Augmentation of Cheek Bone Contour Using Malar Osteotomy


Patients with a narrow face have often a defect in expansion of the maxillary–malar complex. A malar osteotomy, separating the malar–zygomatic complex from the orbit and the maxilla, allows an anterolateral cheek projection when performing an external rotation. This technique changes facial contour and improves facial aesthetics. During the past 5 years, 18 malar osteotomies have been performed; the external rotation was stabilized with interposed coral graft in six patients and with interposed bone graft fixed by a miniplate or with a stainless steel wire in 12 patients. Simultaneously septoplasty was performed in five patients, rhinoplasty in 13 patients, and genioplasty in two patients. Six patients had a face and neck lift, one patient had a forehead lift, and one patient had onlay iliac crest bone graft to treat atrophic maxillary alveolar ridges prior to implant placement. Stability was defined after 1 year follow-up. The increase in projection was correlated to the size of the graft. At least 5 mm were necessary to have cheek modification. Mucous inflammation, maxillary sinusitis, and relapse were observed with the use of interposed coral graft, but no complications were observed with bone graft. Malar osteotomy is a simple and safe procedure; it allows an anterolateral cheek projection and seems to be effective for treating transverse midface deficiency.

This is a preview of subscription content, access via your institution.

Figure 1
Figure 2
Figure 3
Figure 4
Figure 5


  1. 1

    G Couly (1975) ArticleTitleBone statics of the face: the frontal-sphenoid-pterygoid bone pillars as biomechanic equivalents of the mandible. Rev Stomatol Chir Maxillofac 76 607–619 Occurrence Handle1:STN:280:CSmC2sjptFE%3D Occurrence Handle1063433

    CAS  PubMed  Google Scholar 

  2. 2

    H Sicher (1960) Oral anatomy. Mosby St Louis

    Google Scholar 

  3. 3

    R Guerrero Vicuna A Salazar Giottonini (1994) ArticleTitleBone expansion in facial rejuvenation. Aesth Plast Surg 18 85–90 Occurrence Handle1:STN:280:ByuC28fhtV0%3D

    CAS  Google Scholar 

  4. 4

    R Gola (2000) Rhinoplastie fonctionnelle et esthétique. Springer Verlag Paris

    Google Scholar 

  5. 5

    MY Mommaerts JV Abeloos CA De Clercq LF Neyt (1995) ArticleTitleThe “sandwich” zygomatic osteotomy: technique, indications and clinical results. J Cranio Maxillofac Surg 23 12–19 Occurrence Handle1:STN:280:ByqB3MzjvFc%3D

    CAS  Google Scholar 

  6. 6

    MY Mommaerts N Nadjmi JV Abeloos LF Neyt (1999) ArticleTitleSix year’s experience with the zygomatic “sandwich” osteotomy for correction of malar deficiency. J Oral Maxillofac Surg 57 8–15 Occurrence Handle1:STN:280:DyaK1M7ht1Gqtw%3D%3D Occurrence Handle9915389

    CAS  PubMed  Google Scholar 

  7. 7

    CL Straith JR Lewis (1999) ArticleTitleAssociated congenital defects of the ear, eye lids and malar bones (Treacher Collins syndrome). Plast Reconstr Surg 4 204–213

    Google Scholar 

  8. 8

    WR Siemian MR Samiian (1988) ArticleTitleMalar augmentation using autogenous composite conchal cartilage and temporalis fascia. Plast Reconstr Surg 82 395–402

    Google Scholar 

  9. 9

    P Tessier (1982) ArticleTitleAutogenous bone grafts taken from the calvarium for facial and cranial applications. Clin Plast Surg 9 531–538 Occurrence Handle1:STN:280:BiyD2sfgtVA%3D Occurrence Handle6756759

    CAS  PubMed  Google Scholar 

  10. 10

    UT Hinderer (1975) ArticleTitleMalar implants for improvement of the facial appearence. Plast Reconstr Surg 56 157–165

    Google Scholar 

  11. 11

    LA Whitaker (1987) ArticleTitleAesthetic augmentation of the malar-midface structures. Plast Reconstr Surg 80 337–346

    Google Scholar 

  12. 12

    TS Wilkinson (1983) ArticleTitleComplications in aesthetic malar augmentation. Plast Reconstr Surg 71 643–649

    Google Scholar 

  13. 13

    SE Metzinger EG McCollough JP Campbell DE Rousso (1999) ArticleTitleMalar augmentation: a 5-year retrospective review of the silastic midfacial malar implant. Arch Otolaryngol Head Neck Surg 125 980–987

    Google Scholar 

  14. 14

    SR Coleman (1995) ArticleTitleLong-term survival of fat transplants: controlled demonstrations. Aesth Plast Surg 9 42l–425

    Google Scholar 

  15. 15

    SR Coleman (1997) ArticleTitleFacial recontouring with lipostructure. Clin Plast Surg 24 347–367 Occurrence Handle1:STN:280:ByiB1cjjvVU%3D Occurrence Handle9142473

    CAS  PubMed  Google Scholar 

  16. 16

    P Tessier (1969) ArticleTitleSurgical widening of the orbit. Orbits too small. Basedow exophthalmos. Exorbitisms of cranio-facial dysostosis. Congenital anophthalmia, mivrophthalmia. Orbital atresia of young enucleasted eyes. Orbital tumors (angioma, meningioma, Recklinghausen). Ann Chir Plast 14 207–214 Occurrence Handle1:STN:280:CS%2BC3M7mvVI%3D Occurrence Handle5370652

    CAS  PubMed  Google Scholar 

Download references

Author information



Corresponding author

Correspondence to Walid Layoun M.D..

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Layoun, W., Guyot, L., Richard, O. et al. Augmentation of Cheek Bone Contour Using Malar Osteotomy . Aesth. Plast. Surg. 27, 269–274 (2003).

Download citation


  • Narrow face
  • Malar osteotomy
  • Bone graft
  • Cheek projection