Facial bone contouring — bone is removed, and removed bone does not come back

The width and angles of a face are mostly made by bone. Once you are past what fat or an implant can change, what is left is to work on the bone.

Three things are done, separately or together.

Zygoma reduction cuts the body of a prominent cheekbone, moves it inward and fixes it. Both the width seen from the front and the projection seen from the side come down.

Mandible angle reduction removes the angled part of the lower jaw. Sometimes a thin layer of the outer cortex is shaved as well.

Genioplasty cuts the chin bone and moves it forward or back, up or down, left or right, then fixes it.

The incisions are usually made inside the mouth. So the scars do not show — which is not the same as the operation being small. It is done under general anaesthesia and has among the longest recoveries on this site.

It cannot be undone. Bone that has been removed does not grow back. An implant can come out and a thread can be released; here there is no such option. This fact comes before everything else on this page.

The swelling is on a different scale. You can be out in public at about two weeks, but the line of the face takes six months to a year to settle. Judging the result from the face you see in between will usually be wrong.

Sensation changes for a while. The nerve supplying the lower lip and chin runs inside the mandible. Numbness or dullness for several months afterwards is common; rarely, it persists.

Sagging can follow. Reduce the bone and the soft tissue that covered it is left over. The older you are and the less elastic the skin, the bigger this problem.

If you cannot open your mouth well, if chewing stays painful, or if swelling returns on one side, that may not be something time will fix. Tell the surgeon who operated.

Start from a CT scan. Whether what protrudes is really bone, or the fat and muscle over it, cannot be told from the outside. If the cause is not bone, removing bone will not produce the change you expect.

Look at the chewing muscle too. If a square look comes from a thickened masseter rather than from bone, botulinum toxin comes first. It is reversible and a far smaller undertaking.

Not smoking matters especially here. Blood flow is directly involved in bone healing and in the mucosa closing.

Chewing is restricted for several weeks afterwards. Preparing for that in advance makes recovery easier.

Doing several areas at once adds risk. Cheekbone and jaw are often done together, but anaesthetic time and blood loss rise together with it.

Set the irreversibility down in front of you once more before deciding. The other operations on this site leave you at least something to do if you change your mind. This one does not.

A face is not read in parts. Narrow the cheekbones and the nose looks larger; narrow the jaw and the width of the forehead comes into view. Change one region and the rest rearranges itself.

It is hard to set a goal from photographs. The same bone structure looks different under different skin thickness and soft-tissue volume.

You do not have to decide now. Facial soft tissue thins with age, and how a reduced bone reads then is not how it reads now. There is usually no medical reason to hurry this.

Whether to have it done is settled with a doctor, and it is better not to settle it on one consultation alone.