In short. The faces that read wide because of something else entirely, and the consultations that should end in no operation on the bone at all.
Key points
- Where the masseter contributes most of the width, there is a genuine argument for treating it first and observing the result before considering anything permanent.
- It is reversible in the sense that the effect wears off, it involves no operation on the bone, and it answers the diagnostic question at the same time as it treats the appearance.
- A patient who is satisfied has her answer and needs nothing further.
This site exists because a wide lower face caused by the mandible can be narrowed, and for patients with that finding the operation is a reasonable answer. It is worth being equally clear about the cases in which nothing should be done to the bone, because a wide appearance is a description rather than a diagnosis.
The width that comes from muscle
A heavy masseter produces a broad lower face that is soft rather than angular and that becomes more prominent when the teeth are clenched. It is treated by a means that relaxes the muscle, and the effect is temporary rather than permanent. That combination makes it an unusually informative answer: the patient sees what a narrower lower face looks like on her own face, and the diagnosis is confirmed or corrected by the result. No bone is removed for a finding that is not skeletal.
Try the muscle first where it is the finding
Where the masseter contributes most of the width, there is a genuine argument for treating it first and observing the result before considering anything permanent. It is reversible in the sense that the effect wears off, it involves no operation on the bone, and it answers the diagnostic question at the same time as it treats the appearance. A patient who is satisfied has her answer and needs nothing further.
The width that comes from fat
Fat over the jaw produces an appearance that patients frequently describe as a wide jaw. It is soft, it moves with the skin rather than with the bone, and it changes when the face is lifted or the cheeks drawn back. Removing fat is a different treatment from reducing bone and does not narrow the skeleton. Where fat is the contributor, a bone operation changes something the patient is not looking at.
The request that has no operation behind it
A patient who wants a particular face from a photograph, or who was told by somebody else that her jaw is wide, is not describing a finding that an operation can address. Where the concern is general rather than specific, the assessment should establish what exactly is wanted before any plan is made, and where the answer is that the whole face should look different, the honest response is that an operation on one measurement will not achieve it.
Consultations that should end without an operation on the bone
- The width is produced mainly by the masseter muscle or by the fat over the jaw.
- The complaint is general rather than a specific measurement the patient can describe.
- The plan would remove bone to change something bone does not determine, such as length or the neck.
Being told that the bone is not the problem, or that a temporary treatment should be tried first, is the assessment doing its work. The operation narrows a lower face that is wide for a skeletal reason, and the most valuable thing a consultation can establish is whether that is the finding in front of it.
Frequently asked questions
What if the width is from the muscle?
Then the bone is not the target. A heavy masseter is treated by a means that relaxes it, and its effect is temporary, which makes it both a treatment and a test of the diagnosis. This is one of the most common conclusions of an assessment for jaw contouring, and it is a finding rather than a refusal.
What if I just do not like my face?
That is worth saying plainly at an assessment, because it is a different problem from a wide jaw. An operation can change a specific measurement and it cannot change how a face reads as a whole or how a patient feels about it. Where the concern is general, the assessment should establish what specifically is wanted before any plan is made.
Is it common to be told no?
It is common to be told that the bone is not the cause, which is not the same as being told no. The assessment separates three layers, and in a substantial proportion of patients the largest contributor is muscle or fat rather than bone. In those cases the honest plan treats the layer that is responsible, and the bone is left alone.
Risks & Limitations
- Removing bone is easier than restoring it. Over-reduction is difficult and sometimes impossible to correct, so the amount removed is decided from imaging and treated as fixed.
- The marginal mandibular nerve, which moves the lower lip, runs through the operative field. Weakness after surgery is usually temporary and usually resolves over weeks to months; a lasting weakness is uncommon but possible.
- Swelling hides the result for months. The face reads unevenly at two weeks, is not close to final until around six months, and is judged honestly at around a year.
- Numbness of the chin and the lower lip is expected, is watched rather than treated in the early weeks, and may not return fully in some areas.
- The two sides of a jaw are rarely identical, and reducing both by the same amount can make a pre-existing difference more visible.
- The operation changes width and the border between the jaw angle and the chin. It does not lengthen the face, correct a bite, or change the soft tissue over the new contour.
When to Seek Care
- Swelling that is increasing rather than settling after the first week, or that is much greater on one side — contact the team.
- A wound that is opening, or discharge, spreading redness or warmth around an incision.
- A weakness of the lower lip that is worsening rather than improving, or difficulty breathing or swallowing &mdash — seek emergency care at once.
- Fever, or feeling generally very unwell with a wound or a swollen area.
- Calf pain, swelling or tenderness in one leg, or shortness of breath or chest pain &mdash — seek emergency care at once.
References & Further Reading
- American Society of Plastic Surgeons (ASPS) - facial bone contouring and patient safety guidance
- National Institute for Health and Care Excellence (NICE, UK) - guidance on facial surgery and on venous thromboembolism prevention
- Cochrane Library - systematic reviews in oral and maxillofacial surgery
- British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS) - patient information on facial surgery
- Chinese Medical Association Plastic Surgery Branch - clinical guidance
This page is patient education, not medical advice, and it does not cite individual studies. Discuss your own case with a qualified clinician. To arrange an assessment at Chongqing West District Hospital, see Contact & Consultation.