Are your patients really considering hitting their faces with hammers? Believe it or not, a trend emerged on TikTok in 2023 where individuals did just that, dubbing it "bone smashing."

 

Based on a misinterpretation of Wolff’s Law, this bizarre trend even led to a series of videos with the hashtag #bonesmashing, which racked up over 618 million views on TikTok and counting.

 

Factors influencing jawline shape

 

The jawline's shape is influenced by several factors: mandibular structure, muscle condition, age, submental fat, soft tissue tension, bone alignment, and medical conditions. 

 

As well, conditions such as acromegaly enlarge facial bones, and osteoporosis affects bone metabolism, altering jaw structure. 

So, does "bone smashing" consider any of these factors? Absolutely not—this risky, unscientific method completely disregards the complexity of human anatomy and physiology. What your patients end up with instead are nasty risks like bone fractures, soft tissue injuries, scarring, excessive bleeding, and possibly long-term damage to the facial structure.

 

Doing it right

 

According to researchers publishing in the Journal of Cosmetic Dermatology, jawline rejuvenation depends upon many factors, including “the prominence of the mandibular angle, jawline, chin projection and length, prejowl sulcus, and Marionette line.”

Vazirnia A, Braz A, Fabi SG. Nonsurgical jawline rejuvenation using injectable fillers. J Cosmet Dermatol. 2020;19(8):1940–1947.

 

Practitioners should be mindful of critical neurovascular and anatomical elements in the vicinity, including “the facial artery and vein, the marginal mandibular nerve, the parotid gland and duct, and the masseter muscle,” per the researchers.

 

Nonsurgical methods

 

Dermal fillers

Common fillers utilized for jawline revitalization include hyaluronic acid (HA), calcium hydroxylapatite (CaHA), poly-L-lactic acid (PLLA), and autologous fat. HA and CaHA are particularly valuable because their firmer gel properties offer structural support along the jawline.

 

CaHA (Radiesse) is a biodegradable filler that progressively stimulates collagen production, making them ideal for deep-volume restoration and substantial jawline contouring. It offers longer-lasting effects than HA fillers and can address mild-to-moderate age-related mandibular bone resorption.

Moradi A, Shirazi A, David R. Nonsurgical Chin and Jawline Augmentation Using Calcium Hydroxylapatite and Hyaluronic Acid Fillers. Facial Plast Surg. 2019;35(2):140-148.

 

Neurotoxin injections 

Neurotoxins like Botulinum toxin-A (Botox, Dysport, or Xeomin) can both slim and contour the jawline, with results lasting for a few months. Injecting the platysma muscle enhances jawline definition and tackles neck bands.

In cases of jaw hypertrophy due to enlarged mastication muscles, Botulinum toxin can be employed to relax the affected masseter or temporalis muscles.

Yi KH, Lee HJ, Hur HW, et al. Guidelines for botulinum neurotoxin injection for facial contouring. Plast Reconstr Surg. 2022;150:562e–571e.

 

Surgical threads

Injectables can enhance facial appearance by volumizing and relaxing muscles but may not always reposition soft tissue effectively. Surgical threads, composed of materials like Poly ε-caprolactone or PLLA, provide a reliable alternative, particularly for skin tightening in the jowl area, with results lasting up to a year.

Singh S, Ballani I, Patil CY, et al. Retrospective real-world study of Definisse threads for jaw line reshaping in Indian patients (REDEFINE JAW study). J Cosmet Dermatol. 2023;22(10):2785–2790.

 

Energy-based devices

Ultherapy (ultrasound therapy) and radiofrequency treatments complement other jawline rejuvenation techniques. Both devices use energy to heat the skin's deeper layers, promoting collagen remodeling.

Liposuction and lipolysis

These techniques aim to reduce submental liposis (chin fat) to improve the jawline. Liposuction is a surgical option, while lipolysis, using Kybella (deoxycholic acid), is a non-surgical alternative, especially for chin fat.

Patel S, Kridel R. Current trends in management of submental liposis: a pooled analysis and survey. JAMA Facial Plast Surg. 2018;20(3):202–206.

 

 

Surgical options

 

 

Surgical options are a better choice for patients seeking more permanent results.

Rhytidectomy

A rhytidectomy, or facelift, is a surgical procedure that corrects sagging or loose skin and tissues in the lower face. A traditional facelift extends from the temples to the ears.

Yang AJ, Hohman MH. Rhytidectomy. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; March 1, 2023.

 

Orthognathic surgery 

All of the above-mentioned procedures are purely cosmetic and not covered by insurance. However, depending upon the indication, jaw surgery, also known as orthognathic surgery, might be covered by insurance. It corrects abnormalities and misalignments of the jaw and facial bones.

Beyond jawline rejuvenation, it may be recommended for the following:

• Correcting malocclusion (misalignment of upper and lower jaws), which can cause bite problems such as overbite, underbite, crossbite, or open bite

• Addressing facial asymmetry caused by differences in jawbone size or position

• Rectifying jaw misalignments that lead to functional issues like difficulty eating, speaking, and breathing

• Treating obstructive sleep apnea due to jaw or facial bone abnormalities by opening the airway

Orthodontic braces may accompany orthognathic surgery to align teeth and optimize the bite. Repositioning the maxilla, mandible, or both may be necessary for proper alignment.

Zammit D, Ettinger RE, Sanati-Mehrizy P, et al. Current Trends in Orthognathic Surgery. Medicina (Kaunas). 2023;59(12):2100.

 

Jaw reduction 

Also called mandibular contouring or jaw shaving, this surgery involves removing excess bone or modifying the jaw's angle for a narrower and refined jawline.

Lee HH, Singh M. Jaw Reduction Surgery. Otolaryngol Clin North Am. 2022;55(4):859-870.

 

Segmental mandibular advancement (SMA) 

SMA is effective in treating moderate-to-severe obstructive sleep apnea. It improves facial aesthetics and enlarges the skeletal airway at the base of the tongue, alleviating breathing problems. A pilot study has shown significant improvement in the apnea-hypopnea index (AHI) score postoperatively with SMA, with a substantial decrease in breathing disturbances during sleep.

Leung YY, Wan JCC, Fu HL, et al. Segmental mandibular advancement for moderate-to-severe obstructive sleep apnoea: a pilot study. Int J Oral Maxillofac Surg. 2023;52(9):956–963.

 

To sum it up, jawline reshaping procedures come in various forms, catering to different needs, whether for aesthetics or addressing medical issues. Selecting the right procedure for the right patient is critical.