Reduction Malarplasty with Small Preauricular Incision

Abstract

Sir: Zygoma reduction surgery is performed with many methods on Asian patients. We insert an osteotome through a small preauricular incised part, fracture the zygomatic arch to the inside, and shave the body of the zygoma with a shaver. We think this approach to zygoma reduction surgery is safe and effective and thus wanted to report our findings. We performed zygoma reduction surgery on 1446 patients from March of 2003 to December of 2009. We determined which patients needed surgery based on medical photographs and radiographs before surgery, and performed surgery on 117 male patients and 1329 female patients. The average age of the male patients was 27.5 years and that of the female patients was 28.5 years. The average observation period after surgery was 6.4 months. We compared the medical photographs and radiographs before surgery and after surgery to show the results. Under general anesthesia, we made an incision 1 cm ahead of the tragus and then made an incision on the periosteum. We continued the dissection through the zygomatic arch through the subperiosteal level. Then, we fractured the forepart of the tubercle of the zygomatic arch using an osteotome, fractured the zygomaticotemporal suture and intrafractured the arch, and pushed it in while the inner periosteum was still attached (Fig. 1). We inserted a cylinder guide into the incision site on the forepart of the tragus and also placed a rasper to shave the prominent zygomatic body. To maintain the symmetry of both zygomas, we constantly watched and checked it by touching it with our fingers from the outside. After finishing the shaving, we trimmed up the tubercle to avoid step-off, which is a back part of the fractured arch, with a rasper that has a smaller tip. After we checked for bleeding, we deterged and sutured the part. For 3 days after surgery, we dressed it with elastic bandage and tape, applying pressure.Fig. 1.: 1 and 2, Sites for the osteotome; 3, site for shaving.For every patient, the zygoma was effectively reduced and satisfaction was achieved regarding aesthetic outcome. Eighteen patients reported that they were not satisfied, and nine patients reported asymmetry. However, all of the patients were satisfied after the second operation. There was no second operation performed resulting from infection or bleeding (Fig. 2).Fig. 2.: (Left) Preoperative view of 27-year-old woman with malar prominence. (Right) Postoperative view after reduction malarplasty.In 1983, Onizuka et al. introduced zygoma reduction surgery by intraoral incision.1 Since then, other ways of performing zygoma reduction surgery have been introduced by many other surgeons.2–5 We do not approach by the intraoral route. Because there is only little tissue incision and dissection, swelling, tissue damage, and bleeding hardly occur and do not give discomfort while eating. Because fracture of the body is not performed, drooping is rare. The technique uses only a preauricular incision of 1 cm so that no large scar is left. The substance that was used for fixing the arch is not needed, and there is no substance found on radiographs; as a result, we are pleased to introduce this new way, which minimized side effects. DISCLOSURE None of the authors has a financial interest to declare in relation to the content of this article. PATIENT CONSENT The patient provided written consent for the use of her image. Ho Jang, M.D. Seungchan Lee, M.D. Gangjae Jung, M.D. Small-Face Aesthetic Clinic Seoul, South Korea