Reduction malarplasty using a zygomatic arch-lifting technique

Abstract

Broad or excessive malar protrusion is a trait associated with aggression and old age in Asian cultures. Although various methods of shifting the zygoma have been introduced for reduction malarplasty, soft tissue sagging and inadequate bony union still remain great challenges. We have devised an arch-lifting technique that helps overcome these issues. An analysis of surgical outcomes is presented herein. A total of 54 patients subjected to lifting malar reductions between January 2013 and November 2014 were retrospectively reviewed. The reduction procedure entailed an L-shaped osteotomy of the zygomaticomaxillary junction via an intraoral approach. In addition, a prefabricated U-shaped microplate was applied for arch fixation in the lifted position. The follow-up period ranged from 6 to 18 months (average, 9.2 months), during which medical records, photographs, and facial bone computed tomography (CT) images were obtained to assess the postoperative results. Patients were generally satisfied with aesthetic outcomes, thus rating the procedure excellent in terms of zygomatic prominence, midfacial width, symmetry, and resistance to cheek drooping. There were no major complications, such as facial nerve damage or trismus. An inadequate bony contact occurred in two instances due to unanticipated trauma, with immediate reduction and fixation thereafter. Minor wound infections developed in three patients but responded well to antibiotics. Zygomatic reduction procedures must consider the dynamics of the adjacent muscles, which are stabilized through arch fixation. The use of our arch-lifting technique for reduction malarplasty efficiently elevates the zygomatic complex, thereby ensuring an adequate bone-to-bone contact. Predictable and accurate outcomes are thereby achieved.