The mandible's contour determines the shape of the lower part of the face and thus influences the appearance of the face and neck. There are two types of operative procedures that can be used on mandibular contour and they do not require orthodontic treatment: mandible angle reduction and genioplasty. We divided the mandible angle reduction group into Types A, B, and C according to the grade of angle protrusion. Type A needs just an angle resection, Type B needs an angle resection and resection of part of the body, and Type C needs resection of the angle, the body, and part of the symphysis. We have performed 258 mandibular contouring procedures. In genioplasty, shaving, advancement, shortening, and lengthening generally can be employed. Furthermore, when vertical lengthening is used, ostectomized mandible angle bone is carved and then grafted between the horizontal osteotomy site. Of the mandible angle reduction cases, 21 were Type A, 186 were Type B, and 28 were Type C. The curved ostectomy is most important in mandible angle reduction cases in order to achieve a more natural curve of the mandible's lower border. A total of 71 patients were very pleased with the results of the combined procedures of genioplasty and angle reduction.

Since the development of mandibular contouring surgery, there have been many unfavorable results due to technical reasons. Those results include asymmetry, undercorrection, overcorrection, and an incorrect contour line. Over three years the authors have analyzed 19 cases of unfavorable results and found the following: (1) There have been 7 cases of undercorrection, 5 cases of asymmetry, 5 cases of incorrect contour line, and 2 cases of overcorrection. (2) The main technical errors that cause unfavorable results seem to be the simple straight cutting of mandible angles instead of curved cutting using multistaged curved ostectomy. (3) We suggest that the basic way to prevent unfavorable results in mandibular contouring surgery is to contour the mandible, including angle, body, and symphysis, as a whole by way of multistaged curved ostectomy.

The infracture technique for reduction malarplasty has been widely used as an aesthetic surgical procedure in northeast Asia. Since 1988, the authors' original method of infracture technique was performed through the combined approach of intraoral and temporopreauricular incision, which may leave a rather long scar on the temporal region. To shorten the external scar, a new technique using a short preauricular incision instead of a long temporopreauricular incision was developed. From September of 2000 to June of 2001, this new approach was applied to 142 patients for correction of prominent zygoma. In this procedure, anteriorly, incomplete fracture of the zygomatic body was performed through an intraoral approach for bending inward. Posteriorly, full-thickness cutting of the zygomatic arch was performed through a preauricular incision. Then, lateral bulging of the zygomatic arch was reduced with infracturing, and the infractured site was fixed in a new position with a microplate and three screws. The advantages of this technique are reduction of the operation time, reduction of the length of the external scar, and reduction of postoperative edema around the operative region. With this combined approach, the authors were able to sufficiently expose the zygomatic arch and body and able to change the lateral convex arch into a concave one. Under direct vision, the authors could effectively and precisely perform the infracture technique through a much shorter preauricular incision that did not result in a long, conspicuous external scar.

In the Orient, prominent malar regions are considered unaesthetic and the majority of women with a prominent malar want to reduce the zygoma. Various operative procedures such as shaving or chiseling the zygomatic body or the zygomatic arch have been used for reducing malar eminence, but the zygomatic arch cannot be reduced sufficiently by these methods. By combining intraoral shaving of the zygomatic body and a new effect arch infracture technique through a temporopreauricular incision, we have obtained very satisfactory results in 19 cases and notable minimal complications over the last three years.