Underwent Reduction Malarplasty Research Articles

The Spatial Relationship Between Coronoid Process and Zygomatic Complex After Reduction Malarplasty.

Reduction malarplasty presents challenges in terms of postoperative complications, particularly limited mouth opening. Excessive inward displacement of the zygomatic complex can impinge on the coronoid process resulting in restricted mouth opening. This study aimed to assess the spatial relationship between the coronoid process and the zygomatic complex after reduction malarplasty. A retrospective study was conducted, including consecutive patients underwent reduction malarplasty. Radiological measurements were performed before surgery and during the final follow-up, including the coronoid-condylar index, distance between the coronoid process and zygomatic complex, and thickness and density of the temporal and masseter muscles. Clinical and radiographic data were recorded and analyzed. A total of 159 female patients were included with an average age of 28.1 years and a mean follow-up of 6.7 months. The mean coronoid-condylar index was 1:1.4, ranging from 1:0.6 to 1:2.6. Following surgery, the distances between the coronoid process and the anterior zygoma decreased by approximately 1 mm. Additionally, the postoperative distance between the highest point of the coronoid process and the zygomatic arch decreased by around 4 mm horizontally and changed approximately 1 mm vertically. No significant changes were observed in the thickness and density of the temporal and masseter muscles after surgery. Reduction malarplasty led to a slight decrease in the distance between the coronoid process and the zygoma. The operation generally resulted in proximity between the highest point of the coronoid process and the zygomatic arch. However, we believe that common reduction malarplasty rarely leads to osseous impingement. 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.

The importance of the mortice and tenon joint on the zygomatic arch in reduction malarplasty-a retrospective study

The aim of this study was to compare two kinds of reduction malarplasty in terms of their bony consolidation. Patients that underwent reduction malarplasty were reviewed retrospectively. The medial movement of the zygomatic body and the zygomatic arch as well as the complications and satisfaction of patients were investigated. The surgical procedure entailed a classical or modified L-shaped osteotomy through intraoral and sideburn approaches. Two groups were distinguished, those for whom a mortice and tenon joint was formed on the zygomatic arch (Group I), and those that formed end-to-end bone contact (Group II). All the cases in Group I showed an improved facial contour with sufficient bone contact. A larger medial movement of the zygomatic arch was observed in Group I (4.54 ± 0.41 mm) than in Group II (2.72 ± 0.29 mm) (P = 0.016). More bone malunion was observed in six cases of Group II (P = 0.030) and four required a second operation. In conclusion, this study indicates that the mortice and tenon approach is preferable when the priority is bony consolidation.

Reduction Malarplasty With Subperiosteal Lift Via a Single Limited Temporal Incision.

Different from Western culture, prominent zygoma and rectangular facial contour are deemed as unaesthetic and masculine in Asians. To achieve an ideal oval facial shape, reduction malarplasty is often performed. Twenty-two eligible patients who underwent reduction malarplasty between November 2008 and December 2018 were reviewed. The reduction malarplasty involved repositioning of the osteotomized zygomatic arch and subperiosteal lift via a limited temporal incision. Photographs were collected both preoperatively and postoperatively. Complications and postoperative outcomes were evaluated. Twenty-two patients underwent reduction malarplasty with subperiosteal lift between November 2008 and December 2018. Their mean age was 35 ± 2.30 years. Prominent zygoma and facial contour were significantly improved after surgery. Patients demonstrated satisfaction with outcome (73.77 ± 6.83) and with facial appearance (75.00 ± 5.60). No cheek drooping and major complications were observed during the long-term follow-up. Prominent zygoma treated with reduction malarplasty with subperiosteal lift via limited temporal incision has a stable and long-lasting effect. This approach can be regarded as a true alternative for facial contour reshaping.

Radiologic Analysis of Malar Arch Movement in Reduction Malarplasty Without Bony Resection.

Reduction malarplasty has been popular among Asians with a wide facial width. In general, malar setback after bony resection is regarded as the standard objective of reduction malarplasty. However, unnecessary bony resection may lead to various postoperative complications. Therefore, we suggest the use of reduction malarplasty without bony resection to achieve a similar narrowing effect of the facial width, based on radiographic analysis of malar arch movement. This retrospective study analyzed 48 patients with a wide midface who underwent reduction malarplasty between September 2018 and December 2019. We included 40 cases of advancement repositioning malarplasty (AR) without bony resection and 8 cases of setback reduction malarplasty (SR) with bony resection. The three-dimensional position of the malar arch expressed by coordinates (x, y, and z) on three-dimensional computed tomography scans was used to compare the positional change between the surgical methods. The paired t-test, Wilcoxon text, and independent t-test were used in data analysis, and statistical analysis was performed using SPSS 23.0 software. Medial and superior movement of the freed malar arch segment was significantly different between AR and SR (P < 0.05). Although medialization and superiorization were not significantly different between AR and SR, there was a significant difference in anterior-posterior movement between AR and SR (P < 0.05). The radiologic analysis based on malar arch movement between AR and SR showed similar narrowing effects on medialization and superiorization of the malar arch regardless of bony resection. Therefore, the AR can be effectively applied in case of arch dominant type or malar asymmetry. In addition, further comprehensive study including analysis on movement of facial soft tissue following malar bony movement is expected based on this study in near future.

The Relationship Between the Facial Proportion Changes in Hard Tissue and the Satisfaction of Patients After Reduction Malarplasty: a Research Based on Three-Dimensional Cephalometry.

We aim to measure the zygomatic width and protrusion changes in hard tissue after reduction malarplasty and then calculate facial proportion changes and analyze the relationship between facial proportion changes and patients' satisfaction. We retrospectively reviewed our database and selected 36 eligible patients who underwent isolated reduction malarplasty in our department from March 2015 to July 2018. The preoperative and postoperative facial width and protrusion, as well as head height, in hard tissue were measured using ProPlan software. Patients' satisfaction was evaluated by questionnaire. The correlations between the facial proportion changes and patients' satisfaction were analyzed using Spearman correlation analysis. The preoperative and postoperative midface widths were 135.87 ± 4.09mm and 129.06 ± 4.95mm. The relative zygomatic protrusion was reduced by 3.29 ± 1.54mm in the left and 2.88 ± 1.73mm in the right after surgery. The ratio of the midface width to lower face width changed from 1.43 ± 0.05 to 1.36 ± 0.06 after surgery. And the ratio of the head height to midface width changed from 1.53 ± 0.05 to 1.61 ± 0.05 after surgery. The ratios were indeed close to the ideal ratios we presumed (4:3 and 1.618). Moreover, patients' total and morphology satisfaction were both significantly higher with the postoperative ratio of the midface width to lower face width closer to 4:3 (R = - 0.732, P < 0.001; R = - 0.906, P < 0.001, respectively). But only morphology satisfaction was higher with the ratio of the head height to midface width closer to 1.618 (R = - 0.404, P = 0.014) and the ratio of the postoperative midface to lower face width decreased (R = - 0.434, P = 0.008). We found patients' morphology satisfaction was higher with the proportion of the postoperative midface to lower face width decreased. What's more, the proximity degree between the postoperative facial proportion and the ideal facial proportions we presumed was significantly correlated with patients' high satisfaction. Therefore, 4:3 and 1.618 may be the ideal postoperative facial ratios for the patients who underwent reduction malarplasty. 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 https://www.springer.com/00266.

Application of the Bracing System in Reduction Malarplasty in Asian Population.

In the East, a broad and prominent malar is considered to express an aggressive and unpleasing impression; therefore, patients seek to improve their appearance through malar reduction. Although most of the techniques have been greatly improved, still there are some pitfalls in the form of cheek sagging or bone nonunion. In this study, we performed a reduction malarplasty using a firm bracing system to minimize major postoperative complications. This was a retrospective study evaluating the results of a total of 157 patients (139 women and 18 men) who underwent reduction malarplasty using a bracing system via intraoral and periauricular. The age of the patients ranged from 17 to 44 with a mean age of 25.3years. The mean follow-up period was 9.4months. All patients underwent routine physical and laboratory examinations. Facial photographs in the frontal, oblique, and submentovertical views were taken. Patients with severe facial asymmetry and facial deformities were excluded from the study. Preoperative states and patients' desires were considered. In some patients, combined malarplasty with mandibular angle reduction or genioplasty was performed. A total of 157 patients who underwent this modified reduction malarplasty between January 2015 and January 2019 were retrospectively reviewed. Decent postoperative facial stability and satisfactory aesthetic results were realized among all patients. Major complications such as severe asymmetry or bone nonunion were not observed in our patients. Based on a thorough anatomic understanding of zygoma and masseter action, we modified previous L-shaped reduction malarplasty through constructing a firm bracing system on the malar complex. Satisfactory surgical outcomes were obtained. Our method is an ideal surgical method to effectively reduce the height and width of the zygomatic arch and prevent complications such as bone nonunion and cheek drooping. 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.

External radiopaque marking of Gillies posterior zygomatic arch osteotomy in reduction malarplasty

Although the Gillies (temporal) approach to reduction malarplasty helps preserve supportive soft tissue and avoid facial scars, the osteotomy site is difficult to gauge when using this blind technique. Our experience with external radiopaque marking of the zygomatic arch to guide this process is presented herein. This retrospective review included all patients who underwent reduction malarplasty (as above) at our clinic between August 2013 and September 2015. Procedures entailed L-shaped osteotomy only (no segmental excision) of the zygomatic body by the intraoral route, and posterior zygomatic arch osteotomy by the Gillies approach, guided by external radiopaque markings. Patient characteristics, surgical outcomes, and complications were analyzed to assess the merits of this strategy. Postoperative results were evaluated by both the patients and the surgeon. Most patients expressed satisfaction during the follow-up period (range, 3-27 months). Posterior osteotomies were properly performed as planned, with no major complications (i.e., malunion or nonunion, cheek drooping, or facial nerve injury), although minor complications were recorded in three instances. Use of external radiopaque markings provides guidance during malarplasty by the Gillies approach and may help avoid procedural complications.

Zygomatic Complex Change After Reduction Malarplasty and Its Geometric Model: A Retrospective Clinical Study

To achieve optimal outcomes in reduction malarplasty, the amount of removed zygomatic bone must be planned accurately. This study aimed to analyze the associations between the width of bony resection and changes in zygomatic bony parameters, to propose a geometric model to guide surgical planning, and to objectively evaluate the surgical outcomes of reduction malarplasty based on computed tomographic (CT) images. This was a retrospective observational study of patients who underwent reduction malarplasty. Digitized CT images were used to evaluate the bony parameters of the zygomatic complex. A geometric model was proposed to guide surgical planning for malar reduction. The primary predictor variable was the width of the bony segment to be resected. The primary outcome variables were changes in malar prominence and attractiveness. Other variables included gender, age, and other bony parameters of the zygoma. Bivariate correlation analysis and multiple linear regression analyses were performed between predictor and outcome variables. Presurgical and postsurgical data were analyzed with paired-samples t test to evaluate surgical outcomes. Differences were considered statistically significant at a P value less than .05. Fifty-one patients who underwent reduction malarplasty with an L-shaped osteotomy from 2012 through 2014 were included in the study. Statistical analysis showed a significant decrease in malar prominence and increased attractiveness between presurgical and postsurgical images (P < .001). The width of bony resection was statistically associated with all outcome variables after adjusting for potential confounders. Reduction malarplasty with a modified L-shaped osteotomy resulted in a notable decrease in malar prominence and a statistical decrease in the zygomatic arch width. The amount of bone that must be removed from the zygoma to achieve a desired reduction can be calculated with geometric equations. The proposed methodology could assist surgical design and improve surgical accuracy.

Reduction Malarplasty According to Esthetic Facial Unit Analysis: Retrospective Clinical Study of 23 Cases

Because the zygoma is located in the middle third of the face, its prominence, contour, and width will have a large effect on the facial impression. Unlike whites who will mainly complain of a hypoplastic zygoma, Asians will commonly present with a prominent zygoma. The purposes of the present retrospective study were to evaluate the indications for reduction malarplasty and to analyze the complications of patients who underwent reduction malarplasty. According to the esthetic facial unit concept, a patient with a hyperplastic anterior midface can undergo reduction body malarplasty (RBM). If a patient complains of a hyperplastic anterior and posterior mid-face, the clinician can perform reduction body and arch malarplasty (RBAM). The subjects included 23 adult patients (5 males and 18 females; mean age 22 years; 11 RBM and 12 RBAM; mean follow-up period 30 months). The early and late postoperative complications and patient satisfaction with their appearance were investigated retrospectively. Complications after RBM included transient skin numbness around the zygoma in 1, a nonfractured zygomatic arch in 1, and a nonunionized zygomatic body in 1. After RBAM, 3 patients complained of transient skin numbness around the zygoma and 2 of transient injury to facial nerve. The skin numbness and facial nerve weakness resolved within a few months. For the nonfractured zygomatic arch and nonunionized zygomatic body, repeat fixation with miniplates and screws was performed. All the patients were satisfied with the surgical results. If an appropriate type of reduction malarplasty has been chosen using the esthetic facial unit concept, reduction malarplasty can effectively improve the facial esthetics without serious postoperative complications.

A Modified Reduction Malarplasty Utilizing 2 Oblique Osteotomies for Prominent Zygomatic Body and Arch

The shape of the zygomatic body and arch have great influences to the facial contour of Orientals. The prominent zygoma makes the appearance look more fierce. Nowadays in China, the number of patients who underwent reduction malarplasty is increasing rapidly. Therefore, it is important to develop a reliable surgical procedure with small wound and good effects. Included in this report were 46 patients with prominent zygomatic body and arch treated between October 2007 and November 2010. Combined intraoral and extraoral approaches were used, and 2 oblique osteotomies were performed to anterior and posterior part of malar complex, respectively. The isolated zygoma segment was then internalized utilizing z-plasty for the posterior end and inward sliding and internal fixation for the anterior end. The extraoral approach was made through a small temple incision. All patients were subjectively satisfied with the postoperative appearance. Their face contours were effectively improved by the modified procedure. One patient had short-term numbness of the medial zygomatic region skin; no other complications were observed during the follow-up period. This surgical procedure was carried out using combined intraoral and extraoral approaches. No visible scars left on the face. After 2 oblique osteotomies were made, the anterior inward sliding and posterior z-plasty could be easily performed to the isolated zygomatic bone. No segmental bone removal was required. The natural curve of the face contour was maintained while the malar complex was reshaped. We concluded that it is an effective and safe reduction malarplasty technique for Orientals.

Preservation of the Deep Facial Vein in Reduction Malarplasty

Many facial bone contouring surgeries, including reduction malarplasty, are performed in Asian countries to give the face an oval shape. When performing reduction malarplasty, a few large vessels can be injured, including the deep facial vein. The aim of this study was to determine the anatomy of the deep facial vein and to investigate the best method to prevent injury of deep facial vein during reduction malarplasty. A retrospective chart review was performed for all patients who underwent reduction malarplasty with L-shaped osteotomy between March 2009 and February 2010. We performed a chart review focusing on complications associated with bleeding, which result in an emergency operation. A total of 324 patients underwent reduction malarplasty with L-shaped osteotomy during the study period. In 2 cases, the deep facial vein was injured during vertical osteotomy at the posterior wall of the maxillary sinus, resulting in major bleeding. Because it was difficult to access the deep facial vein that lies just behind the posterior side of the maxillary sinus, the fixed free zygomatic bone segment had to be disassembled to access the vessels. In reduction malarplasty using L-shaped osteotomy, the subperiosteal dissection should be performed carefully and osteotomy should be performed cautiously not too deep to reach the periosteum of the posterior side of the maxillary sinus. The surgeon should consider the possibility of major bleeding because of injury to the deep facial vein, and it may be necessary to notify patients and explain this risk.

Compared Study of Asian Reduction Malarplasty

The zygomatic body and arch are usually prominent in Asians; therefore, malar reduction is one of the most popular procedures for aesthetic facial contouring. The purpose of this study was to establish a new option for reduction malarplasty and analyze the merits and demerits of conventional operative techniques, thus searched for more effective and reliable surgical procedures. Records of 570 patients who underwent reduction malarplasty in our center from 1988 to 2008 were reviewed in this study. Several introduced malar reduction techniques were used until an alternative wedge-section osteotomy technique was performed by the senior author (X.M.) in 2002. This new technique consisted wedge-section osteotomy of the lower zygomatic body via intraoral approach and greenstick infracture of the posterior zygomatic arch through a tiny sideburn stab incision. In this way, the prominent malar complex could be reduced by being pressed inward and stabilized by only surgical suture in moderation. The surgical indications, major complications, and patient satisfaction of different techniques were compared. In our experience, intraoral incision was better than coronal incision because of less iatrogenic scar formation and postoperative complications. Our wedge-section osteotomy was more effective and reliable as compared with other conventional methods. Recently, intraoral and minor preauricular incision for malar reduction was more likely acceptable by surgeon as a typical procedure. Our new method was proven to be a safe, effective, and easily handled technique for malar complex reduction and thus was an optimal strategy for aesthetic facial shaping in Asians.

Reduction malarplasty using sliding setback osteotomy.

A prominent malar complex results in a triangular facial shape. When combined with a prominent mandibular angle, the face appear to be aggressive and masculine. Surgical procedures to correct these features are commonly requested by Asian women. Baek introduced reduction malarplasty by under-positioning of the "osteotomized" zygoma. We modified Baek's procedure by sliding the osteotomized zygoma superoposteriorly. The posterior surface is not separated from the soft tissue to preserve the blood supply to the zygoma. Ten patients with prominent zygomas underwent reduction malarplasty from March 1994 through July 1996. Seven patients were female and 3 patients were male. All patients were satisfied with their results. A symmetrical appearance was achieved in all patients. This method provides for precise malar reduction under good exposure. Symmetry of the zygoma is easily achieved. There is no effect on the survival of the malar bone after the procedure because the osteotomized zygoma has its own blood supply on the posterior surface. The masseteric origin is preserved, which ensures minimal cheek drooping after reduction.