Cheekbone reductions are typically done by a bone repositioning technique. Using an osteotomy cut through the main body of the zygoma done intraorally and an external skin approach to a bone cut through the posterior zygomatic arch, the entire cheek bone is moved inward. The analogy I often make is that it is like taking a long spanning bridge and lowering it at each end. This procedure is most effective when the zygomatic arch is fairly convex and creates a prominent width to the side of the midface.
Cheekbone reduction by shaving is very different and is not an interchangeable procedure with cheekbone reduction by osteotomies. Such shaving reduction is done intraorally and is limited to the anterolateral body of the zygomatic major bone and mainly affects its anterior projection and some anterior cheek width. (the zygomatic arch can not be shaved down due too lack of access as well as being a very thin bone) Its effectiveness is restricted to the following clinical situations; 1) the excessive cheek size/width is anterior and can be accessed by an intraoral incision, 2) the zygomatic arches are flat and lack convexity, and 3) the patient is opposed to the use of metal hardware for bone fixation.
In doing cheek bone reductions by intraoral shaving (ostectomies) it is important to recognize what can and can not be achieved. The only part of the cheekbone that be shaved is the anterolateral part of the large cheekbone body which is seen intraorally. No part of the zyygomatic arch can be reached. This is really the corner of the zygomatic body where the maxilla and the cheekbone meet. (its most convex part) There are strong tendinous attachments of the masseter muscle at this bottom corner which is why it actually exists. (aka form follows function) In doing these reduction two different shaving methods are used. A reciprocating saw is used to remove the bottom corner over the tendinous attachment, keeping most of it intact. Then high speed burring can be done to make the anterolateral convexity flatter. It is easy to see by the diagram how this is radically different than cheekbone osteotomies. The difference in their spelling (ostectomies vs osteotomies) is minor but the aesthetic differences between the two procedures is major.
Cheekbone reductions by shaving has a limited role in cheek contouring and often is misued when osteotomy/bony repositioning methods are more suited to the patient’s aesthetic goals. This misapplication can occur due to either the patient desiring a less invasive surgery (with the misbelief that the effects are the same) or the surgeon’s experience in performing cheek bone reduction is limited to the lesser shaving method. Like all surgeries matching the problem to the solution gives the best chance for a satisfactory result. Lesser is never more, it is always less…and that is the role of shaving in cheekbone reductions
Dr. Barry Eppley
World-Renowned Plastic Surgeon