Facial contouring surgery contributes to creating a smaller, more harmonious impression by improving the overall proportions and lines of the face. However, many people are concerned about skin sagging after bone reduction. Especially when considering mid-face reduction and V-line surgery, an integrated approach that considers not only bone but also soft tissue changes is crucial.
How Can We Address Skin Sagging After Facial Contouring Surgery?
After mid-face reduction, it's necessary to induce skin contraction through various lifting procedures such as Ulthera, Thermage, and Sofwave. I always emphasize to patients that these device procedures are essential for managing post-surgical sagging. However, the chin area is slightly different from the mid-face. Sagging in the chin is primarily related to muscle relaxation, so procedures that directly contract the muscles are effective.
"I've mentioned that after mid-face reduction, it's necessary to induce skin contraction with Ulthera, Thermage, Sofwave, etc., but the chin is different from the mid-face. For the chin, muscle contraction is needed."
For this reason, chin Botox is one of the best methods for muscle contraction. Botox can reduce excessive movement of the chin muscles and induce contraction, creating a smoother jawline.
Chin Botox: How to Enhance its Effectiveness?
Typical pebble chin Botox tends to have a short duration of effect, lasting about a month. However, chin Botox administered after facial contouring surgery to reduce the bone structure has a much greater effect. This is because a synergistic effect can be expected where the entire soft tissue, including muscles and skin, contracts to fit the reduced bone structure.
Key benefits of chin Botox include:
- Alleviates excessive movement of the chin muscles, improving an uneven surface.
- Results in a smoother and more refined jawline.
- Helps soft tissues naturally adhere to the surgically reduced bone structure.
While a single treatment can show results, repeated treatments, typically 3 to 5 sessions, are recommended for sustained effects. Immediately after the procedure, there might be slight discomfort when moving, but this gradually subsides over time.
On Clinic's Unique Mid-Face Reduction and V-Line Surgery Process
The patient we are introducing underwent mid-face reduction surgery in the cheekbone area along with V-line surgery. This patient, in particular, had a somewhat long-looking chin, so the surgery was performed to effectively reduce the chin while preserving a natural angle, rather than eliminating the angle entirely. A CT scan taken one year after surgery shows that the osteotomy lines, previously visible, have completely fused, indicating strong bone union. Viewed from below, the bones are perfectly fused and stable.
The patient expressed satisfaction, saying, "My face has become much smaller, and I look pretty like a celebrity in photos." Even before the surgery, her face was on the smaller side, but now, with the ideal improvement in facial proportions, her overall impression has significantly enhanced.
Non-Surgical Approaches for Jawline Improvement
Sagging skin under the chin after V-line surgery is a common concern. Many consider liposuction or neck muscle tightening to address this. However, at On Clinic, we believe that highly satisfactory results can be achieved through various non-surgical methods such as Ulthera, Tightan, and fat-dissolving injections. This patient, too, achieved both fat reduction and skin contraction effects simultaneously through Ulthera treatment.
The crucial point here is the surgical method. If the jaw is rounded with a long curve instead of an angular shape, or if only the outer cortex is cut (cortical osteotomy, also known as 'shaving only the outer bone'), the bone structure will not be properly supported. In such cases, the jawline will not be defined, no matter how much liposuction or neck muscle tightening is performed. Even a facelift or neck lift might not yield the desired shape.
"We never perform cortical osteotomy by cutting only the outer cortex; it is imperative to cut both the inner and outer cortices simultaneously."
This is because the core bone structure that determines the jawline contour has not been properly formed. Therefore, to achieve a firm and clear jawline, it is essential to precisely osteotomize the bone in a way that preserves the angle during surgery, and then combine it with procedures like Ulthera. This patient is a clear example of this principle: by performing surgery that preserved the angle, all issues were resolved without sagging, even with Ulthera alone.
On Clinic goes beyond simply shaving bone; we consider each individual's facial proportions and characteristics to find the most natural and beautiful lines. We also provide systematic post-operative care to ensure that satisfying results are maintained for a long time.
Dr. Myungjun Oh, On Clinic | Last Reviewed 2026-05-23