eMedicine Specialties > Plastic Surgery > Craniofacial
Craniofacial, Asian Malar and Mandibular Surgery: Follow-up
Updated: May 1, 2009
Future and Controversies
Malar reduction
The alternative to a coronal approach reposition operation is an intraoral approach to bur down the malar prominence and to create an anterior osteotomy, combined with a preauricular approach to complete the posterior osteotomy. Symmetry may be harder to obtain through this route, and malar soft tissue ptosis may occur.
Mandibular contouring
The masseter muscle may be removed as part of the operation. From a frontal view, the muscle can contribute significantly to mandibular prominence. Some believe that removal of the bone alone changes the dynamics of masseter muscle contraction and leads to thinning of the muscle by disuse atrophy. Others believe that the muscle should be resected to achieve maximal effect.
Botulinum toxin
The use of botulinum toxin to reduce the hypertrophy of the masseter muscle will play an important role in the future. Although the boney prominence remains, the reduction of muscle thickness significantly improves the appearance of the mandibular angle.
The use of botulinum for masseter hypertrophy is quickly becoming the treatment of choice for mild to moderate forms of prominent mandibular angles. Surgery is preferred for more severe situations or for patients who prefer to avoid repeated injections to the masseter.
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References
Onizuka T, Watanabe K, Takasu K, Keyama A. Reduction malar plasty. Aesthetic Plast Surg. 1983;7(2):121-5. [Medline].
Watanabe K. Cosmetic contouring of the midface. In: Song IC, ed. Facial Cosmetic Surgery in Orientals. Problems in Plastic and Reconstructive Surgery. Vol 1. 1991:643-53.
Baek SM, Chung YD, Kim SS. Reduction malarplasty. Plast Reconstr Surg. Jul 1991;88(1):53-61. [Medline].
Morris DE, Moaveni Z, Lo LJ. Aesthetic facial skeletal contouring in the Asian patient. Clin Plast Surg. Jul 2007;34(3):547-56. [Medline].
Ahn J, Horn C, Blitzer A. Botulinum toxin for masseter reduction in Asian patients. Arch Facial Plast Surg. May-Jun 2004;6(3):188-91. [Medline].
Baek SM, Kim SS, Bindiger A. The prominent mandibular angle: preoperative management, operative technique, and results in 42 patients. Plast Reconstr Surg. Feb 1989;83(2):272-80. [Medline].
Kim JH, Shin JH, Kim ST, Kim CY. Effects of two different units of botulinum toxin type a evaluated by computed tomography and electromyographic measurements of human masseter muscle. Plast Reconstr Surg. Feb 2007;119(2):711-7. [Medline].
Al-Ahmad HT, Al-Qudah MA. The treatment of masseter hypertrophy with botulinum toxin type A. Saudi Med J. Mar 2006;27(3):397-400. [Medline].
Castro WH, Gomez RS, Da Silva Oliveira J, Moura MD, Gomez RS. Botulinum toxin type A in the management of masseter muscle hypertrophy. J Oral Maxillofac Surg. Jan 2005;63(1):20-4. [Medline].
von Lindern JJ, Niederhagen B, Appel T, Berge S, Reich RH. Type A botulinum toxin for the treatment of hypertrophy of the masseter and temporal muscles: an alternative treatment. Plast Reconstr Surg. Feb 2001;107(2):327-32. [Medline].
Al-Muharraqi MA, Fedorowicz Z, Al Bareeq J, Al Bareeq R, Nasser M. Botulinum toxin for masseter hypertrophy. Cochrane Database Syst Rev. Jan 21 2009;CD007510. [Medline].
Kang J, Han K. Cosmetic contouring of the lowerface. In: Song IC, ed. Facial Cosmetic Surgery in Orientals. Problems in Plastic and Reconstructive Surgery. Vol 1. 1991:654-66.
Ousterhout D. Mandibular width reduction including surgical treatment of benign masseteric hypertrophy. In: Aesthetic Contouring of the Craniofacial Skeleton. Boston, Mass: Little Brown; 1991:451-69.
Further Reading
Keywords
malar surgery, mandibular surgery, Asian malar surgery, Asian mandibular surgery, cheek bone reduction, malar reduction, reduction malarplasty, zygoma reduction, zygomatic reduction, reduction zygomaplasty, Asian malarplasty, benign masseteric hypertrophy, jawline contouring, jawline reduction, mandible reduction, jawline shaving, bone contouring, facial bone surgery, BOTOX® jawline, BOTOX® jaw muscle, BOTOX® masseter muscle, botulinum toxin therapy, botulinum toxin, BOTOX®, masseteric hypertrophy, work hypertrophy, habitual jaw clenching, habitual teeth grinding, teeth grinding, jaw clenching, prominent malar bones, malar prominence, zygomatic prominence, Asian plastic surgery, oriental plastic surgery
Follow-up: Craniofacial, Asian Malar and Mandibular Surgery