Reduction malar plasty

ArticleinAesthetic Plastic Surgery 7(2):121-5 · February 1983with 85 Reads
DOI: 10.1007/BF01571117 · Source: PubMed
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Abstract
Among Caucasians, augmentation malar plasty is occasionally performed, but, most often Orientals complain of the prominent zygoma and want an oval face. The procedure of the reduction malar plasty is not reported here. Instead, this article discusses the authors' method of reduction malar plasty and presents several cases.

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  • Article
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    Because of the various defects of malarplasty, including a large incision, much bleeding, visible scars after the operation, and so on, caused by the conventional coronal incision or the temporal incision with the intraoral incision approach, the malarplasty by simple intraoral approach is an innovative development. Through the intraoral approach and subperiosteal dissection, we can reach the osteotomy point on the zygomatic body directly and arrive at the osteotomy point at the zygomatic arch end along the medial side of the zygoma. A new L osteotomy is applied with the reciprocating saw. In addition, the osteotomy was performed on the zygomatic arch from the inside out with an angle of 20 degrees horizontally. From 1997 to 2010, we were satisfied with the results of 114 cases of malarplasty with the intraoral approach and L osteotomy as the observed objects. There are 103 cases for women and 11 for men. Ages ranged from 16 to 48 years. The mean operation time is approximately 1 hour. We just had a few complications: 3 nonunion at the osteotomy line and needed a second surgery to repair as well as 2 slight cheek drooping during the initial period and required face lifting. The method of intraoral approach and L-shaped osteotomy for zygoma reduction can reduce prominent zygoma while maintaining the natural curves of the zygomatic body and arch. Because of the simple procedures, fewer complications, and excellent results, this method will be considered a relatively desirable way. Therapeutic, III.This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License, where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially. http://creativecommons.org/licenses/by-nc-nd/3.0.
  • Article
    Full-text available
    The reduction malarplasty is becoming prevalent among Asians due to their characteristics of protruding cheekbones. As the cheekbone protrusion is known among the Asians as a feature which gives strong and perhaps a negative impression, people nowadays are relying more on the revisional reduction malarplasty for a symmetrical facial line. At Youtiful Vom Plastic Surgery, eleven cases of malar reduction were performed using the endoscopic zygomatic arch infracture technique (EZ technique) from January to May of 2013. Then, eight patients of the eleven completed a survey based on their level of satisfaction of the surgical process. When performing the surgery, we made a temporal incision and used the endoscopic application to open up the area malar prominence and the previously osteotomy line. We then made a complete osteotomy on the zygomatic arch after making the incomplete osteotomy on the zygomatic body. The surgery was completed after finally infracturing the fragmented segment with a mallet in a greenstick fracture. After the surgical performance, we surveyed the patients regarding their level of satisfaction of the surgery, the anesthesia used during surgery, the recovery period, and the postoperative pain all out of a scale from 1 to 5. Based on our results, the level of satisfaction in terms of the patients' surgical results accounted for 4 out of 5 and a 4.3 out of 5 for the level of satisfaction of patients in terms of the anesthesia used during surgery. Thus, the patients achieved a high level of satisfaction. Like so, the EZ technique is an effective and simple revisional method that can be used to correct the protrusion of the zygomatic arch with also a relatively quick recovery period.
  • Background Reduction malarplasty is one of the most common surgical procedures performed in the Asian population for aesthetic purposes. Although multiple methods have been developed for reduction malarplasty, including a variety of infracture techniques, most of the current procedures have limitations. In the current study we created a new infracture method to circumvent these shortcomings. Material/Methods Between January 2004 and October 2013, we applied this novel infracture technique in 700 patients. The highest area of the zygomatic body was marked pre-operatively and ground intra-operatively through an intraoral incision. An L-shaped incomplete osteotomy of the zygomatic body was performed with a reciprocating saw, and then a complete perpendicular osteotomy (1 cm anterior to the articular tubercle of the zygomatic arch) was made through a pre-auricular incision. Light pressure on the posterior part of the arch produced a greenstick fracture of the anterior osteotomy site, resulting in posterior-inward repositioning of the malar complex. Internal fixation was not required. Results Satisfactory aesthetic results and good post-operative stability were achieved. Three months post-operatively, the bone around the zygomatic arc osteotomy line was remodeled. The bone posterior to the articular tubercle of the zygomatic arch was partially absorbed, leading to a depression of the root of the arc and a natural transition on both sides of the osteotomy line, making the midface more slender. Instead, the anterior bone presented with new bones, making the malar complex more stable. Conclusions This new method has multiple advantages, including simple manipulation, no need for internal fixation, short operative and recovery times, and few complications. X-ray images showing the bony changes demonstrated that the infracture technique is an effective and ideal method for reduction malarplasty.
  • Article
    Background Although reduction malarplasty is a well-accepted procedure for Asians with prominent cheek bones, some patients are not fully satisfied with the outcomes and request further surgery. This is because much attention on the contouring procedure has focused on the position of the zygomatic body and arch. As a result, periorbital appearance including the axis of the lateral canthal angle and the protrusion of the inferolateral orbital rim are often overlooked or ignored. The authors introduce a new surgical technique for maximizing the effect of reduction malarplasty that allows for both the lowering of the lateral canthal angle and reduction of the orbital rim in selected Asian patients. Methods In this retrospective study, the medical records of 41 patients who underwent lowering lateral canthoplasty in conjunction with reduction malarplasty were reviewed. Of those, orbital rim reduction was combined in 21 patients. In addition to the intraoral and preauricular approach for standard reduction malarplasty using an L-shaped osteotomy, lower eyelid and continuous canthotomy incisions were made. And then the protruding inferolateral orbital rim was shaved off, followed by inferolateral repositioning of the lateral canthus. Outcome measurements included a square millimeter of the cheek area surface using a software program (image J: IJ 1.46r) in 17 patients. Results A statistically significant difference can be observed between preoperative and postoperative measurements of the area. Average decreases of measurements were 4761.59 mm² (18.5%) from 23,639 mm² preoperatively to 18,878 mm² postoperatively (P < 0.05, paired t test). The up-slanting lower eyelid margin was lowered, and the protruding zygomatic body with inferolateral part of the orbital rim was reduced by the procedure in all cases. Cosmetic outcomes were encouraging and satisfying to most patients. Four complications occurred: asymmetry in two patients (4.9%) and lid malposition in two patients (4.9%). Conjunctival edema was noted in half of the patients but resolved within 1 month. Conclusions The simultaneous lowering lateral canthoplasty and reduction malarplasty offer Asian patients desiring a slim and soft image a novel surgical option. The procedures proved to be a reliable and consistent technique that provided satisfactory results in carefully selected patients. Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
  • Article
    Background Reduction malarplasty via an intraoral approach for correction of a prominent malar complex is quite popular in the Orient. However, one point of fixation in the anterior zygoma body area, the most widely used method, sometimes is insufficient and likely to result in malunion and cheek drooping. We designed a new assisted fixation technique to strengthen the effect of fixation. Methods Two parallel oblique vertical ostectomies were performed on the zygomatic body with a groove left in the inner osteotomy line. The zygomatic arch root was cut obliquely through a small sideburn incision just in front of articular tubercle, medial to lateral and anterior to posterior. The freed malar complex was medially and superiorly repositioned with the zygomatic body wedged in the groove, followed by fixation with one miniplate or wire. Finally, the periosteum in the zygomatic area was pulled and sutured to the deep temporal fascia. Results Most patients were satisfied with their results. No inferiorly displaced malunion occurred in the zygomatic body. There were no serious complications such as nonunion or permanent facial nerve injury. Minor complications, including palpable step-off, mild asymmetry, hematoma, and mild cheek drooping, occurred in some cases. Conclusion Our assisted fixation method, combined with subperiosteal lifting, can provide ideal effects and sufficient fixation in malar reduction to prevent many complications such as malunion and cheek drooping. Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www. springer. com/ 00266.
  • Article
    Fibrous dysplasia is a chronic developmental disease of the skeleton involving formation of immature bone. Involvement of facial bones can result in deformation of facial contour. Prominent cheek area is often treated with malarplasty, which has a variety of modifications, depending on the surgeon's preference. The authors report on a case of polyostotic fibrous dysplasia in which the patient's right cheek had a prominent appearance. The prominence was corrected with malarplasty without internal fixation. The soft nature of bone involved in fibrous dysplasia could provide greater flexibility for modification of the traditional surgery.
  • Article
    Purpose To develop a novel technique for narrowing the wide midface in Asians using virtual surgical planning (VSP) and two bent plate fixation. Materials and Methods A total of 19 patients with wide midface underwent midface narrowing by VSP and two bent plate fixation between 2009 and 2013. In each case, a three-dimensional spiral CT scan of the skull was obtained before surgery. The CT data were imported into the SurgiCase software and VSP was performed. VSP was used to direct the amount of adduction and advancement during midface narrowing surgery. During the actual surgery, we combined zygomatic arch osteotomy and I-shaped osteotomy of the zygomatic body, and moved the zygomatic complex upward and inward following these preoperative data. We then reset the free zygomatic complex to a target position and fixed it with two bent plates. The correction effectiveness was then evaluated through 3D-CT as well as pre-and post-surgical standard facial photographs. Results Most patients were satisfied with the results and suffered no severe complications. No cases of nonunion or permanent facial nerve injury were reported. Conclusion VSP can provide precise data to guide modified reduction of a zygomatic arch protrusion. The bent plate fixation method can provide sufficient support and ideal mid-facial contours. Our technique is recommended for narrowing wide midface which caused by lateral prominent zygomatic arch.
  • Article
    Protrusion of the zygoma is commonly considered undesirable and unattractive among East-Asians, and many try to achieve a harmonious oval midface by having various cosmetic operations. However, effective contouring for a severe protruding zygoma has rarely been reported .The objectives of this study therefore were to investigate the feasibility and effectiveness of a horizontal V-shaped ostectomy for correction of protrusion of the zygoma and zygomatic arch, and to discuss its indications. From January 2008 to December 2011 we treated 27 patients by contouring of the zygoma with a horizontal V-shaped ostectomy through intraoral and preauricular incisions. The effectiveness was then evaluated with cephalometric radiographs, 3-dimensional computed tomography, and standard facial photographs taken before and after operation. The postoperative appearance of all 27 patients showed that the protrusion had been effectively reduced with no serious complications, and the facial contour had improved. The final aesthetic outcomes were satisfactory for both surgeons and patients. The horizontal V-shaped osteotomy is a good technique for the reduction of protrusion of the zygoma and zygomatic arch, and it has the advantages of more convenient multishifting, better results, and fewer complications. It also ensures the integrity of the structure of the malar complex.
  • Article
    Since the zygoma is located in the middle third of the face, its prominence, contour, and width have a large impact on facial impression. Unlike Caucasians who mainly complain of hypoplastic zygomas, Asians commonly present with prominent zygomas. The purposes of this retrospective study are to evaluate the indications of reduction malarplasty and to analyze the complications of patients who underwent reduction malarplasty. According to esthetic facial-unit concept,1 a patient with hyperplastic anterior mid-face can receive a reduction body malarplasty (RBM). If a patient complains of a hyperplastic anterior and posterior mid-face, a clinician can perform reduction body and arch malarplasty (RBAM). The subjects consist of twenty-three adult patients (5 males and 18 females; mean age, 22 year; 11 RBM; 12 RBAM; mean follow-up period, 30 months). Early and late post-operative complications and patients’ satisfaction with appearances are investigated retrospectively. Complications after RBM include transient skin numbness around the zygoma (N=1), non-fractured zygomatic arch (N=1), and non-unionized zygomatic body (N=1). After RBAM, patients complained of transient skin numbness around the zygoma (N=3) and transient injury to facial nerve (N=2). The skin numbness and facial nerve weakness resolved in a few months. For the non-fractured zygomatic arch and non-unionized zygomatic body, refixations with miniplates and screws were performed. All of the patients were satisfied with the surgical results. If an appropriate type of reduction malarplasty is chosen according to the esthetic facial-unit concept, reduction malarplasty can effectively improve facial aesthetics without serious post-operative complications.
  • Article
    The purpose of this study was to evaluate the effect of adventitial stripping methods on patency and thrombus formation at microvascular anastomoses in the femoral artery of rabbits. The experimental ani- mals were divided into 3 groups according to stripping methods: In Control group, arterial adventitia was not stripped at microvascular anastomoses (n=4); in Sharp stripping group, adventitia stripped by sharp stripping method using microscissors and Jeweler' s forceps (n=4); and in Blunt stripping group, adventi- tia stripped by blunt stripping using two Jeweler' s forceps (n=4). The patency was evaluated by empty-and-refill test immediately, 30 minutes and 3 days after microvas- cular anastomoses. Thrombus formation was evaluated by the microscopic examination 3 days after microvascular anastomoses and the histological examination was done around the anastomosed site. Thirty minutes after microanastomoses, the patency of both Sharp and Blunt stripping groups was better than that of Control group, but there was no statistically significant difference in patency among 3 groups. Three days after microanastomoses, the patency of both Sharp and Blunt stripping group was better than that of Control group (P
  • Article
    The shape of the zygomatic body and arch have great influences to the facial contour of Orientals. The prominent zygoma makes the appearance look more fierce. Nowadays in China, the number of patients who underwent reduction malarplasty is increasing rapidly. Therefore, it is important to develop a reliable surgical procedure with small wound and good effects. Included in this report were 46 patients with prominent zygomatic body and arch treated between October 2007 and November 2010. Combined intraoral and extraoral approaches were used, and 2 oblique osteotomies were performed to anterior and posterior part of malar complex, respectively. The isolated zygoma segment was then internalized utilizing z-plasty for the posterior end and inward sliding and internal fixation for the anterior end. The extraoral approach was made through a small temple incision. All patients were subjectively satisfied with the postoperative appearance. Their face contours were effectively improved by the modified procedure. One patient had short-term numbness of the medial zygomatic region skin; no other complications were observed during the follow-up period. This surgical procedure was carried out using combined intraoral and extraoral approaches. No visible scars left on the face. After 2 oblique osteotomies were made, the anterior inward sliding and posterior z-plasty could be easily performed to the isolated zygomatic bone. No segmental bone removal was required. The natural curve of the face contour was maintained while the malar complex was reshaped. We concluded that it is an effective and safe reduction malarplasty technique for Orientals.
  • Article
    One limitation of orthognathic surgery is the narrow surgical field, which makes it difficult to view the operative site directly. Thus, many perioperative complications can occur. In this study, we evaluated the usefulness of computer-aided navigation techniques in orthognathic surgery. We enrolled 10 patients (3 men and 7 women) with facial deformities who were treated between July 2010 and February 2011. A Le Fort I osteotomy, sagittal split ramus osteotomy, and reduction malarplasty were performed with guided navigation. All 10 patients were treated successfully using the computer-assisted navigation surgery. Using the navigation system, instruments were visualized on a monitor in real time and all maneuvers were performed safely. Orthognathic surgery, such as a Le Fort 1 osteotomy, sagittal split ramus osteotomy, and reduction malarplasty, can be performed safely under the guidance of a surgical navigation system. Navigation systems enable surgeons to carry out preoperative plans accurately without injuring important anatomic structures because the positions of the instruments can be visualized on site in real time.
  • Article
    Aesthetic units of the face can be divided into facial content (FC; eyes, nose, lips, and mouth), anterior facial frame (AFF; a contour line from the trichion, the temporal line of the frontal bone, the lateral orbital rim, the most lateral line of the anterior part of the zygomatic body, the anterior border of the masseter muscle, to the inferior border of the chin), and posterior facial frame (PFF; a contour line from the hairline, the zygomatic arch, to the ramus and gonial angle area of the mandible). The size and shape of each FC and the balance and proportion between FCs create a unique appearance for each person. The facial form can be determined through the combination of AFF and PFF. In the Asian population, clinicians frequently encounter problems of FC (eg, acute nasolabial angle, protrusive and everted lips, nonconsonant lip line, or lip canting), AFF (eg, midface hypoplasia, protrusive and asymmetric chin, vertical deficiency/excess of the anterior maxilla and symphysis, or prominent zygoma), and PFF (eg, square mandibular angle). These problems can be efficiently and effectively corrected through the combination of hard tissue surgery such as anterior segmental osteotomy, genioplasty, mandibular angle reduction, malarplasty, and orthognathic surgery. Therefore, the purposes of this article were to introduce the concepts of FC, AFF, and PFF, and to explain the effects of facial hard tissue surgery on facial aesthetics.
  • Article
    Full-text available
    The 2 most common complications of reduction malarplasty are nonunion or malunion and cheek drooping. Because masseter muscle is attached from zygomatic process of the maxilla to inferior two thirds of the zygomatic arch, rigid fixation and intimate bone contact without creating a gap are crucial for reduction malarplasty. Mesial-clockwise rotation of the zygomaticomaxillary complex can produce intimate bone contact and facilitates reduction malarplasty.
  • Article
    Many Asians have faces with prominent zygomas, and therefore reduction malarplasty is one of the most frequently undergone surgeries in Asia, including South Korea. It is performed using various surgical approaches (external, intraoral, bicoronal or their combination). The reduction technique that is the most effective, safest and with the lowest morbidity needs to be determined. From December 2005 to January 2010, 1652 patients who wanted to undergo zygoma reduction for purely aesthetic reasons were operated on using a novel technique that we have developed (the 3S technique), which is a simple and safe surgical technique that results in only a short scar. First, under local anaesthesia, a 13- to 15-mm-long skin incision is made at each sideburn. The subperiosteal dissection is continued anteriorly all the way to the body of the zygoma. Zygoma reduction is then performed in three steps: (1) malar shaving (lateral area of the zygoma body), (2) lateral corticotomy (zygomatic arch) and (3) full-thickness osteotomy (pretubercular area of the temporomandibular joint). Next, the zygomatic arch is displaced medially with digital pressure (infracture). Finally, a Silastic drain is inserted through the incision site, skin repair is completed and a gentle compressive dressing is applied. Most of the patients were satisfied with the results of the operation. This technique provides the following advantages: (1) it is simple and safe because it is performed under only local anaesthesia; (2) only one scar is created at the sideburn; (3) no foreign bodies, such as wires or miniplates, are used; and (4) it is minimally invasive, and as such there are fewer potential complications (e.g., no cheek drooping due to a wide muscle incision or dissection, less oedema and bleeding and a short hospitalisation time). The presented technique is simpler and more effective than previously described surgical techniques for reduction malarplasty.
  • Secondary deformities that result from midface fractures are seen even after proper care is delivered by the best physicians. Malpositioned or missing skeletal fragments provide a faulty foundation and disrupt the harmony of the overlying soft tissues. Weak bony support will lead to its collapse and cicatrical loss of soft-tissue volume, thereby compounding the challenge. Successful management hinges on the surgeon's ability to distill the disfigurement to its individual components. Symmetry is key to proper reconstruction in general and particularly, in the face. In addition, proper facial projection and height must be reestablished. Systematic evaluation of the midface, including position of the globes, orbits, zygomatic (facial) width, and occlusion, is paramount. Our basic approach to the evaluation of these deformities and particularly useful techniques for their correction are presented, along with a representative case
  • Article
    To achieve optimal outcomes in reduction malarplasty, it is important to preserve the natural curvature of the cheek while reducing the zygoma prominence and the width of the midface. The present article introduces an effective technique that aims to achieve these purposes. Through an intraoral approach, boomerang-shaped bone incision lines are marked on the anterior aspect of the zygomatico-maxillary junction. The lines are placed medial to the most prominent part of the zygoma. The zygomatic arch is divided at its posterior part through a small incision made in the pre-auricular region. By performing these manoeuvres, a unit of bone-composed of a part of the zygoma body and zygomatic arch - is mobilised. The mobilised bone is shifted medially, reducing the width of the midface and making the zygoma region less prominent. After performing reduction malarplasty for 89 patients (10 males and 79 females) using this technique, clinical outcomes were evaluated. Outcomes of the treatment was optimal, with over 80% of the patients evaluating the results as excellent in terms of effectiveness in malar prominence, facial width and symmetry. Because the continuity of the main part of the zygoma body and zygomatic arch is preserved in our technique, medial transfer of the zygoma is enabled while preserving the natural curvature of the malar region and the superior-inferior position of the zygomatic arch. Because of these advantages, we recommend our technique as an effective technique of reduction malarplasty.
  • Article
    To achieve optimal outcomes in reduction malarplasty, the area of zygoma from which volume should be reduced must be accurately identified. This anatomical study aims to evaluate the location of the zygoma region that contributes most to the protrusion of the cheek. The morphology of the zygoma was studied on 121 Japanese adults (73 men and 48 women). The midpoint of the inferior orbital rim, zygomaticomaxillary junction, the junction between the frontal process and the zygomatic arch, and the lateral orbital rim were marked to be used as anatomical reference points. Then, a vertical plane intersecting the anterior and posterior edges of the zygoma was marked. The point of the zygoma most distant from the plane was defined as the summit of the zygoma. Three-dimensional measurement using graphic software was performed, and the positional relationships between the summit and the four reference points were evaluated. In terms of horizontal position, the summit is located lateral to the lateral orbital rim and medial to the junction between the frontal process and the zygomatic arch. Regarding vertical position, the summit exists at higher positions in men than in women. The summit of the zygoma is located medial to the junction of the frontal process and zygomatic arch. Therefore, bone incision lines should be placed medial to the posterior edge of the frontal process in reduction malarplasty; effective correction of the protrusion cannot be achieved solely by detachment of the zygomatic arch. The summit is located higher for men than for women. Therefore, bone incision lines should be placed higher for men than for women.
  • Article
    The zygomatic body and arch are usually prominent in Asians; therefore, malar reduction is one of the most popular procedures for aesthetic facial contouring. The purpose of this study was to establish a new option for reduction malarplasty and analyze the merits and demerits of conventional operative techniques, thus searched for more effective and reliable surgical procedures. Records of 570 patients who underwent reduction malarplasty in our center from 1988 to 2008 were reviewed in this study. Several introduced malar reduction techniques were used until an alternative wedge-section osteotomy technique was performed by the senior author (X.M.) in 2002. This new technique consisted wedge-section osteotomy of the lower zygomatic body via intraoral approach and greenstick infracture of the posterior zygomatic arch through a tiny sideburn stab incision. In this way, the prominent malar complex could be reduced by being pressed inward and stabilized by only surgical suture in moderation. The surgical indications, major complications, and patient satisfaction of different techniques were compared. In our experience, intraoral incision was better than coronal incision because of less iatrogenic scar formation and postoperative complications. Our wedge-section osteotomy was more effective and reliable as compared with other conventional methods. Recently, intraoral and minor preauricular incision for malar reduction was more likely acceptable by surgeon as a typical procedure. Our new method was proven to be a safe, effective, and easily handled technique for malar complex reduction and thus was an optimal strategy for aesthetic facial shaping in Asians.
  • Article
    Reduction malarplasty with L-shaped osteotomy has been widely applied to correct malar prominence because of its simple manipulation, satisfactory outcome, and few complications in east Asians. Secondary surgery for the removal of titanium miniplates or microplates and screws is often needed because of the drawbacks of implants. To overcome the disadvantage, the authors applied absorbable plates and screws instead of titanium fixation system and evaluated the feasibility of them. A total of 47 women (mean age, 26.8 y) diagnosed with malar prominence were randomly selected and received L-shaped osteotomy for malar reduction from January 2008 to December 2009. Of these, 22 patients (group A) received absorbable plates and screws (Fixsorb-MX, Takiron, Japan) for fixation and 25 patients received titanium fixation system as control (group B). The outcomes were evaluated by photographs and x-ray films. The distance of the anterior protrusive point of the bilateral zygoma (Zv-Zv), the distance from the paries anterior of acoustic duct (P) to the anterior protrusive point of zygoma (P-Zv), and the angle formed by the nasion-Zv line and the P-Zv line (∠NZP) were analyzed through posteroanterior and lateral cephalograms preoperatively, 10 days postoperatively, and at 6 to 12 months of follow-up, respectively. In group A, 20 patients (90.9%) were satisfied with the outcomes compared with 92.0% in group B. No zygomatic nonunion and other complications occurred after surgery in both groups. In group A, the values of Zv-Zv and P-Zv were 88.4±1.6 and 68.6±6.8 mm at 10 days after surgery, which increased to 90.6±1.5 and 70.7±3.0 mm at 6 to 12 months of follow-up. The value of ∠NZP was 105.0±4.3 degrees at 10 days after surgery and 103.2±3.6 degrees at 6 to 12 months after surgery. In group B, the values of distance and degree maintained almost the same at different time points after surgery. The results had no significant difference between groups A and B (P>0.05). The findings of the study suggested that the application of absorbable plate system in reduction malarplasty with L-shaped osteotomy is feasible. The absorbable fixation system would have a wider application in craniofacial surgery.
  • Prominent zygoma is commonly seen in the East Asian population with the clinical characteristics of anteriorly and/or laterally projected zygoma and zygomatic arch resulting in an increased midfacial width. The esthetic surgical modification of zygoma is one of the major aspects of facial-contouring surgery in certain parts of the world. This article aims to evaluate the effectiveness of various surgical methods for reducing the prominent zygoma so as to obtain a harmonious and natural facial contour. Surgical approaches, such as zygomatic complex shaving, I-shaped osteotomy, L-shaped osteotomy, and C-shaped osteotomy were used according to the clinical characteristics of zygoma and zygomatic arch protrusion. The corrective effectiveness was then evaluated through cephalometric radiographs, 3D-CT, and pre- and postsurgical standard facial photographs. The zygoma and zygomatic arch protrusion was effectively corrected resulting in improved facial contours in all cases postoperatively. The postoperative period was uneventful except for the slight limitation in mouth opening, which recovered fully after mouth-opening exercises. Serious complications, such as facial nerve injury, were not witnessed in our study. Malar reduction is an effective and a safe method for the treatment of prominent zygoma. The selection of surgical procedure should be based on different presenting characteristics of zygoma and zygomatic arch protrusion. The correction of prominent zygoma should be designed well, performed precisely, and observed carefully to avoid severe complications so as to achieve a harmonious facial contour.
  • Article
    The slender, oval-shaped face is considered to be attractive in East Asia. To obtain the ideal contour of the midface, reduction malarplasty has been popularized in oriental countries in recent years. This report describes a surgical technique for reduction of the zygomatic body and arch. After labiobuccal vestibular incisions are made, the anterior zygomatic body and lateral orbital rim are exposed by subperiosteal dissection. Thereafter, an L-shaped osteotomy is performed. Two parallel horizontal osteotomies are made in the anterior part of the zygomatic body, and the middle bone segment is removed. The zygomatic arch root is fractured through a small sideburn incision just anterior to the articular tubercle. Finally, the freed zygomatic complex is medially repositioned and fixed with one or two bicortex screws. Operations on 32 patients demonstrated that this technique may be a sound method for malar complex reduction, with the advantages of simple manipulation, stable fixation, and less risk of a drooping face.
  • Article
    Background: The midfacial width is dominated by the lateral protruding degree of the zygomatic arch. The best way of narrowing the midface is to reduce the arch height and the arc length for patients with an overly curved lateral protruding zygomatic arch. The existing techniques for reduction malarplasty cannot change the degree of curvature of the zygomatic arch. We provide a new technique for efficient midfacial width reduction by multiple osteotomies at different sites on the zygomatic complex and bone resection at the most protruding middle part of the zygomatic arch. The amount of bone resection can be calculated with a simplified geometrical solution according to the desired reduction rate of the arch height. Methods: A digitalized CT image was used to estimate the arch height and the length of bone for removal from the zygomatic arch. A specific piece of bone was removed from the most protruding point of each zygomatic arch. Greenstick fractures were made at the anterior and posterior roots of the zygomatic arch. The open arches were rotated inwardly until both ends met. Result: The arch heights of 1,020 sides of the zygomatic arch were reduced in a range from 3 to 11 mm. All the reduced zygomatic arches were reunited properly and healed solidly. The overall satisfaction rate was high. Conclusion: This technique reduces the width of the midface by changing the degree of curvature of the zygomatic arch. The simplified geometrical calculation solutions are helpful in assuring the reunion of the zygomatic arch at a pre-designed lower arc height level after a calculated shortening of the arc length. Level of evidence iv: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
  • Article
    Operative procedures for reduction malar bone plasty were considered in our consecutive series of 28 Japanese cases. The patients consisted of 7 males and 21 females whose ages ranged from 21 to 57 years. The operative procedures used were either shaving the protruded zygomatic body and arch with chisels by means of an intraoral approach and/or an extraoral sideburn-lateral canthal approach or, alternatively, mobilizing the protruded zygoma en bloc medioposteriorly into reduction of the prominent zygoma by a coronal approach. In principle, the noncoronal approach was indicated for males and young females, and the coronal approach, conducted in association with forehead lifting with or without canthopexy, was indicated for females over age 40. These procedures have individual merits and demerits. In some cases, associated surgery was performed concomitantly according to the facial balance or facial rejuvenization. We believe that the optimal operative approach and operative procedure should be considered in accordance with the patient's sex, age, wishes, and/or cultural background. (C)1995American Society of Plastic Surgeons
  • Article
    Full-text available
    Reduction malarplasty (RMP) to reshape the facial contour is one of the most popular aesthetic surgical procedures in Asia. Here we report a case of intracerebral hematoma (ICH) after RMP. A 31-year-old woman was referred to our hospital following RMP. On arrival at our emergency room, she presented with deep drowsy mentality and right hemiparesis. Computed tomographic scan demonstrated an ICH. We conducted stereotactic aspiration of the blood clots. Because of increased ICH after the operation, the patient underwent craniotomy and hematoma evacuation. After removal of hematoma, intraoperatively a defect of the middle cranial fossa dura, a skull base bony defect, and a bony fragment were noticed. We think that these lesions have been caused by aggressive manipulation of surgical instruments. To our knowledge, ICH after RMP was not reported. The radiologic features of this case and suggested mechanism of the complication are described.
  • Article
    Background: Reduction malarplasty to correct prominent malar complex is popular in Asians. Despite the popularity of reduction malarplasty, most of the surgical methods applied are not selected according to the degree of zygoma protrusion. In this study, we analyzed the effectiveness of two different surgical procedures to clarify their appropriateness for each zygoma type. Methods: One of the procedures used was the "bidirectional wedge ostectomy," in which a bidirectional wedge-shaped bone fragment was removed from the zygomatic body via oral incision and oblique complete osteotomy of the zygomatic arch via sideburn incision. Another was the "quick osteotomy," a greenstick osteotomy of the zygomatic body and complete osteotomy of the zygomatic arch via two skin incisions. We classified zygoma protrusion into two categories: only zygomatic arch protrusion (group 1) and zygomatic body and arch protrusion (group 2). Results: The cross-sectional area of the most prominent malar region decreased by 9.4 ± 2.5 mm laterally (zygion-to-zygion) and by 2.9 ± 0.8 mm obliquely (average of center-to-right and left maxillozygion) after the ostectomy. However, in patients who underwent the osteotomy, while the cross-sectional area decreased by 10.9 ± 2.7 mm laterally, it did not decrease obliquely. Thirty patients (73.2%) in group 1 underwent the osteotomy, and the remaining eleven (26.8%) underwent the ostectomy. In group 2, 83% (n = 39) underwent the ostectomy. Conclusion: We were able to find the more appropriate procedure for each zygoma protrusion type through outcome analysis. With these results, we suggest that if each procedure is performed according to this classification, more favorable esthetic results of zygoma reduction can be achieved.
  • Chapter
    There are some patients seeking additional improvement after reduction malarplasty. Major reasons are as follows: One is suboptimal reduction of zygomatic body, and another is prominence being located at or close to the orbital rim that cannot be improved by conventional reduction malarplasty.
  • Chapter
    Flat and wide midface makes requests for malar reduction quite common in the East Asian population.
  • Chapter
    Prominent high cheekbones are regarded as attractive and youthful by Western standards of beauty. However, they considered as less attractive by Asians as it gives a strong and aggressive impression. To attain a more slender and smooth midfacial contour, reduction malarplasty is commonly performed among Asians.
  • Chapter
    The purpose of reduction malarplasty is to reduce the width of the cheekbone. However, surgeons should consider changing the boxy and flat facial contour into a three-dimensional shape and achieving a smooth, feminine facial line as a major purpose of reduction malarplasty.
  • Chapter
    In the fields of facial bone contouring surgery, there is an increase in demand on improving mild or borderline problems in a minimally invasive manner.
  • Article
    Background Reduction malarplasty is one of the most common aesthetic surgeries performed in the Asian population. Traditional procedures have several complications such as bone non-union, malunion, cheek drooping, and damage to the infraorbital nerve and maxillary sinus. Therefore, a more straightforward and effective method of reducing the width of the midface is needed. In the present study, we introduce an infracture technique using the inward displacement of the zygomatic arch without fixation. Methods A total of 680 patients received zygoma reduction using this method from 2012 to 2016 in Department of Plastic Surgery, Minhang Shanghai Hospital. Radiologic and photographic documentation were completed preoperatively. The mean follow-up period was 24 months. The preoperative and postoperative photographs were compared. Results All patients were satisfied with their results. The mean operation time was approximately 30 minutes. The patients were discharged 5 days after the surgery and the mean recovery time was 2 weeks. The continuity of the outer cortex of the zygomatic complex and excellent bone union was observed in all patients 6 months postoperatively. Twenty-three malar prominence relapses occurred and were reset once again. Conclusion The new method that we developed has been proven to be safe and effective. It has three advantages. First, cheek drooping is avoided, and the damage caused by periosteum dissection on the whole zygomaticomaxillary area is limited. Second, bony fixation is unnecessary; thus, the risks of bone non-union, malunion, and step-off deformity caused by improperly fixation or looseness are prevented. Third, the operation time and the recovery time are short.
  • Article
    Background: Various surgical methods have been developed and used to reduce prominent malar bones. The most common reduction malarplasty methods are resection of the bone strip of the malar bone with L-osteotomy or I-osteotomy, followed by setback and fixation. However, these methods could be associated with complications due to the bone strip resection. The present article introduces an effective and safe method that reduces the zygoma without resection of a malar bone strip. Methods: Through preauricular and intraoral incisions, we performed the current L-osteotomy without resection of the malar bone strip using a reciprocating saw. We created back space for zygoma setback by removing the posterior wall of the maxillary sinus, which acted as a bony interference. We were able to set the lateral segment of the zygoma back about 3-5 mm. We fixed the zygomatic arch with wire and the zygomatic body with a prebent plate and screw. Thereafter, we performed rasping of the anterior part of the zygoma to achieve sufficient reduction. After performing our reduction malarplasty for 139 patients, clinical outcomes were evaluated. Results: Most patients responded to the satisfaction survey as excellent and good. There were no major complications 6 months postoperatively. Conclusions: The key of our method of reduction malarplasty is to create posterior space without resecting the malar body strip, which results in an effective setback. This method enables surgeons to effectively maintain the zygoma body, which leads to high satisfaction rates and fewer complications. Therefore, this study proved the safety and effectiveness of our method of reduction malarplasty. Level of evidence iv: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
  • Article
    Background Many patients undergo a revision surgery after malar reduction, which is one of the most popular aesthetic surgeries in Asia. We reviewed the leading causes of revision for malar reduction surgery to establish proper indications for revision, seek adequate surgical strategies, and share the results from revision surgical cases. Methods A retrospective review was conducted involving 341 patients who underwent malar reduction reoperation between March 2010 and June 2015. Surgical strategies were decided based upon specific problems and complaints from the previous surgery. Facial photographs, cephalography, and computed tomography images were analyzed, and a patient satisfaction survey was conducted before and after the surgery. Results A total of 341 patients (321 women, 20 men; average age, 26.6 years, range 18–40 years) were included. The main causes of reoperations were subjective dissatisfaction and nonunion-related symptoms. Undercorrection of the zygomatic body and arch (n = 175, 51.3%) was the most frequent reason for dissatisfaction. The patients underwent revision surgeries via different techniques and strategies based on previous problems from primary surgery, and postoperative patient satisfaction was high. Complications occurred in 35 patients (10.3%) after revision. Conclusions Based on the results of this study, patient dissatisfaction with the procedure can be minimized beforehand through accurate goal identification and careful planning. Bone nonunion is usually due to excessive bone resection during zygoma reduction surgery. Careful selection of the reposition site and appropriate fixation based on a thorough understanding of masseter action are essential in ensuring satisfactory outcomes without adverse side effects. Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
  • Article
    Background: Each year, thousands of patients, particularly Eastern Asians, receive reduction malarplasty to achieve a more feminine and slender facial appearance. To date, there lacks a systematic analysis regarding the postoperative complications related to this procedure. Hence, the authors performed a comprehensive literature review with meta-analysis. Methods: Articles were searched and reviewed using the MEDLINE and Embase databases. Among the studies regarding surgical outcomes after reduction malarplasty, articles with explicit reports and clear numbers of postoperative complications were selected for meta-analysis. Additionally, manual searches were made from references of selected articles. Results: A total 14 retrospective review articles that represented 3149 cases were reviewed, and 7 different postoperative complications were analyzed. The complication that showed the highest weighted mean percentage of frequency was transient sensory weakness, with 5.8% (Z = -18.012; 95% confidence interval, 4.3-7.6%), followed by drooping (2.8%), nonunion (2.2%), asymmetry (1.8%), mouth opening restriction (1.8%), uncontrolled bleeding (1.3%), and facial nerve injury (0.9%). Conclusions: According to our meta-analysis of previous literatures, the aggregated rates of various complications related to reduction malarplasty were not high. Among the various complications, short-term sensory weakness was shown as the most frequent complication, emphasizing the necessity of patient warning and education before and after the operation. Moreover, soft tissue drooping and bone nonunion are also not rare and surgeons should be aware of these complications.
  • Article
    Reduction of mid-face width is a major concern in Asian facial contouring surgery, and some patients want their mild or borderline problems to be improved in a minimally invasive manner. The authors' mini-zygoma reduction surgery technique is indicated for patients who seek both minimal invasiveness and reliability. Patients presenting with a wide mid-face and isolated zygomatic arch protrusion without severe zygomatic body prominence were included into the study. All surgeries are performed under local anesthesia and on an outpatient basis. Through temporal and sideburn incisions, complete osteotomy was performed on the temporal process of the zygomatic body and just in front of the anterior tubercle of the zygomatic arch. After transposition to a proper inward position, the osteotomized segment was rigidly fixed on the zygomatic arch with metal fixtures. All surgeries were successfully performed without excessive blood loss or any unpredicted events. Over the 6 to 18-month follow-up period, most patients were satisfied with the aesthetic results of the surgery, the rapid recovery, and the minimal postoperative swelling. Even with a 1-point fixation, the segment remained stable and did not show displacement of the bony segment. In patients showing a minimal zygomatic arch prominence and seeking minimally invasive surgery, the proposed technique can be a proper surgical option with reliable and predictable results. The surgery can be performed without general anesthesia and on an outpatient basis, thereby resulting in prompt postoperative recovery. Predictability and reliability is assured with rigid fixation with a metal fixture on the zygomatic arch.
  • Chapter
    This chapter focuses on the midfacial and orbitozygomatic regions, in the context of aesthetic skeletal and soft‐tissue optimization. This includes review of the relevant anatomy, as well as the intricacies of analysis, operative approaches to the region, as well as orthognathic, periorbital, and adjunctive manipulations. The most frequent scenario for the aesthetic orthognathic surgeon is a patient with some degree of midfacial and orbitozygomatic malposition of unknown etiology, and an associated cosmetic imbalance. During evaluation, the patient may not specifically complain about the appearance of their midface and malar complex. The management of orbitozygomatic and midface problems is targeted and based on the diagnosis, with recognized regions of relative deficiency or excess. In the patient seeking aesthetic orthognathic or facial cosmetic surgery, the appropriate strategies are employed to manage the global and regional problems present, and optimize the facial balance and appearance.
  • Article
    Background We hypothesized that the amount of bone resection and setback together controls the effect of reducing the zygomatic body during reduction malarplasty; however, quantitative analyses of this movement are lacking. MethodsA retrospective study of patients who underwent reduction malarplasty between Aug. 2013 and Jan. 2015 was performed. We used 3-dimensional computed tomography (3D CT) scanning to measure movements of the summit of the zygoma (SOZ). We analyzed 394 zygomas in 197 patients. ResultsThe bone resection amount was not significantly correlated with the anteroposterior movement of the SOZ (p = 0.270); in contrast, the setback amount, was significantly correlated with anteroposterior SOZ movement (p < 0.001). The bone resection amount was not correlated with cephalocaudal movement (p = 0.158); however, cephalocaudal movement was significantly correlated with the setback amount (p < 0.001). Both the bone resection amount and the setback amount were correlated with mediolateral movement (p < 0.001). The amount of bone resection determined the mediolateral movement. Both the bone resection amount and the setback amount were correlated with the mean movement distance of the SOZ (p < 0.001). Both the R2 (0.704 > 0.084) and β (0.839 > 0.290) values indicated that the setback amount made a larger contribution to the SOZ movement distance than did the bone resection amount. Conclusions Whereas bone resection was the major factor in the medial movement of the SOZ, bone setback was the major factor in the anterior and superior movement of the SOZ and a minor factor in the medial movement. The results indicate that both bone reposition and bone resection are important factors in maximizing surgical results of the reduction malarplasty. Level of Evidence IIIThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
  • Article
    Reduction malarplasty surgery has become increasingly popular in recent years, especially in many East Asian countries. This is, in part, because many Asians consider a small, smooth, and feminine face to be more attractive and aesthetically desirable. Among the various reduction malarplasty methods, the L-shaped osteotomy technique, through intraoral and sideburn incisions, is now one of the most frequently performed surgical techniques. During the surgical procedure, it is important to shave the zygomatic process of the temporal bone through the sideburn incision. By carrying out this simple adjunctive procedure, several remarkable results can be achieved. The facial width is reduced, especially in those patients with protrusion of the posterior portion of the arch. The outward curvature of the zygomatic arch is changed to point inward. And finally, the bony step that originates from the medial repositioning of the zygomatic arch is reduced, resulting in decreased palpability.
  • Conference Paper
    The Oriental face is generally mesocephalic: short and wide. Thus the prominent zygoma in relation to a flat nose will make the face seem flatter. The unfavorable social connotations associated with a prominent zygoma are a reality in Korea. Reduction will not only relieve the patient of such psychological burdens but also afford a face with a cheerful and youthful appearance. Thus not a few patients seek surgery for these reasons. Previously, chiseling or burring of the zygoma body and arch was frequently used for zygoma reduction but was usually less than effective in reducing the wide face. Segmental osteotomy and repositioning of the arch by means of a bicoronal approach was another method, but this involved an extensive operation and left a long visible scar. We felt that these methods were less than ideal as aesthetic procedures. A simple and yet effective method of reducing the prominent zygoma was needed. Reduction of the prominent zygoma was performed in 26 patients by shaving the zygoma body and displacing the zygomatic arch inwardly after two-point fracturing, greenstick fracture anteriorly, and complete osteotomy posteriorly by means of a small preauricular and upper buccal sulcus incision. We obtained satisfactory results using the relatively simple procedure. The advantages of our technique are as follows: (1) there is a small skin incision and resulting inconspicuous scar, (2) the technique is simple and effective, (3) there is no use of foreign bodies such as wires or miniplates, and (4) there is less postoperative discomfort.
  • Article
    Zygoma reduction is commonly performed in Asian patients because a broad face is considered stubborn in appearance and unattractive. Consequently, a number of different techniques have been developed for zygoma reduction, the majority of which involve simple manipulations. However, no consensus has been reached on the optimal method. In the present report, we introduce a new method involving ostectomy and fixation that uses a 3-dimensional approach to zygoma reduction. From 2007 to 2013, 221 Korean patients (39 men, 182 women) underwent zygoma reduction using this technique. The bone was accessed via an intraoral and preauricular incision and removed in the body area using a small L-shaped osteotome through bone cutting in the arch area. The zygoma was moved anteriorly, medially, and caudally, and then fixed with a miniplate and screws. All patients were followed up for over 6 months and asked whether they were satisfied with the results. Four patients (1.8%) required further reduction and underwent a reoperation, but all were eventually satisfied. Two patients (0.9%) experienced overcorrection with a sunken area around the zygoma, which was corrected with autologous fat grafting after 6 months. Two patients complained of sensory changes around the upper lip, which resolved within 6 months. Two patients experienced dizziness, temporomandibular joint pain, infection, and/or cheek drooping. This new surgical technique causes less frequent and less pronounced cheek drooping and requires less bone stepping, resulting in greater patient satisfaction.
  • Article
    To achieve optimal outcomes in reduction malarplasty, the amount of removed zygomatic bone must be planned accurately. This study aimed to analyze the associations between the width of bony resection and changes in zygomatic bony parameters, to propose a geometric model to guide surgical planning, and to objectively evaluate the surgical outcomes of reduction malarplasty based on computed tomographic (CT) images. This was a retrospective observational study of patients who underwent reduction malarplasty. Digitized CT images were used to evaluate the bony parameters of the zygomatic complex. A geometric model was proposed to guide surgical planning for malar reduction. The primary predictor variable was the width of the bony segment to be resected. The primary outcome variables were changes in malar prominence and attractiveness. Other variables included gender, age, and other bony parameters of the zygoma. Bivariate correlation analysis and multiple linear regression analyses were performed between predictor and outcome variables. Presurgical and postsurgical data were analyzed with paired-samples t test to evaluate surgical outcomes. Differences were considered statistically significant at a P value less than .05. Fifty-one patients who underwent reduction malarplasty with an L-shaped osteotomy from 2012 through 2014 were included in the study. Statistical analysis showed a significant decrease in malar prominence and increased attractiveness between presurgical and postsurgical images (P < .001). The width of bony resection was statistically associated with all outcome variables after adjusting for potential confounders. Reduction malarplasty with a modified L-shaped osteotomy resulted in a notable decrease in malar prominence and a statistical decrease in the zygomatic arch width. The amount of bone that must be removed from the zygoma to achieve a desired reduction can be calculated with geometric equations. The proposed methodology could assist surgical design and improve surgical accuracy. Copyright © 2015 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.
  • Article
    Full-text available
    To investigate the proper modifications and usefulness of side-hairline correction surgery in Korean female patients depending on different zygomatic bone structures. Different zygomatic bone structures were classified according to their maximum transverse width among 310 cases of hairline correction surgery in Korean women. The widest transverse width was located on the anterior zygomatic malar area in type 1, on the mid-zygomatic arch in type 2, and on the posterior zygomatic arch in type 3; there was no difference in the transverse width between the anterior and posterior zygomatic arch in type 4. Various modifications of side-hairline correction surgery were performed among the 310 cases according to the zygomatic bone classification. Among 310 patients, 74 had a type 1 zygomatic structure, 106 had type 2, 46 had type 3, and 50 had type 4. Thirty-four patients exhibited different left and right transverse widths: type 1 + 2 (n = 26), type 2 + 3 (n = 6), type 1 + 3 (n = 1), and type 3 + 4 (n = 1). Satisfactory results were obtained in all patients without noticeable side effects. A minor touch-up procedure was performed in 14 patients to achieve density reinforcement 10 months postoperatively, and all 14 patients expressed satisfaction with the results. In East Asian patients, both side-hairline correction surgery and zygoma reduction can be considered eligible treatment options for the purpose of midface slimming. Especially in patients with a type 3 zygomatic bone structure, side-hairline correction surgery may be more effective than zygoma reduction surgery for midface slimming.
  • Article
    Facial asymmetry is usually due to unbalanced development of the lower jaw and zygoma and often results in esthetically unpleasant appearance. However, reasonable and systematic treatment of such an asymmetric face is rarely reported in the literature. This article aims to evaluate the effectiveness of surgical correction of asymmetric facial deformity and discuss their indications. From July 2006 to November 2010, a total of 52 patients received contour reshaping procedures to correct their asymmetric faces. Those patients in whom the asymmetric facial deformities were initiated by hypertrophy of the mandible and zygoma without occlusion and temporomandibular joint problem were chosen for this study. The authors performed a modified reduction malarplasty to correct asymmetric middle face and mandibular outer cortex splitting ostectomy, mandibular "V-line" ostectomy, and rotation genioplasty to improve asymmetric lower face depending on individual asymmetric facial characteristics. The effectiveness was then evaluated through cephalometric radiographs, three-dimensional computed tomography, and presurgical and postsurgical standard facial photographs. The postoperative results of all 52 cases showed that the asymmetric face was effectively corrected without serious complications and the harmonious facial contour improved significantly. The final esthetic outcomes were quite satisfactory for both surgeons and patients. The results indicate that a variety of contouring techniques for facial asymmetric deformity could be carried out based on characteristics of asymmetric face, so as to acquire a symmetric and harmonious face in accordance with facial esthetics.
  • Article
    The slender, oval-shaped face is considered to be attractive in East Asia. To obtain the ideal contour of the midface, reduction malarplasty has been popularized in oriental countries in recent years. This report describes a surgical technique for reduction of the zygomatic body and arch. After labiobuccal vestibular incisions are made, the anterior zygomatic body and lateral orbital rim are exposed by subperiosteal dissection. Thereafter, an L-shaped osteotomy is performed. Two parallel horizontal osteotomies are made in the anterior part of the zygomatic body, and the middle bone segment is removed. The zygomatic arch root is fractured through a small sideburn incision just anterior to the articular tubercle. Finally, the freed zygomatic complex is medially repositioned and fixed with one or two bicortex screws. Operations on 32 patients demonstrated that this technique may be a sound method for malar complex reduction, with the advantages of simple manipulation, stable fixation, and less risk of a drooping face.
  • Correction of the malar eminence
    • T Onizuka
    • K Watanabe
    • K Takasu
    • A Keyama
  • Article
    Augmentation and corrective malarplasty are relatively new procedures that require careful preoperative evaluation to ensure that the effect produced will blend harmoniously with the existing facial structure. A variety of implant types and materials are available to accommodate varying needs, and several surgical approaches are now used. This article discusses in detail the author's use of the subciliary lower eyelid approach, which rarely requires implant fixation, involves minimal postoperative care, and produces very few complications. Advantages of this approach are discussed, as is the incidental finding of decreased depth of the nasolabial furrow.
  • Article
    Esthetic correction of flat malar eminences may contribute to the harmony of facial proportions by making the face more oval and by giving a more youthful appearance. Zygomatic augmentation may also be indicated for the treatment of congenital hypoplasias, asymmetries, or traumatic depressions of the malar region. We have used the procedure in 52 cases since 1964. For augmentation we use a perforated soft, silicone rubber implant. The technique and results are described. The results have been satisfactory, for both the patients and the surgeon.