Standard Zygoma Reduction with Intraoral Approach
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.
The key variables to be evaluated are bizygomatic width, volume and position of the zygomatic body. The amount of ostectomy is determined considering volume of zygomatic body.
The zygomatic body and arch are usually moved medially, posteriorly, and sometimes superiorly or inferiorly during the surgery; the point of maximal malar projection (MMP) is marked and its new ideal position is carefully planned.
Overall facial shape including mandibular prominence and facial length should be considered in planning reduction malarplasty. Particular care should be taken for patients with a long face, as excessive reduction has risk of making the face to appear longer after the surgery.
Reduction malarplasty can be performed solely or in combination with other facial bone contouring surgeries such as mandible reduction, genioplasty, or forehead augmentation.
Soft tissue has a great effect on the results in reduction malarplasty. In patients with abundant cheek fat and sagging skin, the slimming effect might be less obvious and cheek drooping is more probable.
The following five factors are considered high risks for skin and soft tissue sagging generally: (1) age over 40 years, (2) abundant cheek fat, (3) thin skin and skin laxity, (4) class II mandible or ill-defined mandible neck line, and (5) deep nasolabial fold or jowl.
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