Skip ‘bone smashing’: Jawline reshaping, the right way

By Alpana Mohta, MD, DNB, FEADV, FIADVL, IFAAD | Fact-checked by Barbara Bekiesz
Published April 9, 2024

Key Takeaways

  • Jawline shape is influenced by mandibular structure, muscle condition, age, submental fat, soft tissue tension, bone alignment, and bone resorption. Selecting the right reshaping procedure for the right patient is crucial.

  • Nonsurgical methods for jawline rejuvenation include dermal fillers, neurotoxins, threads, and energy-based devices. Surgical options involve liposuction, rhytidectomy, and various orthognathic surgeries.

  • Don’t let your patients take hammers to their faces—instead, suggest these safer surgical and nonsurgical alternatives for jawline reshaping.

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."

Related: Young patients are smashing bones in their faces with hammers. Here's why and what you can do to stop it

It's as shocking as it sounds—people using hammers, bottles, candle jars, and massagers on their mandible to reshape it.

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. 

Hypertrophy from overusing mastication muscles enlarges the jaw. Aging reduces bone density and collagen, causing sagging and development of jowls. Alveolar bone resorption and tooth loss further decrease facial support. Malalignments like mandibular prognathism or retrognathia change the jaw's appearance. 

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

Far from the primitive idea of blunt trauma, modern cosmetology and plastic surgery present a range of nonsurgical and surgical options for reshaping the jawline. 

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.”[]

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.

HA fillers (Juvederm Voluma XC and Restylane Lyft) are the go-to choice in most cases due to their safety, and reversibility. 

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.[]

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.[]

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.[]

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.[]

Surgical options

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

Alpana Mohta, MD, DNB, IFAAD


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.[]

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.[]

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.[]

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.[]

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. 

What this means for you

Healthcare professionals who stay informed about the options for facial rejuvenation can help ensure safe, effective, and informed care to patients, whether they are seeking these procedures for aesthetic or functional reasons. It is especially important that patients are getting the facts, given the rampant health misinformation on social media. 

Read Next: The top 5 riskiest cosmetic procedures
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