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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5207_Библиотеки_им_академика_М_И_Перельмана.pdf
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- •Preface for Second Edition
- •Contents
- •Contributors
- •1.1 Beauty Is Bone-Deep
- •1.2 Beautiful Facial Structure
- •2.1 Pearls
- •2.2 Introduction
- •2.3 Nerves
- •2.4 Vessels
- •2.4.3 Retromandibular Vein
- •2.5 Muscles
- •2.6 Fat
- •2.7 Conclusion
- •References
- •1.4 Beauty Keeps Changing
- •1.9 Why Global?
- •1.10 Surgeon’s Mission
- •References
- •3.1 Pearls
- •3.2 Introduction
- •3.3 Surgical Approaches
- •3.3.1 Intraoral Approach
- •3.3.1.1 Maxillary Vestibular Approach
- •3.3.2 Bicoronal Approach
- •3.3.3 Transcutaneous Approach
- •3.3.3.1 Sideburn Approach
- •3.3.3.2 Gillies’ Approach
- •3.3.4 Periorbital Approach
- •3.3.4.1 Subciliary Incision
- •3.3.4.2 Transconjunctival Incision
- •3.4 Key Technical Points
- •References
- •4.1 Pearls
- •4.2 Introduction
- •4.3 Surgical Instruments
- •4.3.1 Zygoma Reduction
- •4.3.2 Mandible Reduction
- •4.3.3 Genioplasty
- •4.4 Discussion
- •References
- •5.1 Pearls
- •5.2 Introduction
- •5.3.2 Clinical Evaluation
- •5.3.3 Radiologic Evaluation
- •5.3.3.1 Frontal Plane Analysis
- •5.3.3.2 Sagittal Plane Analysis
- •5.3.3.3 Transverse Plane Analysis
- •5.4.1 Chin
- •5.4.3 Asymmetry
- •5.4.4 Soft Tissue Contribution
- •References
- •6.1 Pearls
- •6.2 Introduction
- •6.3 Patient Assessment
- •6.3.1 Frontal Plane
- •6.3.2 Sagittal Plane
- •6.3.3 Transverse Plane
- •6.4 Surgical Technique
- •6.5 Key Technical Points
- •6.6 Case Study
- •6.7.2 Nerve Injury
- •6.8 Discussion
- •6.8.1 Approach: Intraoral Versus External Approach
- •6.8.2.3 Asymmetry
- •6.8.2.4 Soft Tissue Contribution
- •References
- •7.1 Pearls
- •7.2 Introduction
- •7.4 Surgical Techniques
- •7.5 Case Study
- •7.6.1 Nerve Injury
- •7.7 Discussion
- •References
- •8.1 Pearls
- •8.2 Introduction
- •8.3 Patient Assessment
- •8.4 Surgical Technique
- •8.5 Key Technical Points
- •8.6 Case Study
- •8.7.4 Asymmetry
- •8.7.5 Chin Ptosis
- •8.8 Discussion
- •References
- •9.1 Pearls
- •9.2 Introduction
- •9.3.1 Diagnosis
- •9.4 Surgical Techniques
- •9.4.1 Basic Osteotomy
- •9.4.3.1 Classic T Osteotomy
- •9.4.3.2 Two-Parallel Osteotomy
- •9.4.3.3 Bow Tie-Shaped Osteotomy
- •9.4.3.4 Diamond-Shaped Osteotomy
- •9.4.4.1 Inverted V-Shaped Osteotomy
- •9.4.4.2 Spade-Shaped Osteotomy
- •9.4.4.3 Bird-Shaped Osteotomy
- •9.5 Case Study
- •9.6 Discussion
- •References
- •10.2 Introduction
- •10.3 Patient Assessment
- •10.4 Surgical Techniques
- •10.5 Key Technical Points
- •10.6 Case Study
- •10.7.2 Hemorrhage
- •10.7.3 Unsatisfactory Chin Shape
- •10.1 Pearls
- •10.8 Discussion
- •References
- •11: The Mini V-Line Surgery
- •11.1 Pearls
- •11.2 Introduction
- •11.3 Surgical Technique
- •11.4 Key Technical Points
- •11.5 Case Study
- •11.7 Discussion
- •References
- •12.1 Pearls
- •12.2 Introduction
- •12.4 Surgical Techniques
- •12.4.1 Reduction Genioplasty
- •12.4.1.1 Two-Parallel Osteotomy
- •12.4.1.2 Inverted V-Shaped Osteotomy
- •12.4.1.3 Spade-Shaped Osteotomy
- •12.4.1.4 Bow Tie-Shaped Osteotomy
- •12.5 Philtrum Reduction
- •12.6 Key Technical Points
- •12.7 Case Study
- •12.9 Discussion
- •References
- •13.1 Pearls
- •13.2 Introduction
- •13.4 Surgical Techniques
- •13.4.1 Chin
- •13.4.2 Mandibular Implant
- •13.5 Key Technical Points
- •13.6 Case Study
- •13.7.1 Infection
- •13.7.2 Malposition
- •13.7.3 Bony Resorption
- •13.8 Discussion
- •References
- •14: Secondary Mandibular Contouring Surgery
- •14.1 Pearls
- •14.2 Introduction
- •14.3 Case Study
- •References
- •15.1 Pearls
- •15.2 Introduction
- •15.4 Surgical Techniques
- •15.4.1 Laser-Assisted Liposuction
- •15.4.2 Barbed Suture Lift
- •15.4.3 Elastic Lift
- •15.5 Facelift
- •15.6 Key Technical Points
- •15.7 Case Study
- •15.8.2 Neurapraxia
- •15.8.3 Infection
- •15.9 Discussion
- •References
- •16.1 Pearls
- •16.2 Introduction
- •16.3.1 Preoperative Analysis
- •16.3.1.1 Frontal Evaluation
- •16.3.1.2 Three-Quarter Oblique Evaluation
- •Hinderer Analysis
- •Wilkinson Analysis
- •16.3.1.3 Basal Evaluation
- •Zygomatic Arch
- •Zygomatic Body
- •16.3.2 Additional Considering Points
- •16.3.2.1 Soft Tissue Contribution
- •16.4 Discussion
- •References
- •17.1 Pearls
- •17.2 Introduction
- •17.4 Zygomatic Body Analysis
- •17.4.1 Hinderer Analysis
- •17.4.2 Wilkinson Analysis
- •17.5 Zygomatic Arch Analysis
- •17.6 Midfacial Soft Tissue
- •17.7 Surgical Techniques
- •17.7.2 Anterior Osteotomy
- •17.7.3 Posterior Osteotomy
- •17.7.4 Fixation
- •17.8 Key Technical Points
- •17.9 Case Study
- •17.11 Discussion
- •References
- •18.1 Pearls
- •18.2 Introduction
- •18.3 Patient Assessment
- •18.4 Surgical Technique
- •18.5 Key Technical Points
- •18.7 Discussion
- •References
- •19.1 Pearls
- •19.2 Introduction
- •19.4 Surgical Techniques
- •19.4.1 Tripod Osteotomy
- •19.4.2 Orbital Rim Shaving
- •19.5 Key Technical Points
- •19.6 Case Study
- •19.8 Discussion
- •References
- •20: The Mini-Zygoma Reduction Surgery
- •20.1 Pearls
- •20.2 Introduction
- •20.3 Patient Assessment
- •20.4 Surgical Technique
- •20.5 Key Technical Points
- •20.6 Case Study
- •20.8 Discussion
- •References
- •21.1 Pearls
- •21.2 Introduction
- •21.4 Surgical Techniques
- •21.5 Key Technical Points
- •21.6 Case Study
- •21.7.1 Infection
- •21.7.2 Sensory Disturbance
- •21.7.4 Asymmetry
- •21.8 Discussion
- •21.8.2 Host-Implant Interaction
- •21.8.3 Immobilization
- •References
- •22: Secondary Zygoma Reduction
- •22.1 Pearls
- •22.2 Introduction
- •22.3 Patient Assessment
- •22.4 Surgical Technique
- •22.5 Cases
- •22.7 Discussion
- •References
- •23.1 Pearls
- •23.2 Introduction
- •23.3.1 Preoperative Evaluation
- •23.3.2 Patient Selection
- •23.3.2.1 Lowering Lateral Canthoplasty (LLC)
- •23.3.2.2 Midface Lifting Procedure
- •23.4 Surgical Technique
- •23.5 Cases
- •23.6 Discussion
- •References

Facial Bone
Contouring
Surgery
APractical Guide
SanghoonPark
Editor
SecondEdition
123

Facial Bone Contouring Surgery

Sanghoon Park
Editor
Facial Bone Contouring
Surgery
A Practical Guide
Second Edition

Editor
Sanghoon Park
Department of Plastic Surgery
ID Hospital
Seoul, Korea (Republic of)
ISBN 978-981-97-4991-1 ISBN 978-981-97-4992-8 (eBook)
https://doi.org/10.1007/978-981-97-4992-8
© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature
Singapore Pte Ltd. 2018, 2024
This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher,
whether the whole or part of the material is concerned, specically the rights of translation,
reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microlms or in any
other physical way, and transmission or information storage and retrieval, electronic adaptation,
computer software, or by similar or dissimilar methodology now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this
publication does not imply, even in the absence of a specic statement, that such names are
exempt from the relevant protective laws and regulations and therefore free for general use.
The publisher, the authors and the editors are safe to assume that the advice and information in
this book are believed to be true and accurate at the date of publication. Neither the publisher nor
the authors or the editors give a warranty, expressed or implied, with respect to the material
contained herein or for any errors or omissions that may have been made. The publisher remains
neutral with regard to jurisdictional claims in published maps and institutional afliations.
This Springer imprint is published by the registered company Springer Nature Singapore Pte Ltd.
The registered company address is: 152 Beach Road, #21-01/04 Gateway East, Singapore
189721, Singapore
If disposing of this product, please recycle the paper.

Preface for Second Edition
In the preface of the rst edition, I recalled the history of craniofacial surgery
and its progression toward the eld of facial bone contouring surgery. As I sit
down to pen the manuscript for this second edition, it’s become clear to me
that the journey of evolution is far from over; it is still ongoing.
The dynamic nature of aesthetic surgery is a testament to our profession’s
commitment to growth and adaptation, driven by an ever-expanding base of
knowledge and evolving aesthetic preferences.
A good example of this evolution is our recognition that a wide, at chin
and a U-shaped lower facial contour often lead to dissatisfaction after mandible reduction. This insight has underscored the necessity of chin reduction
and reshaping as complementary procedures to total mandible reduction,
acknowledging the chin’s pivotal role in creating facial harmony. The introduction of a new classication for the zygoma is another good example. A
detailed description of the subtypes of the zygoma helps determine the corresponding surgical techniques, offering insights into the nuanced approaches
required for effective aesthetic enhancement of the zygomatic area.
Facial bone surgery has proven effective in sculpting the Asian facial aesthetic into slender, pleasing contours, catalyzing a surge in the global adoption of these procedures. The quest for aesthetic excellence is a delicate
balance, demanding symmetry and harmony across all facial aspects.
Preferences regarding facial shape are deeply personal, inuenced by cultural, temporal, and individual factors. With the changing dynamics of patient
preferences, particularly inuenced by events like the COVID-19 pandemic
and glocalization, a deep understanding of patients’ desires is crucial for the
surgeons.
In this second edition, my aim as the editor has been to provide a coherent
and comprehensive repository of knowledge that spans from simple surgical
approaches to intricate surgical details. My ambition has been to bring to
light the most contemporary concepts across the spectrum of facial bone surgery, addressing potential pitfalls to mitigate or avoid undesirable outcomes.
The ultimate goal is to ensure the patient’s utmost satisfaction.
In closing, I would like to extend my heartfelt gratitude to all the contributors and the dedicated team at ID Hospital. Their excellence and invaluable
support made this work possible.
Seoul, South Korea SanghoonPark
v

Contents
Part I General
1 Evolution of Facial Bone Contouring Surgery . . . . . . . . . . . . . . . 3
Sanghoon Park
2 Anatomic Basis for Facial Bone Contouring Surgery . . . . . . . . . 7
Sanghoon Park
3 Basic Approaches for Facial Bone Contouring Surgery . . . . . . . 15
Sung Jae Ahn
4 Customized Instruments for Facial Bone Contouring
Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Sanghoon Park
Part II Lower Face
5 The Comprehensive Aesthetic Analysis for Lower Face . . . . . . . 29
Sanghoon Park
6 The Standard Mandible Reduction with Intraoral
Approach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
Sanghoon Park
7 The Current Concepts of Sagittal Resection of the Mandible . . 51
Sanghoon Park
8 The Basic Principles in Osseous Genioplasty . . . . . . . . . . . . . . . . 61
Sanghoon Park
9 V-Logic Principle for Genioplasty: Logical Approach
for Balanced Chin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
Kyungmin Lee and Sanghoon Park
10 The V-Line Surgery: Narrowing Genioplasty with
Mandible Reduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
Sanghoon Park
11 The Mini V-Line Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103
Sanghoon Park
vii

viii
12 Consideration in Treatment of Long Face . . . . . . . . . . . . . . . . . . 113
Sanghoon Park
13 Alloplastic Modification of Lower Face . . . . . . . . . . . . . . . . . . . . 125
Sanghoon Park
14 Secondary Mandibular Contouring Surgery . . . . . . . . . . . . . . . . 135
Jihyuck Lee
15 Soft Tissue Surgery Combined with the Mandible
Contouring Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145
Sanghoon Park and Joo Yong Kwon
Part III Midface
16 The Comprehensive Aesthetic Analysis for Midface . . . . . . . . . . 159
Sanghoon Park
17 Standard Zygoma Reduction with Intraoral Approach . . . . . . . 169
Sanghoon Park
18 The Reduction Malarplasty with Coronal Approach . . . . . . . . . 183
Rong-Min Baek and Baek-kyu Kim
19 Extended Zygomatic Reduction for Orbital Rim
Protrusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191
Sanghoon Park
Contents
20 The Mini-Zygoma Reduction Surgery . . . . . . . . . . . . . . . . . . . . . 199
Sanghoon Park
21 Alloplastic Modification of the Midface . . . . . . . . . . . . . . . . . . . . 207
Sanghoon Park
22 Secondary Zygoma Reduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . 219
Jihyuck Lee
23 Soft Tissue Surgery Combined with Zygoma
Reduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 231
Kyungmin Lee

Contributors
Sung Jae Ahn Center for Facial Bone Surgery, Department of Plastic
Surgery, ID Hospital, Seoul, South Korea
Rong-MinBaek Department of Plastic and Reconstructive Surgery, Seoul
National University College of Medicine, Seoul National University Bundang
Hospital, Seongnam-si, South Korea
Baek-kyu Kim Department of Plastic and Reconstructive Surgery, Seoul
National University College of Medicine, Seoul National University Bundang
Hospital, Seongnam-si, South Korea
JooYongKwon Center for Lifting Surgery, Department of Plastic Surgery,
ID Hospital, Seoul, South Korea
JihyuckLee Center for Facial Bone Surgery, Department of Plastic Surgery,
ID Hospital, Seoul, South Korea
Kyungmin Lee Center for Facial Bone Surgery, Department of Plastic
Surgery, ID Hospital, Seoul, South Korea
Sanghoon Park Center for Facial Bone Surgery, Department of Plastic
Surgery, ID Hospital, Seoul, South Korea
ix

Part I
General

Evolution ofFacial Bone
Contouring Surgery
SanghoonPark
1
1.1 Beauty Is Bone-Deep
The adage says that “beauty is only skin-deep.” If
this is true, plastic surgery might be only a single
chapter in dermatology. Plastic surgeons often
observe that even successful operations on the
eyes or nose may not substantially alter a patient’s
overall aesthetic appeal. This realization underscores a crucial insight: the shape of the face,
fundamentally sculpted by bone, plays a pivotal
role in dening one’s appearance. The shape of
one’s face is constructed with bone. The distinct
facial features that differentiate Caucasians from
Asians primarily stem from their differing facial
bone structures. Now we can say that “beauty is
bone-deep.”
1.2 Beautiful Facial Structure
Ethnicity plays a signicant role in shaping the
distinct facial bone structures observed across
different populations. For instance, while
Caucasians predominantly exhibit dolichocephalic traits, Asians are more likely to be
brachycephalic (Fig.1.1). This distinction can
be traced back to the developmental patterns of
the skull, inuenced by the fusion of sutures.
The elongated facial features of dolichocephalic individuals resemble those seen in
scaphocephaly, whereas the broader facial
characteristics of brachycephalic individuals
align with the typical appearance of brachycephaly. From a frontal perspective, the racial
differences become even more pronounced:
Caucasian faces tend to be longer and narrower,
giving them an elongated appearance, whereas
Asian faces often appear wider and shorter,
leading to a more square-like impression
(Fig.1.2). This variance in facial structure is so
marked that it allows for the easy distinction
between individuals from Asian and Caucasian
backgrounds during international travels. This
observation brings us to a pivotal question:
“What is the beautiful face?”
S. Park (*)
Center for Facial Bone Surgery, Department of
Plastic Surgery, ID Hospital, Seoul, South Korea
e-mail: spark@idhospital.com
© The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2024
S. Park (ed.), Facial Bone Contouring Surgery, https://doi.org/10.1007/978-981-97-4992-8_1
3
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