Corrective jaw surgeryis a functional surgery that seeks to correct the bite disharmonies due to disproportionate growth of the jaws. This jaw bone disproportion can give a face a very aggressive or “man-ly” look. Some men may actually like that kind of look if their job requires them to look fierce-some, e.g. night club bouncers and security guards. However, it may be liability in some other occupation. For women, it is almost always never an asset to look masculine. Hence, there is facial feminization surgery, of which corrective jaw surgery can play a part in.
The most famous facial feminization surgery patient in recent times is probably Bruce Jenner, the Olympic decathlon gold medalist of 1976, now known as Caitlyn Jenner. However, not everyone who seeks facial feminization surgery is going for a gender change. Some are women who happen to have certain facial features that portray a certain degree of masculinity and want to reduce them. Some are men seeking surgery to give a less “aggressive” look.
There are distinct differences between the male and female human skulls. That’s why archeologists and forensic scientists are able to differentiate between them. The male skull is generally larger and heavier. Muscles in a male are also more developed, giving rise to prominent bony landmarks on the face. The cheek bones are more prominent and wider, the angle of the lower jaw is also more developed and well defined and the chin is more bulbous. Beyond the lower and midface, the upper part of the face also present distinguishing features of “maleness” such as rounded and prominent bones surrounding the eye, as well as a pronounced and sloping forehead. The nose is broader and more robust.
So, what kind of dentofacial deformities contribute to a more masculine look and what can surgery do to soften this demeanor? The underbite, whereby the lower jaw is excessively developed compared with the upper jaw gives the patient a rather masculine look. With a prominent lower jaw protruding out, it imparts an aggressive first impression. Some underbite cases are “high angle” cases, whereby the angle of the jaw is not prominent and thus do not posed a problem. However, the “low angle” cases usually have overdeveloped angles which may be flared outwards. This can contribute further to the overall masculinity of the face. Underbite deformities are the most corrected dentofacial deformities in Singapore, an indication that the acceptance rate of this deformity by patients is fairly low compared with other deformities. Corrective surgery consists of setting the lower jaw back and in many cases, bringing the upper jaw forward as well. This will restore balance in the face and reduce the “aggressiveness” of the appearance and has the effect of facial feminization.
While the basic surgical procedure is the same for men and women, the objective is different. Precisely because corrective jaw surgery can result in feminization of the face, the degree of change of position of the jaws is different for men and women. In a female patient, I will tend to achieve most of functional correction through movement of the lower jaw and less of the upper jaw. This is because most women prefer to have a smaller and sharper chin. For the men, I tend to correct the bite by having a more even repositioning of the upper and lower jaws in an attempt to maintain the forward projection of the chin to keep to a masculine facial appearance. Genioplasty, or chin surgery, is often combined done at the same time to either augment or reduce the prominence of the chin.
Those who have flaring of the mandibular angles may also need to have recontouring surgery to reduce the acuteness of the angle. Personally, I prefer to do the recontouring surgery in a separate surgery to minimize adding the stripping of the bone which will affect healing. I will usually do the corrective jaw surgery first, let the bones settle and heal, and then go back in to do re-contouring. Another reason why I do this is because recontouring surgery cannot be ‘un-done’. When performed together with the jaw repositioning surgery, there will be a lot of changes in the facial appearance and sometimes, even though we use computer simulation of the surgical results, it is not easy for the patient to know exactly what kind of look he or she prefers. In jaw repositioning surgery, reversal surgery can be done relatively readily. However, in recontouring, once the bone is cut away, it is very difficult to rebuild if the patient does not like the result.
Corrective jaw surgery for underbite can achieve a more feminine look for women. Men can have the same surgery without the feminine look by altering the differential movement of the upper and lower jaws vis-à-vis the surgery for women. Combination of genioplasty can further adjust the look to make it more feminine or maintain the masculinity.