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Ultimate Savior for Square Face – Combined Zygoma and Mandible Reductions

Although people with square face such as comedian, Hsu Hsiao-Shun (known as “許效舜” in Chinese) often leave a deep impression, a square face is generally acceptable in males but not females. Females with square face have less feminine and pleasant appearance. Previously, most patients have chosen to receive long-term botox injections as solution for this type of face shape. However, they do not realize that injections may lead to drooping of facial skin, cheek depression and other problems. In order to improve the condition permanently with significant results, mandible reduction or combining with zygoma reduction plasty may be the ultimate choice.

The author has observed the stereotype of traditional belief on bone reduction surgeries such as surgical risk or unknown results. However, the author has been constantly conducting Korea’s facial contouring surgery and it is an undoubtedly safe surgery. This type of surgery involves intraoral incision on the upper or lower gum, and endoscope with light source is extended approximately 2-3cm into the incision for direct ablation. Since the surgeon has a clear view, nerves and blood vessels beneath the skin or tissues such as salivary duct are completed protected. Complications resulted from nerve damage during traditional bone reduction (through skin) are completely eliminated.

Once the mandibular has been completely ablated, specialized tool with electrical saw of various angles is adopted to perform the removal of protruding bone by referring to the pre-determined design before the operation. The main purpose of this procedure is to balance the symmetry on both sides of the face or correct inherited asymmetrical face shape. Therefore, the aesthetic surgeons have to spend more effort and time during this procedure. When the bone are repositioned and removed, suture is immediately performed and a drainage tube is inserted (this tube is necessary for mandible reduction). The drainage tube will be removed 4-6 hours post-operative observation. All surgery procedures can be completed within 4.5 hours. Patients have to remain overnight in the hospital for further observation and receive necessary treatments with painkiller and antibiotic. Subsequently, patients can return home on the next day right after the doctor’s inspection!

After understanding the procedures of reduction malarplasty, we can learn more about reduction malarplasty surgery for square face. With the latest techniques, there are three types of reduction malarplasty:

1.	I-shaped osteotomy:
	Suitable for mildly to moderately prominent and non-extended cheekbone.
2.	L-shaped osteotomy:
	Suitable for moderately prominent cheekbone.
3.	Combined I-shaped osteotomy and zygomatic piecemeal osteotomy:
	Suitable for severely prominent and protruding cheekbone.

Surgeries above require the utilizing of Titanium alloy plates and screws to secure the new positions. This type of permanent materials can be implanted for life without removal. The bones will completely seal and heal in approximately two months. There are two types of mandible reduction procedures:

1.	Mandible angle resection:
	This is an early approach which is performed by removing the protruding mandibular area, with the purpose of smoothing the skeletal line. However, it cannot completely achieve the results of minimizing the face. Furthermore, symmetry and balance issues are not corrected in patients with inherited asymmetrical face shape. Most of the time, there are complaints about over resection (too sharp) or under resection (no obvious result) in patients. Presently, this procedure has been gradually replaced.

2.	Sagittal split osteotomy:
2.	This procedure involves removing the protruding mandibular area at the 1/2 back of lower jaw by vertical osteotomy. Subsequently, the osteotomy range is extended to the anterior and both sides of the chin. Therefore, this approach can remove protruding angle while achieving the main purpose of minimizing the face. Besides, the chin will appear smaller. If the patients have obvious asymmetrical face shape, the range and thickness of osteotomy are regulated to balance the facial symmetry. With the many years of surgical experience, the author has observed the highest satisfaction in this approach among all reduction malarplasty surgeries.

With the above explanation, readers should be less nervous about this type of surgery now. Nowadays, bone reduction surgery is very mature and aesthetic surgeons who are able to perform this type of surgery have received comprehensive training. Hence, the surgery duration is greatly shortened. With the application of deliberated hypotensive anesthesia, post-operative swelling period is controlled within two weeks and there are extremely low chances of bleeding and complications. Therefore, there are more patients willing to receive this type of facial re-contouring surgery. On the other hand, there are uncertain factors of reduction malarplasty such as healing speed of the bone. The author strongly suggests reduction malarplasty for candidates who are 20-55 years old. If you match the above criteria and has been constantly seeking for effective solution with square face, try to do some research before arranging a face-to-face consultation with your professional aesthetic surgeon!

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