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The cheekbone or zygoma is one of the highlights of the midface area. Most Caucasians prefer a well-defined and prominent cheekbone which can be weak from congenital development or an injury. This is why cheek implants are a common cosmetic procedure in this population. Conversely, by comparison, Orientals prefer a softer facial contour but usually have more prominent zygomas by development. As a result, reduction of the cheekbone or malarplasty is a common cosmetic procedure for them.

Cheek bone reduction is a well described operation for which a variety of bone cutting and reducing approaches have been described. In my Indianapolis plastic surgery experience, an osteotomy at the front and back of the long zygomatic arch using a combined intraoral and perauricular incision has been a common successful approach.

To make the reduction malarplasty operation simpler but still effective, a variation of the osteotomy has been described. In the October 2009 issue of the journal Plastic and Reconstructive Surgery, a new L-shaped osteotomy through an intraoral approach is described. In an impressive 418 cases, the frontal L-shaped zygomatic body included two parallel vertical osteotomies (with bone removal) and one oblique osteotomy. This was then combined with a greenstick fracture at the root of the zygomatic arch from an inside approach. The vertical osteotomies allow good control of the reduction which is then secured with small plates and screws. It offers the advantages of being done completely inside the mouth with very controlled bone cuts and secure stabilization of the repositioned segments. They had a very high satisfaction rate of 96% with the potential for late complications of cheek asymmetry and soft tissue sagging (ptosis) due to over stripping of the attached soft tissues.

Reducing prominent cheekbones can and should be a fairly simple procedure with very predictable results.This new modified technique appears to offer advantages that make that a reality. White this technique may expose the maxillary sinus that is of no consequence as we know from a lot of experience in LeFort osteotomies and cheek bone fracture repair. The design of this new zygoma osteotomy even makes it theoretically possible to be used for lateral cheekbone expansion in cases of post traumatic infracture repair.

Barry L. Eppley, M.D., D.M.D.

Indianapolis, Indiana

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