Face contouring surgery in Turkey

Face contouring surgery encompasses a range of surgical procedures designed to modify the shape and proportions of the face. Unlike non-surgical treatments that primarily address skin texture or superficial volume, surgical contouring targets the underlying bone structure and deeper soft tissues. The goal is to create a more harmonious, balanced, and aesthetically pleasing facial appearance, often tailored to specific gender ideals (feminization or masculinization) or to correct perceived imbalances.

Why Do People Seek Face Contouring?

The motivations behind seeking face contouring surgery are diverse:

1. Aesthetic Enhancement: Many individuals desire to improve specific features they perceive as too prominent, too weak, or out of proportion with the rest of their face. This could include reducing a wide jawline, augmenting flat cheekbones, or reshaping a prominent forehead.
2. Gender Affirmation (Facial Feminization/Masculinization Surgery – FFS/FMS): Transgender individuals often undergo face contouring to align their facial features more closely with their gender identity. FFS, for example, aims to soften angular features, reduce forehead prominence, and create a more delicate facial structure. FMS, conversely, might involve enhancing jawline definition or chin projection.
3. Correction of Asymmetry: Facial asymmetry is common, but significant discrepancies can be corrected through contouring procedures.
4. Post-Trauma or Congenital Deformity Reconstruction: While primarily cosmetic, contouring principles are also applied in reconstructive surgery to restore facial form and function after injuries, birth defects, or tumor removal.
5. Anti-Aging: While not its primary focus, some contouring procedures can contribute to a more youthful appearance by restoring lost volume or tightening sagging skin.

The Importance of a Holistic Approach:

Effective face contouring is not about isolated procedures but about understanding the face as an integrated whole. A skilled surgeon considers how changes to one area will impact the overall facial balance and harmony. This holistic perspective, combined with a deep understanding of facial anatomy and aesthetic principles, is crucial for achieving natural-looking and satisfying results.

Disclaimer: This guide provides comprehensive information for educational purposes. Face contouring surgery is a complex medical procedure with inherent risks. It is imperative to consult with a qualified, board-certified plastic surgeon or oral and maxillofacial surgeon to discuss your individual needs, determine suitability, and understand all aspects of the procedure, including potential risks and benefits.

Understanding Facial Anatomy and Aesthetics

Before delving into specific procedures, it’s essential to grasp the foundational concepts of facial anatomy and the principles that define aesthetic appeal.

Key Facial Regions and Their Impact:

1. Forehead: The upper third of the face. Its shape (rounded vs. flat, prominent vs. recessed) significantly influences perceived gender and overall facial balance. The brow ridge, in particular, is a key gender marker.
2. Temples: The areas on either side of the forehead, adjacent to the eyes. Hollowing in this region can make the face appear gaunt or aged, while fullness contributes to a youthful, harmonious contour.
3. Cheekbones (Malar Bones): These form the prominence of the midface. High, defined cheekbones are often associated with attractiveness and youthfulness, while flat or overly wide cheekbones can alter facial proportions.
4. Jawline (Mandible): The lower border of the face, extending from the ears to the chin. A strong, defined jawline is often considered masculine, while a softer, more tapered jawline is typically feminine.
5. Chin (Mentum): The most anterior projection of the lower jaw. Its projection, width, and height are critical for facial balance, especially in profile.
6. Nose (Nasal Bone and Cartilage): While a distinct feature, the nose’s size, shape, and projection are integral to overall facial harmony and balance with other features.

Concepts of Facial Harmony, Balance, and Proportions:

• Rule of Thirds: A classic aesthetic principle dividing the face horizontally into three equal parts:
  • Hairline to glabella (between the eyebrows)
  • Glabella to subnasale (base of the nose)
  • Subnasale to menton (bottom of the chin)
    Ideal faces often adhere closely to these proportions.
• Rule of Fifths: Divides the face vertically into five equal parts, with the width of one eye ideally fitting into each fifth. This helps assess horizontal balance.
• Golden Ratio (Phi – approximately 1.618): Many aesthetic ideals are linked to the golden ratio, suggesting that certain proportions (e.g., length of nose to length of upper lip, width of nose to width of mouth) found in nature are inherently pleasing.
• Gender Differences in Facial Features:
  • Feminine Features: Softer, more rounded forehead, less prominent brow ridge, higher and more anterior cheekbones, narrower and more tapered jawline, smaller and more pointed chin, smaller nose.
  • Masculine Features: Flatter or more prominent forehead with a strong brow ridge, wider and more lateral cheekbones, wider and more angular jawline, squarer and more projected chin, larger nose.

Role of Bone Structure vs. Soft Tissue:

Face contouring primarily focuses on modifying the underlying bone structure (osteotomies, bone shaving, implants). However, soft tissues (fat, muscle, skin) also play a crucial role. Procedures like buccal fat removal target soft tissue, while fat grafting can add volume. The interplay between bone and soft tissue is vital for achieving natural and lasting results.

Types of Face Contouring Procedures (Categorized by Facial Area)

Face contouring surgery involves a diverse array of techniques, often performed in combination to achieve comprehensive results.

Forehead and Brow Contouring

The forehead and brow region significantly influence perceived gender and age.

1. Forehead Reduction/Setback (Type III Cranioplasty):
   • Indications: Primarily for individuals with a prominent brow ridge, often associated with masculine features, or those seeking facial feminization. It can also address an overly sloped or heavy forehead.
   • Goals: To reduce the projection of the brow bone, creating a softer, more rounded, and typically more feminine forehead contour.
   • Techniques:
     • Type I (Burring): For mild brow bossing, the bone is simply shaved down (burred) with a surgical drill.
     • Type II (Burring with Filling): Burring is combined with filling the area behind the brow ridge with bone cement or fat grafting if there’s a dip.
     • Type III (Osteotomy and Setback): For significant brow bossing, the anterior wall of the frontal sinus bone is surgically removed, reshaped, and then reattached in a more recessed position. This is the most common and effective method for substantial reduction.
   • Incision: Typically made along the hairline or within the hair to hide the scar.
   • Recovery: Swelling and bruising are common. Numbness in the forehead and scalp can last for weeks to months. Pain is usually managed with medication.
   • Risks: Numbness, asymmetry, infection, bone non-union (rare), hairline changes.
2. Forehead Augmentation:
   • Indications: For individuals with a flat, recessed, or overly sloped forehead who desire a fuller, more rounded contour.
   • Goals: To add volume and create a smoother, more convex forehead shape.
   • Techniques:
     • Implants: Custom-designed silicone or PEEK (Polyetheretherketone) implants are precisely shaped to fit the forehead and secured to the bone.
     • Fat Grafting: Autologous fat (taken from the patient’s own body) is injected to add volume. Multiple sessions may be required for desired results.
     • Bone Cement: Medical-grade bone cement can be molded directly onto the forehead bone during surgery.
   • Incision: Similar to forehead reduction, often along the hairline.
   • Recovery: Swelling and bruising are expected. Implants require careful post-operative care to prevent shifting.
   • Risks: Asymmetry, infection, implant displacement, fat graft reabsorption (for fat grafting), contour irregularities.
3. Brow Lift:
   • Indications: To elevate sagging eyebrows, smooth forehead wrinkles, and open up the eye area. Often performed in conjunction with forehead contouring.
   • Goals: To create a more youthful and alert appearance, or to achieve a more feminine brow position (higher arch).
   • Techniques: Various methods exist, including endoscopic brow lift (small incisions within the hairline), coronal brow lift (incision across the top of the head), and direct brow lift (incision above the eyebrow).
   • Recovery: Swelling, bruising, and temporary numbness.
   • Risks: Numbness, asymmetry, hair loss at incision sites, over-correction.
4. Hairline Lowering/Advancement:
   • Indications: For individuals with a high hairline or a long forehead who wish to reduce its vertical height.
   • Goals: To bring the hairline forward, creating a more balanced forehead proportion.
   • Technique: An incision is made just behind the existing hairline. The scalp is then carefully advanced forward, and the excess forehead skin is removed. The scalp is then sutured to the bone or periosteum at the new, lower hairline position.
   • Recovery: Swelling, bruising, and temporary numbness behind the hairline. Scarring at the hairline is a primary concern, though skilled surgeons aim for a natural-looking scar.
   • Risks: Scarring, numbness, hair loss along the incision, poor wound healing.

Midface Contouring (Cheekbones and Temples)

The midface is crucial for facial expression and overall balance.

1. Cheekbone Reduction (Malar Reduction):
   • Indications: For individuals with overly wide, prominent, or high cheekbones that create a broad or masculine midface. Common in Asian facial contouring.
   • Goals: To narrow the midface, create a softer cheek contour, and achieve a more oval or heart-shaped face.
   • Techniques:
     • Osteotomy (Bone Cutting): The most common approach involves making incisions inside the mouth (intraoral) and/or near the sideburns. The zygomatic arch (cheekbone) is cut in specific places (e.g., L-osteotomy, Z-osteotomy) and repositioned inward. The bone fragments are then secured with titanium plates and screws.
     • Burring: For minor reduction, the outer surface of the cheekbone can be shaved down.
   • Recovery: Significant swelling and bruising are typical. A compression garment may be worn. Soft diet for a few weeks. Numbness in the midface is common.
   • Risks: Numbness (infraorbital nerve damage), asymmetry, non-union of bone, infection, implant palpability (if plates/screws are felt), sagging of soft tissues (due to bone reduction).
2. Cheekbone Augmentation (Malar Augmentation):
   • Indications: For individuals with flat, underdeveloped, or recessed cheekbones who desire more projection and definition.
   • Goals: To enhance midface volume, create higher and more defined cheekbones, and improve facial balance.
   • Techniques:
     • Implants: Solid silicone, PEEK, or Medpor implants are custom-selected or custom-designed and inserted through intraoral incisions or small incisions near the temples. They are secured to the bone.
     • Fat Grafting: Autologous fat is harvested from another part of the body and injected into the cheek area. Offers a natural feel but can have unpredictable reabsorption rates.
     • Dermal Fillers (Non-Surgical Mention): Temporary fillers can provide mild augmentation but are not surgical contouring.
   • Recovery: Swelling and bruising are common. Soft diet for a few days.
   • Risks: Asymmetry, infection, implant displacement, palpable implant edges, fat graft reabsorption, nerve damage.
3. Temple Augmentation:
   • Indications: For individuals with hollow or sunken temples, which can make the face appear gaunt or aged.
   • Goals: To restore volume to the temples, creating a smoother and more youthful facial contour.
   • Techniques:
     • Fat Grafting: The most common method, using the patient’s own fat.
     • Dermal Fillers: Temporary solution.
     • Implants: Custom-designed implants can be used for more significant or permanent augmentation.
   • Recovery: Minimal downtime, but swelling and bruising can occur.
   • Risks: Asymmetry, fat reabsorption, infection, contour irregularities.

Lower Face Contouring (Jawline and Chin)

The jawline and chin are critical for defining the lower third of the face and conveying gender characteristics.

1. Jawline Reduction (Mandibular Angle Reduction/V-Line Surgery):
   • Indications: For individuals with a wide, square, or overly prominent jawline, often seeking a more oval or « V-line » facial shape, particularly in Asian contouring and FFS.
   • Goals: To narrow the lower face, soften angular features, and create a more tapered jawline.
   • Techniques:
     • Mandibular Angle Ostectomy/Osteotomy: Incisions are made inside the mouth. The prominent angles of the mandible (jawbone) are surgically cut and removed. The remaining bone may be burred to create a smoother contour.
     • Corticotomy: Shaving the outer cortical layer of the bone.
     • Masseter Muscle Reduction: The masseter muscles (chewing muscles) can contribute to a wide jawline. These can be reduced surgically or, more commonly, with Botox injections (non-surgical).
     • V-Line Surgery: A comprehensive procedure combining mandibular angle reduction with chin reduction/genioplasty to create a sharp, tapered V-shape from the ears to the chin.
   • Recovery: Significant swelling and bruising. A compression garment is often used. A soft or liquid diet is required for several weeks. Numbness in the lower lip and chin is common.
   • Risks: Numbness (mental nerve damage), asymmetry, infection, bone non-union (rare), pain, difficulty chewing, sagging of soft tissues.
2. Jawline Augmentation:
   • Indications: For individuals with a weak, recessed, or undefined jawline who desire more projection and definition. Often sought for facial masculinization or to improve overall facial balance.
   • Goals: To create a stronger, more prominent jawline, enhancing definition between the neck and face.
   • Techniques:
     • Implants: Custom-designed silicone or PEEK implants are inserted through intraoral incisions or small incisions under the chin. They are secured to the jawbone. Implants can augment the angles, the body, or the entire jawline.
     • Fat Grafting: Can provide mild augmentation but is less predictable for significant bone-like structure.
     • Dermal Fillers (Non-Surgical Mention): Temporary fillers can enhance jawline definition.
   • Recovery: Swelling and bruising. Soft diet for a few days.
   • Risks: Asymmetry, infection, implant displacement, nerve damage, palpable implant edges.
3. Chin Reduction (Genioplasty/Mentoplasty):
   • Indications: For individuals with an overly prominent, long, wide, or projecting chin.
   • Goals: To reduce the size or projection of the chin, creating a more balanced and harmonious profile.
   • Techniques:
     • Bone Shaving (Burring): For minor reduction, the outer layer of the chin bone is shaved down.
     • Osteotomy: For significant reduction, an incision is made inside the mouth. A section of the chin bone is surgically removed, and the remaining bone is reshaped and secured.
   • Recovery: Swelling, bruising, and numbness in the lower lip and chin are common. Soft diet for several weeks.
   • Risks: Numbness (mental nerve damage), asymmetry, infection, bone non-union, sagging of soft tissues (if too much bone is removed).
4. Chin Augmentation (Genioplasty/Mentoplasty):
   • Indications: For individuals with a receding, small, or weak chin that lacks projection or definition.
   • Goals: To increase chin projection, width, or height, improving facial balance and profile.
   • Techniques:
     • Advancement Genioplasty (Osseous Genioplasty): An incision is made inside the mouth. The chin bone is surgically cut (osteotomy) and advanced forward, then secured with titanium plates and screws. This method uses the patient’s own bone.
     • Implants: Silicone or PEEK implants are inserted through an incision inside the mouth or under the chin. They are placed directly on the chin bone and secured.
     • Fat Grafting/Fillers (Non-Surgical Mention): Can provide temporary or mild augmentation.
   • Recovery: Swelling, bruising, and temporary numbness. Soft diet for a few weeks.
   • Risks: Numbness (mental nerve damage), asymmetry, infection, implant displacement (for implants), bone non-union (for osteotomy), palpable implant edges.

Nose Contouring (Rhinoplasty)

While often considered a separate procedure, rhinoplasty is frequently performed as part of comprehensive facial contouring due to the nose’s central role in facial harmony.

• Indications: To alter the size, shape, and projection of the nose, correct breathing problems, or address aesthetic concerns like a dorsal hump, wide nostrils, or a bulbous tip.
• Goals: To create a nose that is in proportion with other facial features and complements the overall facial aesthetic.
• Techniques:
  • Open Rhinoplasty: An incision is made across the columella (the strip of skin between the nostrils), allowing the surgeon to lift the skin and directly visualize the underlying bone and cartilage.
  • Closed Rhinoplasty: Incisions are made entirely inside the nostrils, leaving no visible external scars.
  • Both techniques involve reshaping bone and cartilage through removal, grafting (using cartilage from the septum, ear, or rib), or sutures.
• Recovery: Swelling, bruising around the eyes, and a splint/cast for about a week. Final results can take up to a year as swelling subsides.
• Risks: Asymmetry, breathing difficulties, numbness, infection, unsatisfactory aesthetic outcome, need for revision surgery.

The Consultation Process

The journey to successful face contouring begins with a thorough and honest consultation.

1. Finding a Qualified Surgeon:
   • Board Certification: Essential. Look for surgeons certified by the American Board of Plastic Surgery or the American Board of Oral and Maxillofacial Surgery (depending on the specific procedures).
   • Experience and Specialization: Choose a surgeon with extensive experience specifically in facial contouring, particularly the procedures you are interested in. Some surgeons specialize in FFS or complex facial reconstruction.
   • Before-and-After Photos: Review a surgeon’s portfolio to assess their aesthetic style and the quality of their results. Look for cases similar to yours.
   • Patient Testimonials: Read reviews and seek recommendations.
2. Initial Consultation:
   • Discussing Goals and Expectations: Clearly articulate what you wish to achieve. Be realistic about what surgery can deliver.
   • Medical History: Provide a complete medical history, including past surgeries, current medications, allergies, and any medical conditions.
   • Facial Analysis: The surgeon will perform a detailed examination of your facial structure, skin quality, and proportions.
   • Digital Imaging and 3D Modeling: Many surgeons use advanced software to simulate potential outcomes. This helps both you and the surgeon visualize the changes and agree on a plan.
   • Understanding Risks, Benefits, and Alternatives: The surgeon should thoroughly explain the specific risks and benefits of each proposed procedure, as well as non-surgical alternatives where applicable.
   • Cost Implications: Discuss the total cost, including surgeon’s fees, anesthesia, facility fees, and any post-operative care.

Pre-Operative Preparation

Once you decide to proceed, careful preparation is crucial for a smooth surgery and recovery.

1. Medical Evaluation: You will undergo a comprehensive medical evaluation, including blood tests, EKG, and potentially other imaging (e.g., CT scans of the face for bone contouring planning) to ensure you are a suitable candidate for general anesthesia and surgery.
2. Medications to Avoid: You will be advised to stop certain medications, especially blood thinners (aspirin, ibuprofen, certain supplements like Vitamin E, fish oil) for at least two weeks prior to surgery to minimize bleeding risks.
3. Smoking Cessation: Smoking significantly impairs healing and increases complication rates. You must stop smoking several weeks before and after surgery.
4. Alcohol Reduction: Reduce alcohol consumption before surgery.
5. Arranging for Support: Arrange for a trusted friend or family member to drive you home after surgery, assist you during the initial recovery period, and help with daily tasks.
6. Mental and Emotional Preparation: Understand that recovery is a process, and initial swelling and bruising can be significant. Emotional support and realistic expectations are vital.
7. Dietary Considerations: You may be advised to fast for a certain period before surgery. For jaw/chin procedures, stocking up on soft foods and liquids for post-op is wise.

The Surgical Procedure

While specific techniques vary, a general overview of the surgical process includes:

1. Anesthesia: Most extensive face contouring procedures are performed under general anesthesia, meaning you will be completely asleep. For smaller procedures, local anesthesia with sedation may be used.
2. Incision Placement: Surgeons strategically place incisions to minimize visible scarring. Common sites include inside the mouth (intraoral), along the hairline, within the hair, behind the ears, or under the chin.
3. Surgical Techniques:
   • Osteotomies: Precise cuts are made in the bone to remove, reposition, or reshape segments.
   • Burring: A surgical drill is used to shave down bone.
   • Implants: Pre-designed or custom implants are inserted and secured to the bone.
   • Fat Grafting: Fat is harvested (usually via liposuction) and injected into target areas.
4. Duration of Surgery: Depending on the number and complexity of procedures, surgery can last from a few hours to a full day.
5. Closure: Incisions are closed with sutures, which may be dissolvable or require removal. Drains may be placed temporarily to prevent fluid accumulation.

Post-Operative Care and Recovery

Recovery is a critical phase for optimal results and requires patience and adherence to your surgeon’s instructions.

1. Immediate Post-Op:
   • Pain Management: Pain medication will be prescribed.
   • Swelling and Bruising: These are universal and can be significant, especially in the first few days to weeks. Cold compresses help.
   • Drains: If placed, drains will typically be removed within a few days.
   • Compression Garments/Bandages: Often used to reduce swelling and support the healing tissues.
2. Hospital Stay: Some extensive procedures may require an overnight stay in the hospital, while others are outpatient.
3. Diet Modifications: For jaw and chin surgeries, a liquid or soft diet will be necessary for several weeks to avoid stress on the healing bones.
4. Activity Restrictions: Avoid strenuous activities, heavy lifting, and bending over for several weeks. Gentle walking is usually encouraged.
5. Follow-up Appointments: Regular follow-up visits are essential to monitor healing and address any concerns. Sutures, if non-dissolvable, will be removed.
6. Managing Swelling and Numbness:
   • Swelling: Can persist for weeks to months, gradually subsiding. Final results may not be apparent for 6-12 months.
   • Numbness: Temporary numbness in various facial areas is common due to nerve manipulation. It usually resolves as nerves heal, but some degree of permanent numbness is a rare possibility.
7. Scar Care: Follow instructions for scar massage, silicone sheets, or other treatments to optimize scar appearance.
8. Emotional Aspects of Recovery: It’s normal to experience a range of emotions during recovery, including anxiety, frustration, or even « post-operative blues. » Having a strong support system and realistic expectations helps.
9. When to Expect Final Results: While initial improvements are visible relatively quickly, the final, refined results of face contouring surgery typically take 6 months to a year, as all swelling resolves and tissues settle.

Risks and Complications

Like any surgical procedure, face contouring carries potential risks and complications. It’s vital to be fully informed.

1. General Surgical Risks:
   • Anesthesia Risks: Reactions to anesthesia, respiratory problems.
   • Infection: Though rare with proper sterile technique and antibiotics.
   • Bleeding/Hematoma: Accumulation of blood under the skin.
   • Poor Wound Healing: More common in smokers or those with underlying health conditions.
   • Adverse Scarring: Though efforts are made to hide incisions, scars are permanent.
2. Specific Risks for Face Contouring:
   • Numbness/Nerve Damage: Temporary or, rarely, permanent numbness or altered sensation in areas like the forehead, cheeks, lower lip, or chin due to nerve manipulation or damage. Facial nerve injury, leading to weakness or paralysis, is a very rare but serious complication.
   • Asymmetry: Despite careful planning, some degree of asymmetry can occur.
   • Implant-Related Issues:
     • Displacement/Shifting: Implants can move from their intended position.
     • Infection: Can necessitate implant removal.
     • Extrusion: Implant pushing through the skin (very rare).
     • Palpability: Implants or fixation hardware (plates/screws) may be felt under the skin.
   • Non-Union of Bone: In osteotomy procedures, the bone fragments may not heal together properly, requiring further intervention.
   • Unsatisfactory Aesthetic Outcome: The results may not meet the patient’s expectations, or the surgeon’s aesthetic judgment may differ. This can sometimes necessitate revision surgery.
   • Sagging of Soft Tissues: Particularly after significant bone reduction (e.g., cheekbone or jaw reduction), the overlying soft tissues may sag, requiring a facelift or other tightening procedures.
   • Contour Irregularities: Unevenness or visible edges.
   • Hair Loss: Temporary or permanent hair loss at incision sites (e.g., hairline lowering, coronal brow lift).

Non-Surgical Alternatives

While this guide focuses on surgical contouring, it’s worth noting that non-surgical options exist for minor enhancements:

• Dermal Fillers: Can augment cheeks, chin, and jawline, or fill hollow temples. Results are temporary (6-24 months).
• Botox (Botulinum Toxin): Can reduce the size of the masseter muscles for jawline slimming or perform a chemical brow lift. Results are temporary (3-6 months).
• Fat Grafting (Non-Surgical Application): While often surgical, fat can be injected to add volume in a less invasive manner than implants, though it still involves a harvesting procedure.
• Thread Lifts: Can provide a temporary lift and contouring effect, but do not alter bone structure.

These alternatives are generally suitable for subtle changes or for those not ready for surgery. They cannot achieve the dramatic and permanent structural changes offered by surgical contouring.

Face contouring surgery offers a powerful means to sculpt and refine facial features, leading to profound improvements in self-confidence, self-perception, and overall well-being. From the delicate reshaping of the forehead to the dramatic definition of the jawline, these procedures are tailored to each individual’s unique anatomy and aesthetic aspirations.

The journey involves careful consideration, meticulous planning, and a deep understanding of both the art and science of facial aesthetics. By choosing a highly qualified and experienced surgeon, maintaining realistic expectations, and committing to diligent post-operative care, individuals can achieve transformative and lasting results that harmonize their external appearance with their inner self. Remember, the goal is not to erase individuality but to enhance and refine, revealing the most balanced and beautiful version of oneself.