The Orbito-Malar Complex Reduction with Extended Approach

Abstract

1. There are some patients seeking additional improvement after reduction malarplasty. Major reasons are as follows: One is suboptimal reduction of zygomatic body, and another is prominence being located at or close to the orbital rim that cannot be improved by conventional reduction malarplasty. 2. Conventional reduction malarplasty focuses mainly on reduction of the anterolateral zygomatic body and zygomatic arch and offers limited improvement at the orbital rim. 3. In selected patients with malar prominence located close to the orbital rim, reduction malarplasty with a modified tripod osteotomy and burring of the orbital rim provides aesthetically satisfying and reliable results. 4. Both burring of the orbital rim and modified tripod osteotomy can be done through subciliary or transconjunctival approach, not through bicoronal approach. 5. The orbito-malar complex is osteotomized at the zygomatic arch, zygomaticomaxillary suture, and inferior to the usual zygomaticofrontal suture by a reciprocating saw and osteotome. The movable bony segment is repositioned and fixed at the lateral orbital rim, inferior orbital rim, and zygomatic arch. For minimizing bony step around the osteotome line and additional reduction of partial bony protrusion, burring also can be applied. 6. Care should be taken to protect the orbital tissue during the burring and tripod osteotomy by adequated retractors and good knowledge of three-dimensional anatomy.