Reduction Malarplasty by 3-mm Percutaneous Osteotomy

Abstract

Oriental people usually have a wide midface and a prominent malar curve. The zygomatic bone forms the prominence of the cheek, and it is the most important part in determining the ideal oval shape of the face on the frontal view and the character of the oblique profile. Therefore, zygoma contouring is commonly performed. Women with a prominent zygoma have an inferiority complex associated with unattractive facial features resembling aged, melancholic, and strong characters in oriental culture. Zygoma is the highlighted area of the midface and a major determinant of midfacial shape, but harmony with the adjacent area is very important. Therefore, to obtain the optimal outcome of reduction malarplasty, various ancillary procedures must be performed simultaneously. The authors performed 30 reduction malarplasties during the past 2 years. The amount of bone to be removed was determined by the preoperative interview, physical examination, and x-rays. Intraoral incisions provided access to the zygomatic body and lateral orbital rim. After the L-shaped osteotomy, two parallel vertical and transverse osteotomies in the medial part of the zygomatic body, the midsegment was removed. The posterior portion of the zygomatic arch was approached through a stab incision in the preauricular area. A 3-mm osteotome was used. After completion of the osteotomy, the movable zygomatic complex was reduced medially and superiorly, then fixed with miniplates and screws on the zygmaticomaxillary buttress. The combined operations with reduction malarplasty were as follows: reduction of the mandibular angle in 15 cases, rhinoplasty in 14 cases, and double-fold operation in 11 cases. The follow-up period was 2 months to 2 years, and all the patients were satisfied with the results. In conclusion, this method is a very simple, easy, and safe method that reduces the operating time to 1 h and minimizes postoperative edema and swelling. Consequently, recovery time is relatively short, and no conspicuous scars in the preauricular area are left. The authors also performed many ancillary procedures, thereby obtaining optimal satisfaction with their results, including decreased facial width and superior mobilization of the prominent area. They were able to prevent postoperative cheek drooping, and to give the patients a more youthful, charming look.