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When trying to reduce facial fullness due to fat there are three procedures recognized to do so. Submental liposuction (neck), buccal lipectomies (upper/mid cheek) and perioral liposuction (lower cheek) have  been widely used with good clinical success. Because of the location of the facial nerve branches in the rest of the face liposuction is not usually considered because of the risk of nerve injury. 

In the August 2022 issue of the Aesthetic Surgery Journal an article appeared on facial liposuction entitled ‘Liposuction of the Zygomatic Arch Area: A Novel Concept to Improve The Midfacial Contour’. In this paper the authors performed a combined pre-clinical cadaveric study to evaluate the subcutaneous fatty layer over the zygomatic arch and a 49 patient five year clinical study where liposuction of the zygomatic arch area was performed.

The cadaveric study showed abundant fatty tissue in the soft tissue over the zygomatic arch. Liposuction could be performed in this subcutaneous later with facial nerves branches located in the deeper loose areolar tissue plane.

Of the nearly 100 zygomatic arch areas treated the median fat removal per side was 3 ml (range of 2 to 5mls) All patients experienced a visible reduction in the width of the face over the zygomatic arch. Three patients developed some visible depression of the zygomatic arch area when smiling which fully recovered. 

Like other facial regions (e.g., perioral mounds) it is not typically believed that liposuction is possible or that there is any merit in trying to do so. This study provides proof that liposuction in this lateral facial area can be safely and effectively performed.The only major concern with this procedure is whether it could injure the frontal branch of the facial nerve which crosses the zygomatic arch just above its periosteal covering. The authors did not report that facial nerve weakness occurred in any of their patients.

It is important to recognize that this was a study performed in Asian patients who typically have concerns about their facial width and often a thicker subcutaneous fat layer in the face overall. The effectiveness and safety of the procedure is related to good patient selection which would be in fuller/wider facial types. The criteria I would use is whether they have visible zygomatic arches or not. If the arch is visible there is probably not much fat to be removed and the frontal branch of the facial nerve will be more superficial. If the zygomatic arch is not visible then a thicker fat layer is present and small cannula liposuction will be effective with a deeper nerve branch location.

Dr. Barry Eppley

World Renowned Plastic Surgeon

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