Experience in East Asian facial recontouring: reduction malarplasty and mandibular reshaping.

OBJECTIVE To review my experience in both malar reduction and mandibular reshaping techniques to establish optional, effective, and reliable surgical procedures. A square-shaped face is considered aesthetically unfavorable among East Asians; therefore, reduction malarplasty and mandibular reshaping are becoming more acceptable for aesthetic facial skeleton recontouring. METHODS The techniques of zygoma arch infracture or mandibular angle reduction were used until 2 alternative techniques were introduced in 2002: the wedge-section osteotomy in the malar complex and inclined-fullness osteotomy in the mandibular angle and margin. Both osteotomies were selected according to personal experience and communication with patients. The wedge-section zygoma osteotomy was performed in the lower zygomatic body via an intraoral approach and greenstick infracture of the posterior zygomatic arch through a tiny preauricular incision. The prominent malar complex could be reduced by being pressed inward and was stabilized only by surgical suture or self-stabilization without any fixation, and the latter method was chosen in my recent cases. For the lower face, I designed an inclined-fullness osteotomy to address the mandibular angle and margin along the diagonal of marked projection of the mental foramen on the margin of the mandible and the projection of mandibular foramen on the ramus. The surgical indications, major complications, and levels of patient satisfaction for the different techniques were compared, and thus the pros and cons of wedge-section osteotomy and mandibular reshaping vs conventional procedures were analyzed. RESULTS A total of 585 patients who had undergone either reduction malarplasty or mandibular reshaping in the craniofacial center at the Shanghai Ninth People's Hospital from May 1988 through December 2008 were reviewed in this study. Intraoral incision was the dominant method of access in both types of osteotomies. Wedge-section malarplasty osteotomy was more effective and reliable compared with other conventional methods. More than half of the patients in cases of the mandibular reshaping have undergone surgery that included both reduction of the mandibular angle and shaving of the mandibular margin. CONCLUSION As optimal strategy for aesthetic facial contouring surgery in East Asians, reduction malarplasty and mandibular reshaping were proven to be safe, effective, and easily handled techniques for modifying the square-shaped face.