Lowering Lateral Canthoplasty and Orbital Rim Shaving: An Ignored but Necessary Procedure for Maximizing the Effect of Reduction Malarplasty in Asians.

Abstract

Although reduction malarplasty is a well-accepted procedure for Asians with prominent cheek bones, some patients are not fully satisfied with the outcomes and request further surgery. This is because much attention on the contouring procedure has focused on the position of the zygomatic body and arch. As a result, periorbital appearance including the axis of the lateral canthal angle and the protrusion of the inferolateral orbital rim are often overlooked or ignored. The authors introduce a new surgical technique for maximizing the effect of reduction malarplasty that allows for both the lowering of the lateral canthal angle and reduction of the orbital rim in selected Asian patients. In this retrospective study, the medical records of 41 patients who underwent lowering lateral canthoplasty in conjunction with reduction malarplasty were reviewed. Of those, orbital rim reduction was combined in 21 patients. In addition to the intraoral and preauricular approach for standard reduction malarplasty using an L-shaped osteotomy, lower eyelid and continuous canthotomy incisions were made. And then the protruding inferolateral orbital rim was shaved off, followed by inferolateral repositioning of the lateral canthus. Outcome measurements included a square millimeter of the cheek area surface using a software program (image J: IJ 1.46r) in 17 patients. A statistically significant difference can be observed between preoperative and postoperative measurements of the area. Average decreases of measurements were 4761.59mm2 (18.5%) from 23,639mm2 preoperatively to 18,878mm2 postoperatively (P < 0.05, paired t test). The up-slanting lower eyelid margin was lowered, and the protruding zygomatic body with inferolateral part of the orbital rim was reduced by the procedure in all cases. Cosmetic outcomes were encouraging and satisfying to most patients. Four complications occurred: asymmetry in two patients (4.9%) and lid malposition in two patients (4.9%). Conjunctival edema was noted in half of the patients but resolved within 1month. The simultaneous lowering lateral canthoplasty and reduction malarplasty offer Asian patients desiring a slim and soft image a novel surgical option. The procedures proved to be a reliable and consistent technique that provided satisfactory results in carefully selected patients. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .