A prominent jawline creates a masculine or square face appearance that may be undesirable especially in Asian females. Asian beauty emphasises subtlety; a prominent jawline throws off the balance of midfacial structures particularly the nose and chin by overpowering the mid face. Reducing the jawline restores the balance and improves facial harmony. When it comes to the prominent jawline, patients may have a significant muscle component, bone component, or both. The aetiology of this condition is unknown. However, some of these conditions have been associated ethnicity which is commonly seen in East Asian descendants, masseter muscle hypertrophy (jaw muscle overgrowth) as a result of habitual jaw clenching, teeth grinding or diet (dried squid, tough and chewy delicacies).

Reduction angleplasty or mandibular angle reduction surgery is a cosmetic surgical procedure done to transform a square shaped face to a more delicate and feminine facial appearance. This surgical procedure is effective in correcting prominent body and angle of the lower jaw, thus reducing the width of the lower face and changing a square face to an oval or “V” shaped face. In some cases, mandible angle reduction surgery is combined with other facial contouring surgeries such as zygoma reduction, masseter muscle reduction or genioplasty to achieve facial balance. Mandible angle reduction surgery is often performed through the intraoral approach; hence there is no visible scar externally.

Patients who seek mandibular angle reduction surgery have usually had the desire to improve their appearance, and they should not attempt to mimic the Caucasian facial features. Preservation of ethnicity remains the cornerstone of this surgery, and the patient should have realistic expectations from the surgery.

Ideal candidates for mandibular angle reduction surgery

  • Having a positive outlook and specific goals in mind for the improvement of facial appearance
  • Physically healthy with no active or severe pre-existing medical conditions

Preoperative evaluation for mandibular angle reduction surgery:
Communication is vital to achieving the patient’s goals. During the initial consultation, patients will have the opportunity to discuss their goals and desired results with the plastic surgeon. The plastic surgeon will work closely with the patients to reach an agreement about the expectations from the surgical procedures involved and their long term benefits. Every patient is different. Therefore a specific treatment regimen is planned to suit an individual’s need.

  • Discussion about patients’ expectations and desired outcome
  • Medical conditions, drug allergies and previous medical or surgical treatment
  • Use of current medications, vitamins, herbal supplements, alcohol, tobacco and drugs
  • Previous surgeries
  • Examination of the face and its soft tissues
  • Radiological assessment (CT scan of a face)
  • Preoperative evaluation for general anaesthesia
  • Photography for preoperative and postoperative evaluation

Preparation for mandibular angle reduction surgery

  • Blood investigations or a medical evaluation
  • Avoid certain medications or adjust your current medications
  • Stop smoking or alcohol well in advance of surgery, (2-3 weeks before the surgery)
  • Avoid taking aspirin and certain anti-inflammatory drugs and herbal supplements as they can increase bleeding

The risks and safety information on mandibular angle reduction surgery

It is essential for patients to understand that every surgical procedure has its complications and risks involved. However, if a patient is adequately assessed before the surgery and postoperative care is given sufficiently, these risks can be eliminated or reduced. The risks involved in mandibular angle reduction surgery are:

  • Bleeding
  • Blood clot
  • Infection
  • Bruises and swelling
  • Injury to the surrounding nerves, blood vessels, muscles or bones
  • Changes in the skin sensation at the lower lip (temporary)
  • Bony contour irregularity
  • Asymmetry
  • Anaesthesia risks
  • Possibility of revision surgery

Postoperative expectations:

Following mandibular angle reduction surgery, drains (tubes to remove excess blood) may be removed after the second postoperative day. During the initial healing phase, the patient may experience pain, numbness, bruises and swelling around the lower jaw. These symptoms usually fade away after 3-4 weeks. Oral antibiotics and analgesics will be prescribed to reduce the risk of infection and postoperative pain respectively.

Postoperative care:

  • Follow the postoperative instructions given carefully
  • Head elevation especially when sleeping for 3-4 weeks
  • Take the prescribed medications as instructed
  • Cold compressive dressing around the lower jaw might be used for 3-7 days
  • Regular mouth wash or gargle after every meal if there are any oral wounds
  • Soft diet for 2-3 weeks
  • Avoid strenuous physical activities for 3-4 weeks

How much will a mandibular reduction surgery cost?

Cost is always a consideration in elective surgery. The cost of mandibular angle reduction surgery can vary widely. Cost may include:

  • Surgeon’s fee
  • Hospital or surgical facility costs
  • Medical tests (blood and radiological investigations)
  • Anaesthesia fees
  • Prescriptions for medication

Mandibular angle reduction surgery is a cosmetic surgical procedure. Therefore, most of the health insurance companies do not cover cosmetic surgeries or their complications.