We will explain the 7-step facial contouring surgery process thoroughly, from consultation to recovery.
Contouring surgery pre-simulates osteotomy locations to 0.1mm accuracy using 3D CT-based Virtual Surgery Planning (VSP), and reduces the risk of nerve damage by 73% during surgery using Piezo Surgery equipment. The standard range is an average mandibular angle of 15-22mm for square jaw resection and an average zygomatic arch displacement of 5-8mm for cheekbone reduction, and…
Actual Surgical Process Explained by a Specialist
- Minimum CT Slice Thickness: 0.625mm
- Average Duration of General Anesthesia: 2.5-4 Hours
- Minimum 6 Months for Bone Union Completion
Overview
- Contouring surgery pre-simulates osteotomy locations in 0.1mm increments using 3D CT-based Virtual Surgery Planning (VSP), and reduces the risk of nerve damage by 73% during surgery using Piezo Surgery equipment.
- The standard range for mandibular angle reduction is an average of 15-22mm for square jaw resection and zygomatic arch posterior displacement is an average of 5-8mm for cheekbone reduction; excessive resection leads to the formation of secondary angles and accelerates aging
- Sedation in the first week of recovery increases by an average of 142% compared to pre-operative facial volume, and intravenous administration of 1g of tranexamic acid can reduce blood loss by an average of 38%.
Step 1: Precision Imaging Diagnosis — CT Protocol and Analysis
The most important aspect of facial contouring surgery consultation is 3D CT scanning. While standard panoramic X-rays provide only 2D planar information, Cone Beam CT (CBCT) allows for a three-dimensional assessment of the mandibular nerve canal, mental foramen, and zygomatic arch thickness with a slice thickness of 0.625mm. By reconstructing CT data with software such as Simplant Pro or Mimics, the nerve pathway can be visualized in three dimensions.
For patients with facial asymmetry, additional Frontal Cephalometry is performed to quantify the midline deviation angle (average 2-5 degrees) and the difference in mandibular angle height (average 3-7mm). This data serves as the basis for determining the amount of bone to be removed during surgery, and sets the target for left-right symmetry within ±1.5mm. Some hospitals differentiate masseter muscle hypertrophy by measuring the muscle mass ratio using InBody body composition analysis. [Clinical] The mandibular nerve injury rate is reported to be 12-18% when using a traditional saw and 3-5% when using Piezo Surgery (Journal of Cranio-Maxillofacial Surgery, 2019).
| Examination Items | Purpose | Normal Range/Criteria |
|---|---|---|
| CBCT Slice Thickness | Precise Identification of Nerve and Blood Vessel Locations | 0.4-0.625mm |
| Frontal Cephalo | Quantification of Asymmetry | Midline Deviation ≤2 degrees |
| In-Body Muscle Mass | Differentiation of Masseter Hypertrophy | Facial Muscle Ratio 18-22% |
| 3D VSP Simulation | Pre-planning of Osteotomy Volume | Margin of Error ±1mm |
- Average CBCT Scan Time 40-90 seconds
- Average VSP Software Analysis Time 2-3 hours
Phase 2: Surgical Design — Osteotomy Line Design and Fixation Selection
The standard for square jaw osteotomy is a posterior resection of 15-22mm from the mandibular angle, during which the masseter muscle attachment is also dissected. The Long Curve osteotomy connects the mandibular angle to the chin with a smooth curve to prevent the formation of a secondary angle, and the average osteotomy line length is 7-9cm. There are three methods for cheekbone reduction: Type I (anterior osteotomy), Type L (lateral rotation), and Type T (superior movement), and the zygomatic arch is moved posteriorly by an average of 5-8 mm. For fixation after osteotomy, Titanium Miniplates (thickness 0.5-1.0 mm) and Micro-screws (diameter 1.5-2.0 mm) are used. Wire fixation, which was used until the early 2000s, is now rarely used, and while Bioabsorbable plates (PLA/PLLA material) naturally decompose within 12-18 months, their initial fixation strength is only about 60% of that of Titanium. Chin T-osteotomy is fixed with one plate for 3-5mm advancement or retraction, and two plates for movement of 6mm or more. [Key Point] If the amount of osteotomy is excessive (25mm or more for square jaw), chewing force decreases by an average of 32% compared to pre-operatively due to weakening of the masticatory muscles, and the load on the temporomandibular joint increases in the long term. Titanium plate removal rate 15-20% (for aesthetic reasons) PLA plate complete absorption period average 14 months Stage 3: General Anesthesia and Surgery — Real-time Monitoring Contouring surgery is induced with general anesthesia using Propofol 2-2.5mg/kg + Remifentanil 0.1-0.3μg/kg/min, Nasal intubation is performed to secure the airway. To minimize bleeding during surgery, intravenous administration of 1g of tranexamic acid reduces the average blood loss from 350ml to 220ml. Access is made via an intraoral incision (square jaw, cheekbone) or an extraoral incision (part of the chin). Piezo Surgery equipment minimizes soft tissue damage by selectively cutting only bone tissue using ultrasound frequencies of 25-29kHz. The average time required for simultaneous square jaw and cheekbone surgery is 2.5-3.5 hours, and for simultaneous surgery on three areas (square jaw + cheekbone + chin), it is 3.5-4 hours. During surgery, mandibular nerve electrical signals are tracked in real-time using the Nerve Monitoring System, and the osteotomy position is adjusted if the impedance increases by more than 30% compared to the reference value. [Caution] There is a possibility of nasal septal damage during nasal intubation, and nasal congestion and minor bleeding may occur for 3-5 days after surgery. Nerve damage rate when using Piezo equipment 3-5% vs. traditional saw 12-18% Average duration of anesthesia 2.5-4 hours Stage 4: Recovery Room — Intensive observation for the first 24 hours Immediately after surgery, blood pressure, oxygen saturation, and drainage volume are monitored in the recovery room for an average of 2-4 hours. The drainage tube (Hemovac) removes the hematoma with a negative pressure of 100-150 mmHg, and is removed if the 24-hour drainage volume is 50 ml or less. Applying a cold compress to the surgical site (ice pack 15 minutes on/15 minutes off) for 48 hours can reduce the edema peak by an average of 18%. For pain control, a Fentanyl PCA (Patient-Controlled Analgesia) pump is fitted and set to a base infusion rate of 0.5-1.0 ml/h + additional patient administration of 0.5 ml (lock time 15 minutes). The intraoral incision site should be disinfected 4-6 times a day with Chlorhexidine 0.12% mouthwash, and the sutures will naturally dissolve within 2 weeks using absorbable Vicryl 4-0.
| Recovery Phase | Duration | Key Management Items |
|---|---|---|
| Immediate Recovery | 0-4 Hours | Monitor drainage tube, maintain oxygen saturation above 95% |
| Acute Edema Phase | 1-3 Days | Cold compress for 48 hours, elevate head by 30 degrees, Fasting → Liquid Diet |
| Initial Recovery Phase | 4-7 days | Switch to warm compresses, drainage tube removed, start semi-liquid diet |
| Subacute Phase | 2-4 weeks | 60% reduction in edema, soft solid food, light exercise |
| Late Recovery Phase | 1-3 months | 80-90% disappearance of edema, normal diet, bone union progressing |
| Complete Recovery Phase | 6-12 months | Bone union complete, final outline Confirmed |
- 48 hours of cold compresses reduces edema peak by 142% → 117%
- Average duration of PCA use: 2-3 days
Step 5: 1 Week — Edema Management and Dietary Control
Edema reaches its peak on days 3-4 post-surgery, and facial volume increases by an average of 142% compared to pre-surgery. During this period, sleeping with the head elevated by more than 30 degrees improves venous return, shortening the duration of edema by an average of 1.2 days. After 72 hours, switch to warm compresses (40-42 degrees Celsius, 15 minutes, 4-6 times a day) to promote blood circulation. Diet is to be followed in stages: fasting on days 1-2, liquid foods such as rice porridge and roasted grain powder on days 3-4, and semi-liquid foods such as tofu and steamed eggs on days 5-7. Chewing should be prohibited for at least two weeks as it places mechanical stress on the fracture site, and sufficient protein intake (60-80g per day) is necessary for smooth tissue regeneration. There is a study showing that taking Bromelain 500mg three times a day accelerates the rate of edema reduction by an average of 22%, but it is contraindicated for those taking anticoagulants. [Nutrition] Protein deficiency may delay bone union, and supplementation with calcium (1000mg/day) + vitamin D (800-1000IU/day) is recommended.
- Average edema peak time: 72-96 hours
- Edema reduction rate at Week 1: Approx. 30-40%
Stage 6: 1-3 months — Bone union and nerve recovery
Bone union at the osteotomy site begins in week 2, and an initial callus is formed in week 6; complete osseous union takes at least 6 months. During this period, excessive chewing (hard foods, gum, squid) can cause diastole, and if the plate becomes loose, reoperation is required. In case of mandibular nerve damage, paresthesia occurs in the lower lip and jaw area, and most cases recover naturally within 3 to 6 months. Since the nerve regeneration rate is an average of 1 mm per day, it takes about 30 days if the distance from the osteotomy site to the mental foramen is 30 mm. There are reports that taking 1500 μg of methylcobalamin (Methycobal) three times a day accelerates nerve recovery by an average of 18%. Edema decreases by 60% at month 1 and 80-90% at month 3, and the final contour is confirmed at 6-12 months.
- At least 6 months until bone union is complete
- Nerve recovery rate within 6 months: 92-97%
Step 7: Long-term follow-up — Prevention of recurrence and plate removal
The recurrence rate of masseter muscle hypertrophy after contouring surgery is approximately 12-18% at 5-year follow-up, and is mostly associated with chewing habits (chewing on one side, preference for hard foods). Re-injecting 50-100U (total for both sides) of Botulinum toxin A (Botox, Dysport) every 6 months can lower the recurrence rate to less than 5%. The appropriate time for titanium plate removal is 12-18 months after surgery, and the removal rate is approximately 15-20%. The removal surgery takes an average of 30-60 minutes and can be performed under local or sedation anesthesia. If not removed, metal allergies (if nickel is present), MRI artifacts, and cold sensations (coldness in winter) may occur, but most cases are asymptomatic. Long-term follow-up CTs are performed at 1, 3, and 5 years to check for bone resorption or recurrence of asymmetry. [Follow-up] Even after plate removal, the osteotomy line remains permanently and finely, and is observed as a difference in bone density on CT.
- Masseter muscle re-hypertrophy recurrence rate: 12-18% at 5-year follow-up
- Recommended plate removal time: 12-18 months
Comparison of osteotomy fixations
Titanium Miniplate [Standard]
- Thickness 0.5-1.0mm
- Based on 100% fixation strength
- Removal rate 15-20%
- Potential for MRI artifacts
Most widely used, with proven long-term stability
Bioabsorbable Plate (PLA/PLLA) [Absorbable]
- Thickness 1.0-1.5mm
- Fixation strength 60% (Initial)
- Complete absorption within 12-18 months
- Removal surgery unnecessary
When massive osteotomy is performed due to weak initial fixation strength Inappropriate
Wire Fixation [Spherical]
- Diameter 0.4-0.6mm
- Fixation Strength 40%
- Removal Rate Nearly 100%
- Rarely used since the 2000s
A method rarely used currently
Common Misconceptions
Misconception: Complete recovery within 1 month after contouring surgery
Truth: Swelling decreases by about 60% at the 1-month mark, but bone union takes at least 6 months It is necessary, and the final outline is confirmed at 12 months. Consuming hard foods or engaging in strenuous exercise within 3 months carries a risk of dilation of the osteotomy line.
Misconception: The plate must be removed.
Truth: Titanium plates are mostly asymptomatic even if not removed, and the removal rate is only 15-20%. Removal is considered after 12-18 months only when there are specific reasons, such as metal allergies, plans for MRI scans, or cold sensations.
Things You Should Absolutely Not Do During Facial Contouring Surgery
- Anticoagulant effects such as aspirin, Omega-3, and Ginkgo biloba extract during the 2 weeks prior to surgery Taking medication or health supplements (average 2x increase in bleeding) Chewing for 2 weeks after surgery (mechanical stress on the osteotomy line → plate loosening) Sleeping with the head low (reduced venous return → average 1.2-day increase in edema duration) Sauna, hot steam room, or vigorous aerobic exercise within 3 months after surgery (potential interference with bone fusion) Neglecting oral hygiene (risk of osteomyelitis if incision site becomes infected — incidence rate 0.5-1%, but extremely difficult to treat)
Frequently Asked Questions
Does the recovery period double if jawline and cheekbone surgery are performed simultaneously?
Surgery time is about 1.5 times longer compared to a single area, but the recovery period is not double. Since the edema peak and the bone union process occur simultaneously, the overall recovery period is approximately 1.2 to 1.3 times longer than for a single site. However, the degree of edema may be more severe immediately after surgery. Is Piezo Surgery really safer than a conventional saw? Yes. Piezo equipment selectively cuts only bone tissue using an ultrasonic frequency of 25-29 kHz, without damaging soft tissues such as nerves and blood vessels. Numerous studies show that the rate of mandibular nerve damage decreases from 12-18% when using a conventional saw to 3-5% when using Piezo (Journal of Cranio-Maxillofacial Surgery, 2019). What should be done if sensation does not return after surgery? In most cases of mandibular nerve damage, natural recovery occurs within 3-6 months, with a recovery rate of 92-97%. Since the nerve regeneration rate averages 1 mm per day, the recovery time is determined by the distance between the osteotomy site and the mental foramen. Recovery can be accelerated by taking neurotrophic agents such as methylcobalamin, and if sensation is absent after 6 months, nerve reconstruction surgery should be considered. Isn't the effect greater the more bone is removed? No. Excessive resection of more than 25mm in the square jaw weakens the masticatory muscles, reducing chewing power by an average of 32%, and may lead to the formation of secondary angles and accelerated aging (sagging jawline). If the cheekbones are moved more than 8mm, there is a high risk of cheek hollowing and Indian wrinkles. Maintaining the appropriate range (15-22mm for the square jaw, 5-8mm for the cheekbones) leads to higher long-term satisfaction. What happens if I eat hard foods before bone fusion is complete? Excessive chewing force during the early stages of bone fusion (2-6 weeks) can cause dilation of the osteotomy lines, and if the plates become loose, revision surgery is required. Soft solid foods are permitted starting 6 weeks after callus formation, but tough foods (squid, dried fish) and hard foods (nuts, candy) should be avoided for at least 3 months. Can asymmetry recur after surgery? Yes. The recurrence rate due to masseter muscle rehypertrophy is 12-18% at 5-year follow-up, and is mostly related to unilateral chewing habits. Re-injecting Botulinum toxin A 50-100U every 6 months can lower the recurrence rate to less than 5%. Additionally, asymmetry caused by bone resorption or plate laxity occurs in 1-2% of cases, so follow-up CT scans at 1, 3, and 5 years are recommended.
