Protruding Mouth Concerns: Can Facial Contouring Improve It Without Two-Jaw Surgery? (The Secret of the E-Line)

The Standard for an Ideal Profile: What is the Ricketts Line (E-Line)?

One of the key elements that determines a refined impression is a neat mouth profile and a smooth jawline. Just as important as an oval face that tapers when viewed from the front is the side profile's 'E-line (Ricketts line)'.

This standard, proposed by Dr. Ricketts, considers the most ideal state to be when a straight line connects the tip of the nose to the tip of the chin, with the upper lip resting about 4mm behind the line and the lower lip about 2mm behind it. However, since this is based on Western facial structures, the most harmonious proportions may vary depending on the anatomical characteristics of Asians and individual skeletal differences.

3 Approaches to Improving a Protruding Mouth

Methods for resolving a protruding mouth are broadly divided into three categories depending on the cause and severity.

• Orthodontics: A method of retracting the mouth profile by moving the teeth inward through extraction orthodontics. Typically, you can expect an improvement equivalent to the space of about one tooth.
• Two-Jaw Surgery (Orthognathic Surgery) and Anterior Segmental Osteotomy (ASO): Applied to highly complex cases accompanied by severe jawbone asymmetry or occlusal (bite) issues. By fundamentally repositioning the bones, both function and aesthetics are improved simultaneously.
• Facial Contouring Surgery: In cases where there are no occlusal issues but the chin is underdeveloped or the mouth appears relatively protruded, the visual sense of protrusion can be resolved through procedures such as genioplasty (chin advancement).

Case Analysis: Improving the Appearance of a Protruding Mouth with Contouring Surgery Instead of Two-Jaw Surgery

This is a case of a patient who was concerned about a heavy facial line and a protruding mouth. Since functional occlusal issues or skeletal severity were low, a plan was made to add dimension through facial contouring surgery instead of two-jaw surgery, which carries a heavier physical burden.

Complex Facial Contouring Surgery Plan
1. Genioplasty (Chin Advancement): Creates the effect of a relatively retracted mouth profile
2. Mandibular Angle and Cortical Bone Resection: Refines the square jawline
3. Masseter Muscle and Buccal Fat Removal: Forms a slim lower face
4. Cheekbone Reduction (Body & Arch): Improves the dimensionality of the mid-face

When the front chin is appropriately advanced, it creates a visual effect where the relatively protruding mouth appears to recede. Through the CT images below, you can see the changes where the cheekbone and square jawlines have become smoother, and the overall jawline has improved due to the repositioning of the chin.

Safe Protruding Mouth Surgery Emphasized by a Board-Certified Plastic Surgeon

Dr. Park Jong-rim of Gangnam 345 Plastic Surgery possesses extensive clinical experience in two-jaw surgery and protruding mouth surgery. It is crucial to precisely analyze each patient's jaw structure and occlusal state to clearly diagnose whether two-jaw surgery is absolutely necessary or if sufficient aesthetic improvement can be achieved with contouring surgery alone.

Determining the most suitable and safe surgical plan through an in-depth consultation with the operating surgeon prior to surgery is the shortcut to reducing side effects and increasing satisfaction.

345 Plastic Surgery is located near Exit 4 of Sinnonhyeon Station and strives for patient-centered, customized care. If you have concerns about your face shape, we encourage you to find your own optimal line through a diagnosis by a board-certified specialist.