Abstract
Although many societies consider prominent cheekbones attractive, when the midface roundness reaches an excessive proportion this distinction may become undesirable. Besides the issue of hypertrophy, malar asymmetry in any individual may also require correction. Reduction malarplasty is performed through a vertical incision in the canine fossa. After the zygomaticus muscles are bluntly divided and retracted, the periosteal cover is elevated from the cortex. With a high-speed cutting burr, the malar eminence is then drilled until the desired height is achieved. The wound is irrigated and closed. We have performed this procedure successfully in eight patients with up to eighteen months follow-up. Transient loss of zygomaticus muscle function and numbness from traction on the infraorbital nerve occurred in two patients. All patients were completely satisfied with the improvement in their frontal profile. This operation requires a detailed understanding of the mid-face anatomy and the surgical boundaries of the malar bone but will result in a more sculptured front-face outline.
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