Twenty-four years ago, when I was preparing my Master’s thesis, I reviewed a lot of literature on facial norms. I needed to look at what constitute a “normal” face. As it turned out, most of the publications were actually based on aesthetic ideals. Naturally, this is because surgical literature are biased towards surgically enhancing facial proportions and features to achieve an aesthetic outcome. Somehow, “normal” is not what patients who are ready to subject themselves under the knife wanted. In Singapore, we are subjected to chiseled angular facial features of the West and the V-shape face so desired in Asia.
East v West..
Aesthetics is abstract. It is dependent on the judgment of the assessor and is subject to all the personal prejudices of the individual, his cultural background and social environment. It is also subject to changing norms and preferences in society over time. Twenty years ago, before the advent of K-pop and the V-shape face, there was not a lot of difference in aesthetic preferences between Asian and the West. In fact, one of the criticisms back then was that Asians were trying to change their faces to look more like Caucasians. There may be some truth in that. However, what critics overlooked was that Asians were not trying to change their faces to look like any Caucasian, but only the good-looking ones.
Beauty through the ages...
Facial aesthetics have been studied since ancient times. While there are variations in different cultures and through different times, there are some general principles that have always remain constant. Proportionality and symmetry are always critical for aesthetics. In planning for cosmetic jaw surgery, regardless of the patient’s cultural background, I always strived to achieve good proportions and symmetry.
Chiseled vs Softened...
Beyond that, I need to understand the patient’s aesthetic sense. There is no right or wrong, only preferences of the patient. To get a sense of the patient’s preference, I may asked them for a example of a celebrity that they think epitomizes their idea of an aesthetic face. There is a wide range of names that get mentioned, some whom I have not even heard of, which is not saying much as I am not into pop culture. In this spectrum of facial aesthetic features, I assign on the one end, faces like that of Angelina Jolie, who has angular and prominent features and on the opposite end of the spectrum, a face of the typical Korean actress, with the V-shape face and rounded facial angles except for the chin.
V Shape face rules in Asia....
Quite expectedly, most Asians prefer the V-shape face as they can identify more with a Korean actress than a Hollywood star. A Google search for “V shape face treatment in Singapore” yields many pages of websites of clinics offering such treatment. However, the treatment that are usually offered comprises minimally invasive procedures such as dermal fillers and botox injections, thread lifts and radiofrequency tightening of the skin. While the minimally invasive nature of such treatment is attractive, the resulting change is also minimally noticeable. Which means that if there are prominent skeletal features, such procedures are only camouflaging them. Furthermore, effects of fillers and botox are not permanent and regular maintenance is needed. To effect real and lasting change, bony surgery is inevitable.
Central to the creation of a V shape face starts with the lower jaw. To be sure, the V shape is referring to the frontal appearance, just as what one will see in the mirror. For most people, the face is more U shape than V. In fact, many have a rather broad U. Somehow, like a fashion, most Asians have decided that V is more aesthetic than U, at least for an Asian and jaw surgery techniques to achieve that look have been developed.
- Mandibular angle
In most patients, the angle of the lower jaw is about 90 degrees to 100 degrees and is visible from the frontal view. By cutting away this angle and smoothing it out into a gentle curve, the jaw line rendered more feminine in profile view and the width of the lower face as seen from the front becomes narrower.
2. Mandibular body
The body of the lower jaw immediately in front of the angle can also be reduced in thickness. The outer layer of bone is the cortical layer and this can be removed or trimmed down, further reducing the width of the face in front of the angle.
First, the chin is cut and separated from the lower jaw but still attached to the muscles to maintain blood supply. This chin surgery or genioplasty is the final part that completes the V transformation. Thereafter, the mid-section of the chin measuring about 5-10mm is cut away, dividing the chin into left and right halves. These two halves are then approximated together, thereby reducing the width of the lower face at the front-most part of the lower jaw. The chin is reattached to the jaw in a more forward position, thereby creating a small chin prominence. This increased projection also adds to the V-ness of the face.
To complete the V transformation, neurtoxin injections into the masseter muscles may be needed in some cases. Most patients who have undergone bony surgery do not require such injections as the degree of change from surgery is usually quite dramatic already. However, in some patients with a low mandibular angle, the masseter muscles can be rather well-developed and may mask the effect of the surgery. In the past, masseter muscle reduction were done to reduce the muscle bulk but due to the risk of facial nerve injury and maxillary artery bleeding, it is mostly replaced by botox injection now.
However, the face is not made up of just on feature. Jaw contouring surgery to achieve a V shape by itself may not achieve the desired aesthetics as each part of the face needs to be assessed in relation with the rest. It is important not to neglect the other facial contours and features while attempting to create the V shape. Balance, proportionality and symmetry remain the cornerstone of facial aesthetics and should set the tone for cosmetic facial surgery.