Goals/Purpose: Reduction malarplasty is a popular aesthetic surgery for contouring a prominent zygoma in the Orient. Various surgical techniques for reduction malarplasty have been introduced and modified. To achieve the favorable results after reduction malarplasty, accurate reposition and sufficient fixation of the malar complex are important. Reduction malarplasty with a coronal incision can meet these requirements. But, many patients and surgeons prefer less invasive procedures such as intraoral approach and non-fixation technique for reduction malarplasty. However, without appropriate fixation of zygoma, displacement of the malar complex can occur due to masseter muscle action. The authors reduce a prominent zygoma through an intraoral approach combined with a minimal sideburn incision. To provide stability of the zygoma, a double-bridged midplate and a pre-bending midplate were applied to zygoma body and arch, respectively.
Methods/Technique: All patients were examined with the three-dimensional CT scans for the evaluation of zygoma morphology. The amount of zygoma body resection and arch impaction were decided through clinical evaluation and analysis of the three-dimensional CT imaging. The authors approached the body of zygoma through an intraoral incision, and the arch through a 1-cm-long vertical incision within the sideburn. An inverted L-shaped osteotomy and a vertical linear oseotomy were applied to zygomatic body and arch, respectively. According to the surgical plan, the anterior-medial portion of the zygoma could be resected. The osteotomized malar complex was brought into the desired position, and then it is stabilized with midplates and screws(Fig. 1, Left). The body of zygoma was fixed with a double-bridged plate for providing stability against the torque from masseter muscle(Fig. 1, Center). The arch of zygoma was fixed with a pre-bending plate for achieving accurate position as well as stability (Fig. 1, Right). The patients were examined with the 3-dimensional CT scans at 1 day, 3 months, and 6 months after surgery. We evaluated the displacement of zygoma and the presence of bony gap by the 3-dimensional CT imaging.
Fig. 1. Rigid fixation of malar complex. (Left) Double-bridged and pre-bending midplates. (Center) Applying a double-bridged midplate to zygoma body. (Right) Applying a pre-bending midplate to zygoma arch.
Results/Complications: Total 672 patients underwent reduction malarplasty using our method from 2007 to 2011. The follow-up period was 6 to 19 months. The majority of patients were satisfied the aesthetic results (Fig. 2). The amount of zygoma body resection ranged from 0 to 6mm. The amount of zygoma arch impaction ranged from 0 to 3 mm. The displacement of zygoma was observed in 27 cases. The bony gap was observed in 59 cases. The patients with mild displacement and bony gap showed the same clinical outcomes. Severe displacement and large bony gap was observed in 11 patients, and we treated through revisional surgery. The severe displacement of zygoma was related to loosening of plates.
Fig. 2. A 29-year-old woman underwent reduction malarplasty. (Above, left) Preoperative view. (Above, right) Postoperative view. (Below, left) Preoperative three-dimensional CT image. (Below, right) Postoperative three-dimensional CT image.
Conclusion: Appropriate rigid fixation is essential for avoiding displacement of the zygoma which is osteotomized and repositioned for malar reduction. Using a double-bridged midplate and a pre-bending midplate, we could maintain stability of the zygoma. Achieving optimal results from reduction malarplasty requires a precise repositioning and rigid fixation of the malar complex. Our technique for reduction malarplasty satisfies these requirements without a bicoronal incision.