Case Review of Malar Reduction and Genioplasty: Achieving a Smooth Facial Contour

Changes in Facial Contours Through Malar Reduction and Genioplasty

The cheekbones, which are the center of the face, and the chin line, which balances the lower face, are key elements that determine one's overall impression. The case we are introducing today is of a patient who underwent both malar reduction and advancement genioplasty to simultaneously improve protruding cheekbones and the appearance of a weak chin.

1. Pre-operative Analysis: Limitations of the Existing Implant

This patient had a history of undergoing chin implant surgery in the past to improve the appearance of a protruding mouth. However, because the inserted implant was small, the feeling of a weak chin still remained, and the cheekbones protruded unevenly from both the frontal and 45-degree angles, resulting in an uneven facial contour.

Additionally, the nasolabial folds appeared sunken, which made the mouth look even more protruded. To resolve this, we established a combined surgical plan that included fundamental skeletal improvement rather than a simple implant replacement.

• Removal of the existing chin implant and fixation screws
• Advancement genioplasty to directly pull the bone forward
• Malar reduction to smoothly refine the contours
• Paranasal bone grafting utilizing autologous tissue excised from the cheekbones

2. Precise Diagnosis and Surgical Points

As a result of X-ray and CT examinations, a small implant of about 3mm was previously inserted at the tip of the chin, but it was insufficient to provide the three-dimensional effect the patient desired.

Advancement Genioplasty Using Autologous Bone

After removing the existing implant, the patient's own lower jawbone was osteotomized and advanced by a sufficient amount compared to the implant. It was then firmly fixed with plates and screws to form a natural line without any foreign body sensation. Any step deformity (staircase effect) that could occur after the osteotomy was smoothed into a seamless jawline through contouring osteotomy.

Recycling Cheekbone: Paranasal Bone Grafting

We concurrently performed a paranasal bone graft, which involves transplanting the excess bone removed during the malar reduction into the nasolabial fold area instead of discarding it. This has superior biocompatibility compared to artificial implants and helps create a three-dimensional mid-face by enhancing the volume in the nasolabial fold area.

3. Post-operative Progress and Recovery Process

As confirmed through a CT scan immediately after surgery, the wide lower face width was reduced, and the tip of the chin naturally protruded forward, completing a three-dimensional profile.

Summary of Changes by Period

• 2 Months Post-op: This is the period when major swelling gradually subsides and the contours are revealed. You can feel that the uneven cheekbone line has become smoother.
• 6 Months to 1 Year Post-op: This is the period when minor swelling completely disappears and the bone tissue stabilizes. You can expect visual improvements, such as a slimmer chin tip and a reduced facial size.

4. Precautions for Facial Contouring Surgery

Since facial contouring surgery is a highly difficult procedure that deals with bones, it is essential to accurately identify the location of the nerve lines. Additionally, temporary sensory loss, swelling, and bruising may occur after surgery, but these usually alleviate over time. Because the appropriate surgical method varies depending on each patient's individual skeletal structure, an in-depth consultation with a specialist must precede the surgery.