Facial contouring surgery for asians

Abstract

Asian people, especially women, prefer a more delicate and feminine facial shape. To achieve a softer and better facial contour, there are several procedures to change the facial skeleton. Reduction malarplasty and mandibular angleplasty are common facial contouring operations in Asia. A lot of techniques have been developed independently by several authors. Various approaches can be chosen, such as intraoral or external skin incisions. There as also different contouring methods that can be chosen depending on the patient's morphology and the surgeon's technical preferences. The different osteotomy techniques used to mobilize the zygomatic complex can be classified according to the specific portion that is being repositioned. Resection and contouring methods for a prominent mandibular angle can be subdivided according to the specific type of anomaly. The purpose of this article is to review the concepts and various operative procedures for reduction malarplasty and angleplasty. The authors propose a guideline for selecting the appropriate procedure(s) for individual patients. Decisions should be made according to the patient's need, anatomic variations, and possible operative sequelae.

Keywords: Asians; Facial contouring surgery; aesthetic surgery; angleplasty; malarplasty.

Figure 1

Golden facial mask: (A) female mask; (B) male mask. (From Kim YH. Easy facial analysis using the facial golden mask. J Craniofac Surg 2007;18:643–649. Reprinted with permission.)

Figure 2

A method of mobilizing the zygomatic complex could be subdivided according to a specific repositioning portion of zygoma: body, arch, or both. (A) Two osteotomy sites: the zygomatic body and arch. (B) When zygoma body prominence is dominant, the zygomatic complex is moved backward more (large arrow) and when arch is more prominent, the complex is moved medially (small arrow). (C) View after reposition and fixation of zygomatic complex.

Figure 3

(A, B) Preoperative view of a 21-year-old woman with malar protrusion. (C, D) Postoperative views 2 years after reduction malarplasty on each side.

Figure 4

L-shaped osteotomy at the zygomatic body. (From Kim YH, Seul JH. Reduction malarplasty through an intraoral incision: a new method. Plast Reconstr Surg 2000;106:1514. Reprinted with permission.)

Figure 5

Resection of the prominent mandible angle using an oscillating saw through intraoral incision.

Figure 6

Mandibular angle reduction using angle splitting ostectomy. (A) Resected segment of the lateral cortex and some portion of the ascending ramus en bloc. (B) Horizontal and vertical osteotomies using burr saw and osteotome.

Figure 7

(A, B) Preoperative view of a 26-year-old woman who complained of “square face.” (C, D) Postoperative views 5 years after mandibular angle splitting ostectomy. Reduction malarplasty and genioplasty were performed as concomitant procedures.

Figure 8

(A) A 40-year-old woman complained of too steep mandibular angle and depression on angle area after reduction angleplasty. (B) One year after recontouring mandibular body and angle area and fat grafting on depressed area.