The facial skeleton and its covering soft tissues shape the features of the face and the profile. The relationship between the different parts of the face has a fundamental aesthetic importance. Well-marked cheekbones give an aesthetic framing of the eyes, often illuded by a well-made make-up.

Principle:

Bone reduction is done by abrasion or chiselling, sometimes by moving of a bony segment. Augmentation is done either with transplants of bone or cartilage, mostly, however, with synthetic implants. A surgical pocket is created and during healing, the implants will be anchored at place by the surrounding connective tissues.

Some deformities and asymmetries of the face need extensive pre- and postsurgical treatment by different expert teams and these will not be discussed here.

The most performed procedures are:

Shortening of the chin:
Through an incision in the mouth to abrade or chisel off a peace of bone.

Elongation and widening of the chin:
Through an incision in the mouth or below the chin, a suitable implant is inserted.

Hollow middle face:
Augmentation through the mouth or the nose.

Augmentation of cheekbones:
Augmentation through the mouth or during an eyelidoperation.

Narrowing or widening of the lower face:
Either augmentation or removing bone of the angle of the lower jaw through the mouth.

Anaesthetic:

Mostly local anaesthetic and conscious sedation.

Operating time:

1 - 2 hours.

You can expect:

• When the anaesthetic subsides, a short intensive pain can be felt for about ½ an hour. The following discomfort is lessened with painkillers.
• A heavy swelling of the face evolves, that will dissolves in about 7-10 days.The breakdown can be accelerated with ice bags.
• After operations through the mouth, fluid food should be eaten the first 3 days. Otherwise mashed food.
• Prophylactic antibiotics are prescribed.
• Sleeping on the back is mandatory during the first 2 weeks. Normal social activities can be returned to after 10 -14 days.

Complications
Referred unwanted biologic events can occur with a certain low frequency and must be regarded as calculated risks. Other risks not mentioned can also occur. For patients this must be considered before a decision for plastic surgery is set.

Bleeding: All operations can cause postoperative bleeding. These risks increase by the intake of analgesics and Vitamin E. These should be avoided 2 weeks prior to the planned operation.

Infection: All operations can cause infections. The mouth is from surgical point of view heavy contaminated and in spite of prophylactic antibiotics infection can occur. An implant has to removed temporarily and can be reinserted after a few months.

Displacement of an implant: A correctly placed implant is normally kept in place by scary healing to the surroundings. Occasionally an implant can be displaced before proper healing. In that case a re operation is necessary.

Nerve injury: Facial implants are placed in near proximity to nerve exits of sensory nerves. These nerves are protected during the operation. If the implant, however, is displaced, it can irritate or damage the actual nerve, which can cause numbness or pain in the corresponding area.

Smoking: Smoking does compromise blood circulation and healing. Smoking should be abandoned prior to a planned operation.