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Dr. Barry Eppley

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Surgeon Dr. Barry Eppley

Facial Width Reduction By Zygomatic Arch Reshaping (Malarplasty)


The widest part of the face in most people is controlled by the lateral projection of the zygomatic arch. It is uncommon that the width of the temples or the jawline exceeds that of the zygomatic arches in the midface. The zygomatic body almost always sits inside the maximum width of the convexity of the zygomatic arch.

The only effective method of narrowing midface width is to reposition/reshape the zygomatic arch. This is most commonly done by numerous variations of anterior (zygomatic body) and posterior (temporal attachment of zygomatic arch) osteotomies. This moves the whole curve of the zygomatic arch inward.

All known variations of these cheekbone osteotomies works by moving the existing curve of the arch inward, not by changing the shape of the zygomatic arch. It has always seemed that if the shape of the arch can be changed that would be just as effective as moving the whole arch inward at its ends.

In the December 2014 issue of the Aesthetic Surgery Journal, article appeared entitled ‘Zygomatic Arch Reduction and Malarplasty with Multiple Osteotomies: Its Geometric Considerations’. In this paper, a new technique for facial width reduction is presented by making multiple osteotomies and a central bone resection at the middle part of the most protruding part of the zygomatic arch. The amount of bone resection was calculated with a geometrical solution according to the desired reduction rate of the arch height. A 3D CT scan was used to calculate arch height and the length of arch bone that needed to be removed. A central piece of bone was removed from the most protruding point of the zygomatic arch on each side. Greenstick fractures were made at the anterior and posterior roots of the zygomatic arch. The open arches were rotated inwardly until the resected bone met.

Their results in an impressive over 1,000 zygomatic arches were reduced from 3 to 11mms. Amazingly all reduced zygomatic arches healed with solid bony unions. Patient satisfaction with this technique was very high. The success of this cheekbone reduction method is based on changing the shape of the zygomatic arch. Knowing how much bone to remove is the key so that the zygomatic arch ends fall together and meet. That is provided by a simplified geometrical calculation.

Is the central arch resection better than the traditional medial arch displacement technique? In many facial width reduction patients it may not be necessary. But for those with a very convex zygomatic arch shape, changing the shape of the arch is the only way to get a really significant facial width reduction.

Dr. Barry Eppley

Indianapolis, Indiana

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Dr. Barry EppleyDr. Barry Eppley

Dr. Barry Eppley is an extensively trained plastic and cosmetic surgeon with more than 20 years of surgical experience. He is both a licensed physician and dentist as well as double board-certified in both Plastic and Reconstructive Surgery and Oral and Maxillofacial Surgery. This training allows him to perform the most complex surgical procedures from cosmetic changes to the face and body to craniofacial surgery. Dr. Eppley has made extensive contributions to plastic surgery starting with the development of several advanced surgical techniques. He is a revered author, lecturer and educator in the field of plastic and cosmetic surgery.

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