1. New Technique for Zygoma reduction
Minbum Kang,M.D.
Romian Plastic Surgery Clinic, Department of Craniofacial surgery, Seoul, Republic of Korea.
| Background
Zygoma reduction is commonly performed in Asia because a broad face is considered stubborn in appearance and unattractive. Consequently, a number of different techniques have been developed for zygoma reduction, but no consensus has been reached on the optional method; the majority of these techniques involve simple manipulations. In the present report, we introduce a new method involving ostectomy and fixation that enables a three-dimensional approach to zygoma reduction.
| Methods
From 2007 to 2013, 221Korean patients (39 men, 182 women) underwent zygoma reduction with this technique.The bone was accessed via an intraoral and preauricular incision and removed in the body area using a small L-shaped osteotome through bone cutting in the arch area. The zygoma was moved forward, inward, and upward and then fixed with miniplate and screws.
[Table 1] Classification of patients based on age and gender
Age(years)/Gender
Male
Female
Total
<20 4
21-30 23 84
107
31-40 11 60 71
41-50 25 29
51-60 9
>60 1 39
182
221
[Fig.] Schematic simulation of the three-dimensional approach for performing the zygomatic reduction technique.
[Table 2] Patient classification according to the surgeries performed concomitantly with the zygoma reduction
No concomitant surgeries
167
Angle resection, Tubercle resection 6
Angle resection 14
Rhinoplasty 33
Angle resection, Rhinoplasty 1

2. | Results
In total, 215 patients(97.3%) were satisfied with this surgical method. Four (1.8%) required undercorrection and underwent reoperation but were eventually satisfied. Two patients(0.9%) experienced overcorrection with a sunken area around the zygoma, which was corrected with autologous fat grafting after 6months. Two patients complained about sensory changes around the upper lip, which resolved within 6 months. Two patients experienced dizziness, temporomandibular joint pain, infection, and/or cheek drooping.
[Table 3] Complications during the postoperative period.
Complications
(<6months)
No. of patients
Treatment
Bleeding
Admission for 1 day
TMJ pain 1
None
Dizziness(tinnitus) 2
Transfer to ENTclinic
Infection
Daily IV anti treatment for 3days
Sensory change
Revision (undercorrection) 4
Revision
Cheek drooping
Bone nonunion
Overcorrection
Fat graft
| Case 1
A 25-year-old woman presented to our clinic and complained of a broad face that resulted in a masculine appearance. She was recommended to undergo angle resection with tubercles excision concomitant with zygoma reduction. She underwent these surgeries and received a satisfactory result.
| Case 2
A 32-year-old woman complained of a prominent zygoma and facial angle, an anti-mongolian slant and epicanthus, and a flat forehead. She underwent mandible angle resection with tubercles excision, lateral canthoplasty, medial canthoplasty, and autologous fat graft on the forehead and nose. She was satisfied with the results.
| Conclusion
This new surgical technique causes less frequent and pronounced cheek drooping and requires less bone stepping, resulting in greater patient satisfaction.