enjoy the results. You can have normal food from the next day of the surgery even though intraoral incision is used. The incision are will not be bandaged, but will be taped for 2 to 3 days. |
Chin Asymmetry Correction
Asymmetric chin correction is very effective for a well defined and balanced face as asymmetric chin makes the face look off-centered when viewed from the front. However, seriously asymmetric chin requires mandible correction surgery while medium asymmetry can be corrected by front chin osteotomy.
The procedure involves front chinbone osteotomy and adjustment of off-centered bone before asymmetry correction. Most patients with asymmetric face have asymmetric mandible at the same time, so mandibular asymmetry correction will be required.
Procedures
Incision is made only inside of mouth under general anesthesia and the operation takes about an hour. Bandage will be applied for 2 to 3 days after surgery. On the day of surgery, you can drink water, ionic beverages, juice or milk from 5 hours after surgery and the next day you can have light food. Your surgeon will instruct you about dietary restrictions in accordance with the healing phase.
What to expect after surgery
50% of swelling will subside a week after surgery and most swelling will be gone 2 weeks after so that you can get back to normal. For mild swelling, it takes 2 to 3 months to disappear completely and your final facial contours will become apparent. You may experience discomfort such as temporary local numbness or abnormal sensation (such as stretched, tight or pricking sensation), but these symptoms will gradually disappear. Apply a cold pack to the operated area for the first week after surgery, and then apply a hot pack. We recommend you to move the mouth as often as possible, and be seated or stand instead of lying down.
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