Having an oval face is the dream of many people's minds; but pie face or square face is the usual face shape Oriental has, especially with the northern national origin of Mongolia and Korea, the rate is very high; in Taiwan, the square face is less than Korea, but the tall cheekbones or square jaw bone is very common to see.
 
People with particularly developed cheekbones, the cheeks will be relatively large and slightly raised to the front, the so-called "pie face".
People with developed jaw bone, face shape will be particularly square and large, side view there will be an unexpected angle, called "square face".
 
Facial face can be divided into the following categories:

Oval face

Diamond face

Round face

Pear-shaped face

Short square face

Rectangular face

Side：
 

凸嘴

凸嘴下顎內縮

凸嘴長臉

下顎整體凸出

後縮下巴

戽斗下巴

By changing the sleeping posture to improve the shape of the skull, only one year old infants and young children have effect; in the period of children to teenager fastest growing development, face shape with bucket or buck-tooth, you can correct with dental treatment in advance to prevent or improve; but there is no way to prevent square face or pie face. In general, after 16 years of age, facial bone has completely developed, intend to change, have to rely on plastic surgery to reach the goal.

The basic elements that make up the face shape include hard tissue (bone) and soft tissue (skin, fat, muscle), so the method of changing the face shape is also divided into "bone surgery" and "soft tissue surgery", according to the different needs, choose their own way:
Bone surgery - bone is the basis of the face shape, skeleton plastic surgery is the best of all with the best results, and even change face.
Soft tissue surgery - soft tissue is the appearance of the face, but also the place for important nerve and vascular tissue pass through; the effect of soft tissue plastic surgery is not obvious, can be used to improve the appearance, but not easy to have the effect of change face.
 
People need to change or intend to completely change the face, choose bone surgery.
→ Related articles: facial bone sculpture method、zygomatic arch osteotomy push、jaw angle excision、chin surgery
 
People do not dare to try hard plastic or just need a small improvement, choose soft plastic. Soft plastic surgery is divided into injection of botulinum, autologous fat transplantation, facial liposuction.
→ Related articles: fine talk about soft plastic surgery and surgical methods
 

 

1. Whether symmetrical or not
   The probability for the square face both sides of the jaw bone to develop asymmetry is high. Before surgery must be correctly diagnosis, to distinguish the problems belongs to the bone or soft tissue, choose surgery to be amended.
2. Whether the masticatory muscles are overweight
   People with simple masticatory muscles overweight, can choose to inject botulinum, but only temporarily; you can also choose osteotomy, get permanent effect. Surgery does not need to remove the muscle, because the muscles will naturally shrink after surgery, but it takes 3 to 6 months for face shape to be completely fixed down.
3. Full and hypertrophy face shape
   Can also do facial liposuction surgery or remove part of the oral wall fat. The ratio of the chin must also be considered, square face people often have too short jaw problems, can do the chin plastic surgery, to strengthen the overall coordination.
4. Whether the face skin is loose
   People with loose cheek, after the cheekbones bone grinding surgery, may deteriorate, can consider doing pulling surgery at the same time. If it is to do zygomatic reduction and zygomatic arch shift surgery, there will be no such consideration.
5. Are there any other requirements for plastic surgery?
   The most common surgery for face-shaped sculpture surgery is double eyelid and nasal plastic surgery.

1. Masticatory muscle injection of botulinum
   Botulinum can reduce the volume of masticatory muscles, very helpful to improve the jaw curve.
   ◆ Method: direct injection in the masticatory muscles
   ◆ Time: the first week of feeling bite strength reduction, the obvious effect appeared after a month, the effect lasted for six months (favor to bite hard food time will be shortened). Recommended injection once every 6 to 8 months .
   ◆ Effect: masticatory muscle hypertrophy effect is obvious, bite force reduction, can improve the night molar or migraine symptoms, no effect on the mature skeletal shape, (mature bones are not affected by botulinum injection, but after six months of bone surgery recovery period, the injection of botulinum can prevent bone regeneration) must be injected regularly to maintain the effect.
   ◆ Advantages: simple and safe treatment, no recovery period, eliminating the fear of surgery
   ◆ Disadvantages: the effect is often not as expected, the cost is not cheap and must be regular injection, poor economic efficiency
   ◆ Applicable: good skeleton condition, but people with masticatory muscle hypertrophy affect the jaw curve, after the bone sculpture, the prevention of bone regeneration, people with night molars or tension type migraine symptoms.
    
2. Face fat plastic surgery
   Fat has always played a very important role in the face, its quantity, health or not, deeply affect the aesthetic feeling. Fat is also an important structure that protects vital organs from the maintenance of young skin and supports elastic fullness is definitely not the general imagination of the rubbish. So, unless necessary, do not change it in any way.
   
   2-1 Autologous fat transplantation: Many people have cheek depression troubles, because it looks haggard old, most people intuitively think of "make up fat", that the depression can be filled to improve, but sometimes got the disappointed result, because the face becomes larger. This is because there is no proper distinction between "true" and "false" cheek depression before surgery. This idea must be clarified first in order to choose the correct surgical method.

• I-Cut Method  
• L-Cut Large  
• L-Cut Method
• L Cut + Truncate can zoom in and out

正面顴骨位置

側面顴骨位置

數種切割法

Zygomatic arch push principle:
(Figure 1) the widest point of the face shape is in the temporal bone arch back, zygomatic arch push to effectively narrow the face shape.
(Figure 2) zygomatic arch push, the back more than the front end, visual angle changes then can meet the narrow demand.
(Figure 3) zygomatic arch inside only adipose tissue and temporal muscle, adipose tissue can be compressed, therefore, can do the zygomatic arch push.
(Figure 4) zygomatic arch after the push will leave a small part of the prominent, it is the teeth joints, must be retained.

臉形雕塑講究的是視覺重組的概念 ，醫師在每個人不同的基礎條件下，做出最恰當的專業判斷和技術支持，透過調整比例和線條，提升立體度。術前和醫師的溝通很重要，是因為「 工作關係」呢，還是個人單純的「追求美麗」，不同的需求會有不同的作法，如：

• 職業因素，需要上鏡頭的話，可以強調線條感。
• 非職業需求的考量，我們就讓線條符合自然。除此之外，想要偏成熟感呢或是可愛感，也都會有不同的作法。

Ｕ形下巴

菱角下巴

短下巴

長下巴

標準下巴

不對稱下巴

後縮下巴

標準下巴

戽斗下巴

下巴整形在臉形雕塑裡扮演著很重要的位置，下巴的調整可以達到較大幅度的視覺假象，雕塑臉形未必只能靠減法，如:臉太圓，除下顎骨的削骨外，也可以是透過下巴延長手術，去調整臉部比例 。下巴手術是例用手術縫線控制下巴外形，在不影響正常功能的情況下，將肌肉固定在我們希望的活動範圍內，不讓它外擴。手術方法分為以下幾種：

1. 磨骨（改善有限）
2. 人工骨填充
3. 截骨手術（延長、縮短或縮窄）
4. 下巴肌肉縫合

人工骨填充示意1

人工骨填充示意2

人工骨填充示意3

Dr. ZongRu Tsai physician innovation breakthrough
Small angle long axis cutting method
Full titanium staple fixation
Do not use bone graft to fill the gap

General common cutting method
Large angle short axis cutting method

• 上切點：最高點不超過咬合面為原則。
• 定位點：保留寬度決定了定位點；定位點決定了手術結果。
• 下切點：不同定位點，得到不同的切點。
• 保留寬度：建議保留1.5~2.5cm
• 切除寬度：平均介於1.0~2.2cm

• Face swells
  Continue for 2 weeks to 1 month, can prevented or slowed down by positive icing.
   
• wound bleeding, produced hematoma or bruises on the skin
  The purpose of equipped drainage tube and the use of elastic bands is to prevent or slow down these problems. Avoid premature massage of the wound, prevent serious bleeding.
   
• The cheek or the perimeter of the mouth is dull
  A small number of patients will have this condition, because the wound swelling after surgery, facial sensory nerve caused by oppression. Avoid overheating food and prevent accidental burns. Usually takes 2 to 4 weeks of time, wait till the wound swelling elimination then will recover. Very few cases will occur under the "lower orbital nerve" or "lower alveolar nerve" damage, resulting in oral cavity or cheek permanent perceptual paralysis. Experienced physicians can avoid such damage.
   
• Difficulty to open mouth
  Because caused by the masticatory muscle swelling or wound swelling; after swelling elimination will slowly recover, it takes about 2 weeks.
   
• facial nerve injury
  Temporary facial nerve palsy - caused by normal pull during surgery, or wound swelling. Zygomatic surgery may occur the phenomenon of disappearance of the nose pattern; jaw bone surgery may occur on both sides of the asymmetry phenomenon. The probability of occurrence is not high, and after 2 to 3 months will slowly recover.
  
  Permanent facial nerve injury - the probability of occurrence is very low, mostly related to the jaw bone surgery. Many professional design of oral surgery equipment, can avoid such sequelae. However, surgery still need for experienced surgeons to perform, to ensure that surgery is safe and effective.

• The clinic accept scheduled surgery date three months in advance, and is retained until the last week for the final confirm, If the clinic is unable to confirm for the time being, the clinic may transfer the scheduled date to another surgery patient.
• Surgical X-ray and physical examination should be completed one week in advance, the most urgent need three days to complete. (This clinic must accept the medical report of other medical institutions, must be within three months, and meet the requirements of surgical examination items.
• X-ray and physical examination results will be informed by telephone to the surgery patient, meets the surgical safety standards then can confirm the operation; does not meet the standard, it is recommended to give up surgery, or to suspend surgery. Re-test after three months, if still does not meet the standard, it is recommended to give up surgery.
• Try to relax and stay physically before surgery, stop all noninvasive drug intake, including diet pills, anticoagulant drugs or traditional Chinese medicine, and nutritional supplements for unknown ingredients.
• One day before the operation, the clinic will interview by telephone to remind the anesthesia before the note, and do the surgery final confirmation.
• Surgery patient should arrange at least one week after surgery necessities of life,  avoid inconvenient going out after postoperative swelling. (For facial bone surgery to be prepared with liquid food and children's toothbrush)
• Do not drive yourself on the day of anesthesia. Please arrange for family or friends for transfer, or the clinic will arrange for transportation.
• Remember to carry sunglasses, hats, masks or scarves when perform a facial surgery, convenient for cover when return home, to avoid embarrassment.

• P-A View
• Cephalometric View
• Panoramic View

1. Electrocardiogram (EKG)
2. Blood test

• General blood test (CBC routine)
• Prothrombin Time (PT)
• APTT
• Blood type
• Rh factor
• Glucose AC
• Cholesterol
• Liver function (GOT / GPT or AST / ALT)
• Renal function (BUN, Creatinine)
• Hepatitis B (HBsAg)

• See preoperative precautions
• Communicate the expected results with the physician• Preoperative examination of preparation: blood, electrocardiogram and X-ray.
• 8 hours before surgery, fasting, water-deprivation (tea, coffee, etc.)
• Preoperative photography
• take the initiative to inform the physician whether the abnormal physiological condition or disease 

• Do not ride on your own
• 1 to 2 nights stay in the hospital
• Waked up after anesthesia will be given the injection type of pain relieve medication to reduce the pain of the wound; after eating the next day, change to oral pain medication, for 3 to 5 days.
• (After jaw angle surgical removal, the wound bleeding situation is more obvious, need to install the drainage tube, drained out the residual blood in the body to avoid hematoma production, after surgery removal the next day. 

• After surgery the next day can begin eating fresh liquid food and start using prophylactic oral antibiotics for 5 to 7 days.
• Always rinse with boiled water to keep your mouth clean; use a mouthwash after eating to avoid wound infection.
• Continuous ice for at least 3 days, after that you can change to hot compress.
• If the mouth is slightly scratched around the mouth, keep it clean with water and wipe the ointment.
• Can wash face, also can bathe and wash hair, cannot use hot water.
• One month after surgery, the face cannot be forced to massage, to avoid bleeding also reduce the sequelae of loose skin sag. If the bleeding occurs immediately press the wound to stop bleeding and ice, after 15 minutes it should stop by itself, if still cannot stop bleeding continue to press the wound, and immediately seek medical attention.

• Day 1 to 3 days
• Wound bleeding still slowly continues, so the wound will become more swollen, blood stasis will become more and more obvious, most people will feel fear, in fact, this is normal, and therefore the wound need to use elastic bandages, and continue ice, to keep up the posture, to rest completely.
•  
• Day 3 to 4 days
• Bleeding phenomenon is stopped, is the most swollen time, but also the most obvious of the bloody inflammation, inflammation reaction began to increase, the feeling of swelling of the wound becomes obvious, but the pain continue to reduce.
•  
• Day 5 to 6 days
• Swelling peak has passed, began to show signs of swelling, bruising also began to fade yellow, but the color is still obvious.
•  
• Day 7 to 10 days
• There is a close observation of wound inflammation: the normal situation of the wound is no longer pain, persistent eliminate swelling, bruising may have been disappeared, regain clear speak, if the wound suddenly swollen, become more painful, redness, meaning there is inflammation phenomenon, the need for medical diagnosis and treatment, so this is usually the first time back to the clinic after surgery
•  
• Day 10 to 14 days
• Swelling has been eliminated more than 50%, bruising has also been disappear completed, leaving only some yellow ecchymosis on the neck, it is the time able to go out, also can resume to work, but still can see the face swelling; some people will find a goodwill lie to explain to avoid interpersonal embarrassment.
•  
• 2 weeks to 1 month after surgery
• Eliminating swelling slows down, it is because the inflammatory reaction has been transformed into a reorganization stage, the change is very slow, this is the most important time to prevent skin relaxation and help skin tightening, no massage, it is best to continue to use supportive elastic bandages, help skin shaping.
•  
• 1 to 2 months after surgery
• Wound reorganization continues, the lymph circulation has not yet been re-established, so the swelling situation becomes ups and downs, and will change with the amount of water intake and the height of the body posture changes, can use hand lightly press to help eliminating swelling, cannot use rubbing, most of these phenomena can be ignored, will naturally recede, this is the time when the surgical effect gradually show up, so wait with patient.
•  
• 2 to 6 months postoperative
• Postoperative wound reorganization of the physiological period is 3 to 6 months, including skin tightening and bone regeneration, etc., it is recommended to avoid eating hard food at least six months to help bone healing, but also to prevent bone regeneration, in addition to the establishment of lymph circulation also need several months’ time to complete, during this time the wound changes very little, but still the swelling gradually eliminate, feeling like more and more thin, so the final fixed time of face is 6 months.