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Plastic surgery isn't just about wrinkles and nose jobs anymore. Some patients want surgeons to dig deeper, cutting away at bones underneath their faces to create a more perfect visage.
Both men and women are getting procedures to make square faces with blunt jaw lines more rounded or "feminine".
The surgeries are done in the United States, but researchers say they have really taken off in East Asia, including in China and Korea.
"What this is coming down to, is that beauty is not just skin deep," said Dr Jeffrey Spiegel, chief of facial plastic and reconstructive surgery at the Boston University School of Medicine, who said he does two to four of the procedures each week.
"More and more people who are on the forefront of facial plastic surgery are realising that structural issues are critical," he said. "Changing bone – which is the underlying surface on which the skin is resting –is what allows you to really create good, attractive changes."
A study published showed that square-faced men who got the procedure in Nanjing, China, were generally satisfied with their appearance and didn't have any complications a few months down the line.
Surgeons sawed off part of the jaw bone of 19 men and with titanium plates and screws also narrowed patients' chins. Finally, they surgically removed fat from prominent cheeks to make them smaller.
After the surgery, all of the men had swelling and some had trouble opening their mouths for the next couple of weeks. But there were no serious complications or injuries.
How much does the surgery cost?
The procedure typically takes an hour or two, and costs up to $10,000, about R70 000, surgeons said.
The researchers, led by Dr Xiaoping Chen of the Nanjing Medical Center, said that most people who want the face-rounding procedure done are women.
"However, with the increasingly tolerant attitude toward freedom of sexual orientation and development of the transsexual operation (in Asia), the number of men seeking to modify their faces into an elliptical shape is increasing," they wrote in the Archives of Facial Plastic surgery.
Spiegel said that while the procedure will help transgender people transitioning from male to female to get a more feminine-looking face, "there are some (men) who just say, 'My face is too square,' and they don't like that look."
Dr Ross Clevens, a cosmetic surgeon in Melbourne, Florida, said he doesn't treat many male patients who want a more "feminine" face shape.
"What we more commonly see is men who want a more square, more angular, more masculine jaw line," he said.
That procedure, he said, involves putting silicone implants along the angle of the jaw, and sometimes in the chin as well. It's also pretty safe, he said, and "there should not be any significant risks or complications".
Both Clevens and Spiegel were not involved with the new research. While Clevens said that face-shaping procedures are still relatively uncommon in the US, Spiegel thinks that's changing.
"More and more people are realizing that these changes, that they may have thought are not attainable, actually are," he said, adding that the jaw area is "probably the most significant way that we determine gender and attractiveness" in the face.
The authors of the new study caution that surgeons shouldn't do the procedure if they think men have "poor motives" or a mental illness that makes them always see flaws in how they look.
(Reuters Health, Genevra Pittman, July 2011)
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