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The cheekbone occupies a significant part of the midface. It is responsible for the projection and width of the side of the face. The name of the bone, the zygomatic-orbital complex, speaks for the main body of bone and the legs of bone that extend underneath the eye, down onto the maxilla and back towards the ear where it meets with the temporal bone.

The least appreciated part of the cheekbone is the zygomatic arch. This thin leg of bone is shaped so the thick temporals muscle can go underneath it to attach to the lower jaw. This creates a convexity of the bone that is primarily responsible for the width of the side of the midface. Despite this long thin section of the cheekbone, it has a major influence on the width of the face. This is why one type of cheekbone reduction surgery consists of moving this part of the cheekbone inward to create a narrowing effect. Through osteotomies of the front and back end of the zygmatic arch, it is moved inward and secured with small plates and screws. This reduces the convexity of the arch and thus the width of the face.

In some concerns about facial width only part of the zygomatic arch is implicated. Some patients are bothered with their excessive facial width back closer to the ear or back part of the zygomatic arch. In these cases an isolated osteotomy can be done on the posterior zygomatic arch just anterior to where it attaches to the temporal bone. This is. approached through a skin incision one the back side of the sideburn hair. The bone is cut and pushed inward and fixed with a 1.5mm step plate. Even though the front part of the zygomatic arch is not cut, the back of the arch can still be bent inward.

3D CT scans show that inward position of the posterior zygomatic arch, reducing the posterior width of the midface. At 5mms per side the bifacial width can be reduced by 1 cm. Further inward movement can be obtained by partial osteotomies of the anterior attachment of the zygomatic arches. (almost a more complete cheekbone reduction approach)

Dr. Barry Eppley

Indianapolis, Indiana

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