Jaw reduction

Botulinum toxin type A weakens the masseter and reduces its volume — around 31% after three consecutive injection cycles — but it does not touch bone and wears off in roughly 3 to 4 months. Jaw reduction permanently removes bone from the mandibular angle and body. Toxin is right when the width comes from muscle; surgery is for width that comes from the skeleton.

The standard approach places the incision inside the mouth along the gum line, so there is no scar on the face. Extraoral and retroauricular approaches exist and are used selectively. The intraoral route has its own trade-offs — less visibility for the surgeon, and a higher infection risk from oral bacteria.

Swelling rises quickly over the first few days, then subsides substantially across about a month, with subtle residual swelling for several months more. Most people return to work or school at 3 to 4 weeks. The final contour is judged at 6 to 12 months.

Contouring the angle and outer cortex does not move teeth or alter occlusion, so the bite should be unchanged. Restricted mouth opening and weak chewing are expected for a while as swelling and muscle irritation resolve. If the bite is the actual problem, orthognathic surgery — which repositions the jaw and is planned with orthodontics — is the operation you need instead.

Resected adult mandibular bone does not regenerate, so the skeletal reduction is permanent. What keeps changing is soft tissue: masseter volume often decreases over the following months even without muscle resection, and skin laxity increases with age. Weight change and ageing will still affect how the jawline looks.

Jaw reduction addresses the mandible only. Width at the level of the cheekbones is treated by zygoma reduction, a separate osteotomy, and the two are sometimes planned together. We measure bigonial width, gonial angle and masseter thickness on imaging to work out which structure is actually driving the appearance.

Facial bone contouring is tracked as its own category in the International Society of Aesthetic Plastic Surgery's annual global survey, and mandibular angle reduction is among the most frequently performed facial bone operations in East Asia. Single-centre series of several thousand cases over a decade have been published. Volumes remain far lower in North America and Europe.

Anyone whose facial skeleton is still growing, and anyone whose lower-face width comes from masseter bulk or fat rather than bone — surgery cannot fix what it does not touch. We also defer it for active dental or gum infection, since the incision runs through the mouth; for bleeding disorders or anticoagulation that cannot safely be paused; and where a bite problem is the real diagnosis, in which case orthognathic surgery is the operation. Heavy smoking and expectations that no ostectomy could meet are reasons to say no rather than to proceed carefully.

Call us straight away for bleeding that will not settle, swelling that increases rapidly on one side, or any difficulty breathing or swallowing — a haematoma in the floor of the mouth is an emergency. The same applies to fever with spreading redness or foul discharge, to pain that escalates after day 3 to 5 instead of easing, and to a jaw that suddenly cannot open or a bite that feels shifted, which can signal a fracture or a problem with fixation. Numbness of the lower lip and chin is expected and is not an emergency, but tell us about it: numbness still present beyond six months changes how we follow you.

No, and this is the commonest misconception we correct. How much can come out is limited by the mandibular canal and by the soft tissue above it: over-resection produces gonial deficiency — a jaw with no defined angle, which reads older and weaker rather than slimmer — and leaves skin and masseter without bony support, the cause of the sagging cheek reported in about 2.8% of cases. Comparative data favour designs that preserve a physiological gonial angle over maximal removal, so the plan is aimed at a shape, not at a quantity of bone.

Within our €4,000 to €8,500 range the drivers are how much is actually done: angle ostectomy alone sits at the bottom, and adding outer-cortex reduction, masseter reduction or a narrowing genioplasty moves it up, as does the fixation hardware a chin osteotomy needs. The 3D CT planning, the theatre, the anaesthetist and the inpatient night are in every version of the quote. Ask any clinic which of those a headline price excludes.