Square Face, Masseter Muscle Excision failed – Resurgery with Gonial Angle Reduction

Facial cosmetic surgery and the reasons people opt for it

Every one of us desires to have a face that is esthetically appealing and attractive to others. Just like every man would desire to have a prominent jaw with a masculine jawline, every woman desires to have a dainty feminine jaw shape. Masseter muscle hypertrophy is a condition where the masseter muscle becomes greatly increased in size. The masseter muscle is the muscle at the angle of the jaw and is one of the most important muscles of mastication.

When this muscle becomes hypertrophied, it leads to the creation of a strong masculine jaw line and profile. Women who manifest this condition opt for plastic surgery to get this corrected. This is one of the many facial feminization procedures available today. Patient safety is fully assured from this surgery and there are no undesirable side effects when performed by a competent oral and maxillofacial surgeon or a board certified plastic surgeon.

The facial features are softened by this procedure and the feminine quotient of the face is increased. This enables the patient to gain more self confidence and a sense of social acceptance that will enable her to better integrate into the social structure and not feel self conscious about having a broad masculine face. The results often influence the patient’s life to such a degree that it improves the quality of life for the patient right across the board.

Patient undergoes masseter muscle reduction in her hometown

The patient is a 25-year-old woman from Parbhani in Maharashtra, India. She had always felt that her lower face was very broad and square shaped. She disliked this a great deal and said that this made her look very masculine. She had always wanted to change this. Her parents had approached a plastic surgeon in their hometown about a year ago who had referred them to an oral surgeon. After a thorough examination, the oral surgeon had explained to them that the increased breadth of the lower face was due to hypertrophy of the masseter muscle at the angle of the mandible and had recommended masseter muscle reduction surgery.

Patient not satisfied with the results of the master muscle reduction surgery
The patient had undergone masseter muscle reduction, but still was unhappy with the appearance of her face. She felt that her facial structure had not become feminine even after the surgery. They had subsequently approached the plastic surgeon again who then referred them to our hospital as we are renowned for facial cosmetic surgery in India. Jaw reduction surgery and jaw reconstruction surgery is routinely performed in our hospital.

Presentation and treatment planning at our hospital

The patient and her parents thus presented to our hospital for management of her complaint. Dr SM Balaji, facial cosmetic surgeon, examined the patient clinically and obtained radiological studies of the patient’s face. Though clinical examination suggested masseter muscle hypertrophy, the 3D CT scan revealed that the patient had a very broad mandibular structure as well as prominent masseter muscles bilaterally.

It was explained to the patient and her parents that masseter muscle reduction alone would not be enough to correct the patient’s problem and that bony reduction of the mandibular angles also needed to be performed bilaterally. The patient and her parents were in agreement with this treatment plan and consented to the surgical procedure.

Successful surgical reduction of the patient’s lower facial breadth

Under general anesthesia, a modified Ward’s incision was made bilaterally in the mandibular retromolar area. This was followed by elevation of bilateral flaps in the region to expose the gonial angle of the mandible. The gonial angle of the mandible was then carefully reduced to the right size bilaterally using a round bur. This was followed by dissection of the periosteum with identification of the masseter muscle. The masseter muscle was then partially excised with reduction of bulk bilaterally. A drain was placed at the operative site postsurgically to prevent formation of any hematoma in the region. Closure of bilateral incisions was then done using resorbable sutures.

Patient and her parents express their satisfaction at the results of the surgery

The patient was extremely happy with the results of the surgery. She now had a very feminine mandible without the excessive bulk. Her parents were also very happy with the results of the surgery and said that this would help the patient gain more confidence in life.

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