Facial contouring surgery: a discussion on the local removal of the mandibular angle; in facial plastic surgery, the local removal or moderate revision of the mandibular angle has accounted for a large proportion of the current surgery, but the osteotomy or grinding of the mandibular angle or the layered removal of the outer bone plate has reached a very high level for experienced experts and professors, even in less than ten minutes to complete the unilateral bone body The procedure can be done in less than 10 minutes. After all, we are living in a shared society, so the rejuvenation of this surgery, the simplicity of the procedure, the safety and security, and the obvious results have become a skillful asset that doctors must have. Based on the surgical procedures performed by many famous professors in China, the following contents are summarized to show the details related to jaw angle surgery. Please bear with me as to the degree of perfection and technical differences in the presentation, and sincerely thank the older generation of experts and professors for their selfless teaching. The jaw angle surgery for plastic surgeons is not a major surgery, so it is not difficult to do, but difficult in a process of skilled and calm and stable, preoperative explanation and persuasion, surgical equipment supporting the right reason, the emergency treatment of intraoperative conditions, etc. Generally speaking, jaw angle surgery is easy to do, the more you do the better you do, the more experience you accumulate. The surgery is carried out in steps: First, we must have an objective evaluation of the surgical target, understand the condition and make relevant records. To determine the surgical plan for the individual situation, we should determine the amount of bone to be removed and how to remove it. What’s more, we should explain the post-operative effect with the customer, so that they have a clear direction and understanding of their requirements. One of the principles is to leave as much as possible and take as little as possible, how to take? Take the jawline? The cheek fat pad? Or the bite muscle? All the entities that are taken out will produce an effect and are also the factors that create beauty and must be considered as necessary. Second, surgical instrument preparation: choose the surgical instruments to be used for the surgical plan and surgical habits. Third, disinfection: the recipient in the laying of towels, receive the conventional application of disinfection after the eye coated with cream patch protection, the nose along, oral cavity and other parts of the full bit coated, pay attention to prevent the gauze ball with excessive liquid overflow. Fourth, determine the mode of anesthesia: if the patient is general anesthesia then work closely with the anesthesiologist, cardiac monitor monitoring in place, always pay attention to the patient’s condition, but in general the use of local anesthesia with intravenous administration of drugs to do surgery will be much more convenient, but pay attention to the oral cavity dirt is swallowed or inhaled into the lungs caused by vomiting or asphyxiation. Five, incision: from the third tooth opening to the eighth tooth, pay attention to the knife when the top of the gums along a millimeter or two of opening, practical attention not to accidentally injure the chin nerve, but also according to the customary self-designed opening, but do not have to emphasize minimally invasive, the smaller the incision is blind to a wide range, the higher the technical requirements, the more difficult to pull hooks, knives and other access, the higher the risk. Sixth, separation: the left hand holds the lower edge of the mandibular angle with four fingers, the right hand separates the periodontal soft tissue along the incision with the periosteal separator, and then separates to the lower edge of the mandible and the ascending branch of the mandible with the occlusal separator in a large area, at this time, the left hand should follow up the protection at any time according to the degree of force and direction of the right hand to prevent bleeding caused by the insertion of the separator through the periosteum. After the outer bone plate is separated, the medial mandibular separator is inserted into the wound and extended to the bottom of the lower mandibular rim, the mandibular body is gently hooked and the front end of the separator is inflected into the medial mandibular rim, the left hand touches the front end of the separator and the right hand pushes forward or pulls back to separate the bone body and soft tissue of the medial mandible. At this time, the action should be consistent, the force is appropriate, and when the separator enters the medial mandible, the direction of force or angle change should be made according to the shape of the bone body, but do not pull indiscriminately to cause accidental injury to soft tissue, there is a risk of bleeding in this, so pay attention to it. Seven, de-bone: the instrument is ready to install, the foot switch is placed in a convenient location, with the grinding way to do, first with the left hand holding the protection of the hook into the incision to separate the soft tissue and bone body and form a cavity, placed in the location to be ground bone but not contact with the bone surface, grasp the head of the handpiece to step on the foot switch, in the rotary file is a high-speed rotation of the state of gentle contact with the bone surface, there is bone debris discharged in the direction of the anti-clock slightly force layer by layer Grind the bone surface, at this time to master the angle of the rotary file head, protective sleeve and the bone surface, the angle is appropriate to achieve a satisfactory cutting effect. Bone grinding sequence: After all the bone body is exposed, it is determined that the bone is cut or ground. It is safer to do the jaw angle under local anesthesia with an intraoral incision, and there is no risk of waste fluid entering the trachea. With the left hand, the soft tissue is separated from the bone body as much as possible with a mandibular light-guided suction pull hook, and the head of a cylindrical ball-headed file is inserted into the incision, and a scar is ground out with the head of the file between the bone body to be removed and the bone body to be preserved according to the amount of bone removal, to basically determine the amount of bone removal and to have a good idea, and then the file head is lowered layer by layer in the counterclockwise direction deep into the angle of the jaw (about the middle position of the bone body to be removed), and the outer bone pole is ground off and the bone loose oozes out When the inner bone plate is ground to very white and very hard almost transparent, you can use a small bone hammer and bone chisel to gently remove the small bone block, and use a “u” shaped file to slightly repair the sharp corner of the outer end of the mandibular angle, and round the end of the outer bone plate. It is worth noting that all the grinding action of the file head must be carried out under visualization, and it is not allowed to estimate the grinding by fluke under blind vision, because the high speed of the file head can produce danger such as winding if you do not pay attention to it, and only your concentration can make the surgery perfect, and all the misguided automation has unrealistic cases, but the surgery cannot allow a slight mistake, after doing one side Gauze block is filled and then the other side is trimmed, and attention is paid to the basic symmetry of both sides. For jaw angle hypertrophy, zygomatic bone is too high, no saw, no drill, no chisel and no clamp bite. The intraoral approach, with a sheath milling bone rotary file or reciprocating plane file to complete the surgical method of bone fragmentation. The most important feature of this method is that it is safe, reliable, efficient and effective, and the patient gets the best results at minimal cost. Each part has a corresponding grinding tool, which can sculpt the perfect contour of the face, so that the square face or trapezoid face can be sculpted into egg-shaped face and melon face. The above purpose can also be accomplished with reciprocating plane files. [Use cylindrical ball head rotary file A and inverted cone rotary file B to sequentially grind away the deformed and outwardly curved (yellow, green, red, blue) mandibular body bone to sculpt a square face or trapezoidal face into an egg-shaped face. Eight, if the method of osteotomy to do, swing saw, reciprocating saw and bending drill will have to play a major role, the incision is completely separated first with a quantitative osteotomy rotary file on the bone plate to cut a deep 3-5 mm deep groove, at this time the outer bone plate is basically worn off, and then swing saw or bending drill along the deep groove in the suture swing sawing or milling. But at this time, we should pay attention to a little tool angle to move while adjusting the arc angle to prevent the wide plane of the circular saw blade misdirection and bending drill shift direction will be the mandibular ascending branch do not sawing position sawing, another special attention is to pay attention to the bottom of the saw blade blind to the safety of the mandibular medial soft group, the basic sawing (inner bone plate can not be completely sawed off) with a bone chisel inserted into the slot with a bone hammer gently separated and removed, because the sawed off Because of the thicker section, the mandibular margin is moderately rounded with a reciprocating saw or other positions that need to be trimmed with a micro file. Nine, remove the soft tissue, remove the buccal fat pad or part of the bite muscle as needed, but take into account the atrophy of the bite muscle if not necessary, do not remove. Ten, what should go are gone, the removal of bone surgery is basically completed, remove the stuffed gauze, gradually suture from inside to outside, almost remaining a few stitches when the appropriate placement of negative pressure drainage strips (syringes) on each side after a completely sutured. Eleven, wrapping, with pre-prepared and cut cotton pads laid on both sides of the jaw, not thick enough to add gauze pads to increase the pressure at the osteotomy. Pay attention to the pressure at the nostril patient should feel comfortable after tying and fixing the good drainage syringe. Twelve, proper care, give anti-inflammatory drugs and infusion of appropriate nutrient solution, medical advice is clear, after the operation shall not use the hand to rub the wound caused by the second separation, three months shall not bite hard objects, etc.