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Surgical versus Nonsurgical Jawline Contouring: Layperson Perceptions and Preferences
Jonlin Chen, BS1, Mya Abousy, BA1, Amanda Chow, BA2, Alisa Girard, MBS1, Hillary Jenny, MD, MPH1, Jong-Woo Choi, MD, PhD3, Robin Yang, MD, DDS1
1Department of Plastic & Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA, 2Division of Plastic Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA, 3University of Ulsan College of Medicine, Seoul, South Korea

Background: Cultural beauty preferences for a slimmer face have increased public interest in lower face and jawline contouring. Traditional approaches to jawline contouring include surgical resection, reduction, and modeling ostectomy of the mandibular angle or masseter muscle. More recently, nonsurgical techniques have gained popularity, including neurotoxin injection to the masseter muscle. The present study aims to assess layperson perceptions of patient attractiveness and personality traits following jawline contouring using either surgical or nonsurgical treatment.
Methods: We administered a Qualtrics (Qualtrics, Provo, Utah) survey through Amazon Mechanical Turk (MTurk; Amazon, Seattle, Washington) from August to September 2020. Our three-part survey consisted of patient images before and after treatment, preference for surgical versus nonsurgical lower face contouring, and demographics questions. Respondents viewed a series of 14 patient images before and after surgical or nonsurgical jawline contouring, or without any facial aesthetic procedure (control). Respondents rated changes in attractiveness and personality trait scores between the before and after image (score: -50 to 50, with 50 representing the greatest post-treatment increase and 0 representing no change). Multivariable regression determined differences in respondent ratings between patient images. Gonial angles and intergonial widths for all patients were measured and compared using Studentís t-tests across treatments.
Results: A total of 415 respondents (mean age 38 years, 50.6% female) successfully completed the survey. Compared to patients who underwent nonsurgical treatment, those who received surgery had significantly greater increases in attractiveness (P<0.001), femininity (P<0.001), friendliness (P<0.001), intelligence (P<0.001), trustworthiness (P<0.001), financial wealthiness (P<0.001), dominance (P<0.01), and self-esteem (P<0.001). Gonial angles were increased and jaw width was decreased following both surgical and nonsurgical intervention, with no statistically significant difference between treatment groups. More than half of respondents would prefer to undergo surgical over nonsurgical treatment (51% vs. 49%). The most commonly cited reason for preferring surgery was permanence of results (74% of respondents who preferred surgery) while leading reasons for nonsurgical treatment were cost savings (76%) and shorter recovery (56%).
Conclusion:: From the layperson perspective, surgical jawline contouring may offer greater improvements in perceptions of attractiveness and favorable personality traits. Based on these findings, we hope to inform future patient-physician discussions regarding the aesthetic outcomes of jawline contouring treatments.


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