In short. Three months is the first honest checkpoint, not the answer. How to compare photographs properly, and what is still changing after the swelling has gone.
Key points
- Use photographs rather than a mirror, and make them comparable.
- Same distance from the camera, same light, same expression, taken by somebody else, at rest from the front, and then with the lower teeth shown.
- Put the pre-operative set beside the current set rather than relying on memory, because memory adjusts.
Three months after an angle reduction the face is presentable, the bruising has gone, and the shape can be looked at without flinching. It is the first point at which a judgement is worth making and not the point at which the result exists. What is being looked at at three months is a face that is part of the way through a process, and treating it as the outcome is the commonest reason people ask for a second operation they did not need.
What has settled and what has not
Most of the swelling has gone by three months, but not all of it, and it has not gone evenly. The soft tissue that lies over the new bone is still adapting to it, the muscles of chewing are still regaining their bulk and their resting tone, and the small changes that bone remodelling makes to the contour continue. Each affects how wide the jaw reads.
Why the two sides do not match yet
Swelling resolves at different rates on the two sides of the same face, which is why one side can look wider at three months in a face that is not asymmetrical. Comparing the two sides of your own face is not a way to judge it. Comparing this month with last month is.
How to compare properly
Use photographs rather than a mirror, and make them comparable. Same distance from the camera, same light, same expression, taken by somebody else, at rest from the front, and then with the lower teeth shown. Put the pre-operative set beside the current set rather than relying on memory, because memory adjusts.
What is still worth raising at three months
A difference that is new since the operation and stable over several weeks, pain that is worsening rather than settling, a joint that clicks when it did not before, or a wound in the mouth that has not closed. Those are findings. A jaw that looks wider than expected, or unevenly wide, at three months is usually swelling, and the answer is time.
Why an early revision is a mistake
An operation planned from a three month face is planned from swelling. The surgeon would be reducing bone on the basis of an appearance that is still changing, and the amount removed cannot be put back. For this reason revision is normally deferred until the result can be read, which is around a year.
Signs that the result is being judged too early
- The shape is being assessed without photographs from before the operation to compare against.
- The two sides of the face are being compared with each other rather than with an earlier photograph of the same side.
- A further operation considered before the swelling has resolved, or before a year has passed.
Waiting is not passivity. At three months the useful thing to do is to record what the face looks like, because that record is what makes the judgement at a year a comparison rather than a guess.
Frequently asked questions
Is three months too early to judge the result of an angle reduction?
It is early enough to look and too early to conclude. Most of the swelling has gone by then, so the shape can be read for the first time, but the soft tissue is still adapting and the two sides are still resolving at different rates. Three months is a checkpoint to record rather than a result to act on, and revision is normally deferred well beyond it.
How should I take photographs if I want to compare the shape over time?
Make them comparable rather than flattering. Same distance from the camera, same light, same expression, taken by somebody else. One view from the front at rest, one with the lower teeth shown, and one in profile. Keep the pre-operative set beside the current set, because memory adjusts to whatever the face looks like now and a comparison is only useful if it is against a fixed point.
What would justify considering revision before a year?
Very little that concerns the shape. Revision considered early is usually a response to swelling, and operating on a face that is still changing removes bone on the basis of an appearance that will not last. What does justify earlier assessment is a structural problem rather than an aesthetic one: increasing pain, a segment that moves, a wound that does not close, or a joint that locks.
Risks & Limitations
- The change is permanent and the amount removed is treated as fixed. Bone that has been taken away cannot be put back, and material added later does not behave like the mandible it replaces.
- The canal carrying the nerve to the chin runs inside the bone being cut. Numbness of the chin and lower lip is expected rather than rare, usually improves over months, and may not return fully.
- The nerve that moves the lower lip runs near the outer surface of the bone. Weakness after surgery is usually temporary and usually resolves; a lasting weakness is uncommon but possible.
- The vessels supplying the face run close to the surface of the angle. Bleeding afterwards is the complication this operation most wants to avoid, because a collection of blood in the floor of the mouth can compromise the airway.
- The masseter is detached from the bone it was attached to and reattaches. Width can partly return if the muscle thickens again, which is not the bone growing back.
- Swelling hides the result for months. The face reads wider than expected at two weeks, unevenly at three months, and the result is judged honestly at around a year.
When to Seek Care
- Difficulty breathing, a feeling of pressure or swelling in the floor of the mouth, or difficulty swallowing. Seek emergency care at once.
- Swelling that is increasing rather than settling after the first week, or that is much greater on one side. Contact the team.
- Weakness of the lower lip that appears after the first week, or that is worsening rather than improving.
- Numbness that is spreading rather than staying stable, or a wound in the mouth that is opening or discharging.
- Fever, or feeling generally unwell with a swollen and tender jaw. Calf pain or swelling in one leg, or chest pain and shortness of breath, need emergency care at once.
References & Further Reading
- American Society of Plastic Surgeons (ASPS) — procedure and safety guidance
- National Institute for Health and Care Excellence (NICE, UK) — relevant guidance
- Cochrane Library — systematic reviews
- Chinese Medical Association Plastic Surgery Branch — clinical guidance
This page is patient education, not medical advice, and it does not cite individual studies. Discuss your own case with a qualified clinician. To arrange an assessment at Chongqing West District Hospital, see Contact & Consultation.