The patient communicates to the doctor the specific areas they wish to reduce and the desired degree of change. The doctor typically takes X-rays or even an MRI before surgery to clearly understand the patient's bone structure. Based on individual characteristics, the doctor then provides recommendations and determines the method for the bone contouring procedure.
2. Anesthesia
Options include local or general anesthesia. While both can achieve the surgical outcome, local anesthesia allows the patient to feel vibrations from instruments during incision and procedure, potentially causing anxiety. Therefore, if the patient wishes to be completely unaware of the process, general anesthesia is recommended.
3. Incision
An incision is made inside the mouth near the mandibular angle or zygomatic bone. The entire skin and muscle layer is retracted from within the oral cavity. The muscle is then separated from the periosteum to expose the target bone area for surgical intervention.While extraoral incisions were previously used, they have since been phased out. Since most blood vessels and nerves are located at the junction of muscle and skin, an intraoral incision provides an additional layer of muscle between surgical instruments and nerves, enhancing safety.
4. Hemostasis
Effective hemostasis not only ensures surgeon safety during the procedure but is also crucial in preventing postoperative hematomas. Beyond controlling bleeding during muscle-periosteal separation, bone wax is applied to bone surfaces after resection in osteotomy cases. This serves a dual purpose: promoting hemostasis and facilitating bone healing.
5. Surgical Approach
Select the appropriate surgical technique based on individual needs. Crucially, any bone particles dislodged during surgery must be thoroughly rinsed away with saline. If these particles adhere to the incision site, they may reattach to the muscle as it heals, leading to persistent bone ingrowth.
6. Masseter Muscle Management
Post-surgery, changes in the skeletal support structure for the masseter muscles necessitate adjustment based on their hypertrophy.For significantly hypertrophied muscles, partial removal from the posterior aspect may be performed to accommodate the new bone structure. If hypertrophy is mild, no additional adjustment is required as the muscle will naturally atrophy post-operatively.
7. Suturing and Drainage
Drainage tubes are placed during wound closure to eliminate hematoma. These are typically removed on the second postoperative day.
8. Appropriate Pressure Bandaging
Bandaging provides hemostatic effects while aiding facial contouring.During recovery, physicians administer appropriate antibiotics to prevent wound infection. Occasionally, small doses of steroids may be injected to reduce swelling.
Important Note: Choose a licensed hospital for bone contouring! Per Ministry of Health regulations, bone contouring is classified as a Category II surgical procedure. It requires approval from provincial health department experts and must be performed at tertiary-level public hospitals equipped with robust anesthesia departments, recovery rooms, and supporting medical facilities.