Prevention of Complication and Management of Unfavorable Results in Reduction Malarplasty

PURPOSE: Reduction malarplasty is a popular aesthetic surgery for contouring wide and prominent zygoma. However a few patients complain postoperative results and want to revise the midfacial contour. We analyzed the etiology of unfavorable results and treated unsatisfied midfacial contours after reduction malarplasty. METHODS: Total 53 patients were performed secondary operation for correction of unfavorable results after primary reduction malarplasty from elsewhere. Midfacial contour was evaluated with plain films and three- dimensional computed tomography. Unfavorable midfacial contours were corrected by secondary malarplasty. Flaring of zygomatic arch was reduced with infracturing technique and prominent zygomatic body was reduced with shaving. Drooped or displaced zygoma complex has been suspended to higher position and fixed with interosseous wiring. As adjuvant procedure, autologous fat injection has been performed in the region of depressed zygomatic body region. RESULTS: The etiology of unfavorable midfacial contour after reduction malarplasty was classified into 7 categories: undercorrection of zygomatic arch(n=8), undercorrection of zygomatic arch and undercorrection of zygomatic body(n=6), undercorrection of zygomatic arch and overcorrection of zygomatic body(n=28), overcorrection of zygomatic body(n=3), simple asymmetry(n=4), malunion(n=2) or nonunion(n=2). Slim and balanced malar contour was achieved with treatment. And most of the patients were satisfied with the results of the surgery. CONCLUSION: To prevent the unfavorable results after reduction malarplasty, complete analysis of facial contour, choice of appropriate operation technique, precise osteotomy under direct vision, and security of zygoma position are important.

Facial Rejuvenations in North East Asians

In North East Asians, they have many anatomical characteristics different from Caucasians: thick skin, heavy subcutaneous tissue, relatively weak SMAS and platysma muscle, prominent zygoma and mandible. In addition, Caucasians have lean and narrow face, so facial flap can easily be lifted superiorly and posteriorly, but North East Asians have short and wide face, so facial flap cannot be lifted easily in a three dimensional direction especially superiorly and posteriorly. Recent facial rejuvenation has been improved to solve these problems through various combined adjuvant surgery. We performed facial rejuvenation with following surgical emphases:1. Shaving and infracture of zygomatic prominence and multistaged curved osteotomy of the prominent mandibular angle, body and symphysis 2. Earlier Skin resection before flap dissection protects the skin incision margin 3. Sufficient fat removal by facial liposuction4. Plane of dissection; suborbicularis and submalar fat pad in midface: preplatysmal layer in lower face and neck 5. Excision of lateral part of orbicularis oculi muscle for correction of crow's feet. 6. SMAS plication and platysmal sling. Based on our experiences, we offer these personal techniques for facial rejuvenation of North East Asians.

Zygomatic Reduction using Infracture Technique through Intraoral and Short Preauricular Incision

Nowadays infracture technique for the zygomatic body and arch reduction has been popularized in North East Asians. Previously, we could obtain sufficient operative field to handle the zygoma through the intraoral and temporopreauricular incision, and control the amount of shaving and infracturing of zygomatic prominence. To reduce the length of the large temporopreauricular incision, we developed a technique using short 22 mm preauricular incision. We performed malar reduction with the technique in 91 cases from September, 2000 to June, 2001 using infracture technique through short 22 mm preauricular and intraoral incision. We performed posterior bony cutting on the zygomatic arch through the preauricular incision and anterior bony greenstick cutting through the intraoral incision. Then, lateral bulging of zygomatic arch was reduced with infrature and the posterior fractured ends were fixed with a microplate and 3 screws. Advantages of the technique are operative time saving, improved external scar and reduction of postoperative edema around the operative site. However, due to decreased operative field through small preauricular incision, shaving of the lateral portion of zygomatic body is limited and postoperative complications may occur such as asymmetry, undercorrection, overcorrection and incorrect contour lines. To overcome these, the correct understanding of the anatomy and much experience of operator are imperative. With this combined approach, we can sufficiently expose the zygomatic arch and body and change the lateral convex arch to a concave one. We can effectively perform the infracture technique through much smaller preauricular incision without resulting in a large and conspicuous external scar.