Mandibular angle reduction combined with facelift via the premasseter space

The demand for facial rejuvenation surgery is increasing with the increase in the elderly population. Facelift surgery is widely used to lift the soft tissue, thereby weakening the nasolabial groove and providing volumetric fullness to the face [1]. However, owing to differences in anatomical structures between Asian and Caucasian faces, this method does not always result in satisfying outcomes for all Asian women. Asian faces differ from Caucasian faces with respect to the skull structure and distribution of facial fat. Compared with Caucasians, Asians generally have wider and shorter faces. Facial fat descends with age, and Asian faces become more rectangular and boxy [2,3]. For the aforementioned reasons, some old Asian women have a prominent mandibular angle and a face with a rectangular appearance. In these patients, performing only a soft tissue facelift will cause the face to look more rectangular and the mandibular angle to appear more protruded. In Asian cultures, an overly prominent mandible and rectangular face are undesirable because they suggest a harsh and masculine appearance. Instead, facial beauty is characterized by an oval appearance. Patients with a prominent mandibular angle often complain that their face looks more rectangular after surgery when only a facelift is performed without consideration of this cultural difference. Therefore, in light of the cultural and anatomical differences between Asians and Caucasians, lifting soft tissue alone does not proYoon Joo Lee, Il Seok Lee, Ho Jik Yang