Application of three-point rigid internal fixation technique in reduction malarplasty / 中华医学美学美容杂志

Objective To evaluate the effect of three-point rigid internal fixation technique in reduction malarplasty for prominent malar complex.Methods From January of 2014 to January of 2017,45 patients with prominent malar complex were treated with double L shape osteotomy combined bony Z plasty and three-point rigid internal fixation for prominent malar complex.The preoperative and postoperative photographs were taken to monitor the contour improvement,the adverse effects were recorded,and 3D CT was used to assess the bone union situation at 6 months after operation.Results All the wounds got primary intention healing and no severe complication occured in perioperative period.3D CT showed good bone recovery 6 months after operation.Postoperative appearance of all cases showed that the width of middle face was efficiently reduced.All patients expressed high levels of satisfaction.Conclusions Reduction malarplasty with three-point rigid internal fixation for prominent malar complex is an effective and safe method for the treatment of prominent malar complex.

Application of combined osteotomy with midfacial SMAS lift in comprehensive correction of facial shape / 中华医学美学美容杂志

Objective To observe the surgical results of prominent malar-complex and to explore the more effective methods by improving the shape of face through operation.Methods Total 80 patients of prominent malar-complex were treated by strengthening reduction plasty of mala and zygoma through intra-oral approach accompanied with minor pre-auricular incision and the midfacial SMAS lift in order to improve the shape of prominent malar-complex and to prevent malar-cheek parenchyma sag.Results The face skeleton and midfacial chalasis of all patients were significantly improved with satisfaction.All the patients obtained good results during the follow-up period of over six months.Of them there was one case of maxillary sinusitis that had been cured by further symptomatic treatment.Conclusions Strengthening reduction plasty of mala and zygoma accompanied with the midfacialSMAS lift can properly and safely improve the facial shape of patients with prominent malar-complex.

Concept of Reduction Malarplasty

Reduction malarplasty is one of the most frequently performed facial contouring surgeries in eastern Asia. Intraoral approach makes the most of the part, and coronal approach is used in revision cases or older patients who consider simultaneous lifting. In most reduction malarplasty cases malar highlight area is moved medially or posteriorly. The ostectomy should focus on medialization of the body, not reducing the volume. It is better to perform fixation on both body and arch of malar bone. Fixation of the body should at least be done with separate two bridges across the ostectomy line. Risk factors of sagging include low skin elasticity, abundant soft tissue, old age and deep nasolabial fold. The patients with these factors should be explained thoroughly about postoperative cheek drooping. Accurate planning of reposition and solid fixation should always be done.

Prevention of Cheek Drooping in Intraoral Reduction Malarplasty without Internal Fixation

PURPOSE: In general, orientals including Korean, have a mesocephalic face whereas Caucasians, among the western, have a dolichocephalic face .Unlike the western, in orientals including Korean, prominent malar bones are recognized as stubborn and unattractive appearance. That is why reduction malarplasty is one of the most popular aesthetic surgical procedure in Korea. Many surgical methods to reposition prominent malar bones have been performed by means of a coronal incision or a combined incisions, using both the intraoral and the external incision. Bicoronal approach has advantage such as wide operative field, easy to maintain symmetry and possibility of combining facial lift but has shortcoming, such as external scars, long operative time, and the possibility of facial nerve or artery injury. Intraoral approach has advantages of short operative time, simplicity of procedure and no external scar. But this approach is associated with problems of cheek drooping, limited exposure and difficulty in making symmetry. METHODS: During 8 years, we performed a reduction malarplasty without internal fixation through an minimal intraoral incision and dissection in 39 patients. RESULTS: The patients were followed for 46 months, with satisfactory results and no cheek drooping. There was no patient who want to revise the inappropriate operative result such as asymmetry and incomplete correction. CONCLUSION: We conclude that minimal intraoral incision and dissection could acquire satisfactory result of reduction malarplasty along with prevention of cheek drooping.

Effective Reduction Malarplasty Considering Pivot Point

PURPOSE: Reduction malarplasty is one of the common aesthetic procedures performed in the Orient. We have analyzed effective operative methods according to the pivot point for the osteotomy and reposition of the zygoma for reduction malarplasty after confirming the shapes of the individual zygomas. METHODS: Thirty-six patients had been received malarplasty over the last 10 years. The average follow-up period was 16 months. We categorized the patients into three groups according to their prominent appearance features. Group I had a prominently protruded zygomatic body, group II had a prominently protruded zygomatic arch, and group III had a prominently protruded body and zygomatic arch. In the group I, two parallel oblique osteotomies on the body, the middle portion was removed, and with the zygomatic arch as the pivot point, the body was repositioned inwards. In the group II, the zygomatic body and arch osteotomy is performed, with the body as the pivot point, and the arch is depressed medially. In the group III, using the two aforementioned methods, the zygoma was repositioned medially. In each case, postoperative complications and patients satisfaction over the surgery were surveyed. RESULTS: Each group had 25, 5 and 12 patients respectively. No significant complications were found except for one patient who experienced a non-union of zygomatic bone. In the case of group I, four patients underwent a secondary operation. CONCLUSION: Reduction malarplasty is popular as an effective facial contouring surgery. In order to obtain more effective results,however, the zygomatic shape should be identified, and appropriately repositioned by different operative technique according to pivot points.

Reduction Malarplasty

Malar reduction procedure is one of the most frequently solicited facial bone contouring procedures, and at the same time it would appear to be the least understood among surgeons and people. There have always been debates about the surgical techniques, including approaches, osteotomies, ostectomies, fixations and the outcomes such as cheek droop, symmetry, and visible scars. Many authors have described various ways of malar bone reductions, and surgical techniques have continuously developed, but not the philosophy for the procedures. From the beginning, the most important parts have relatively been ignored. Is the malar reduction really necessary for Orientals, while Western people desire their cheek bones augmented? What are the indications and contraindications of the malar reduction procedures? What are the real benefits of these procedures? I present herein my personal concepts about the malar reduction procedures, so as to move on from the debates of detailed techniques to a new paradigm, which best explains the cons and pros of reduction malarplasty.

Intraoral Reduction Malarplasty with Simultaneous Zygomatic Soft Tissue Lifting: Prevention of the Mid-Face Sag

No abstract available.

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.

Intraoral Reduction Malarplasty without Internal Fixation

The concept of the Asian facial beauty is different from that of the western. Caucasians, especially among the western, consider prominent malar bones as a sign of youth and beauty. But in Orientals including Koreans, prominent malar bones are recognized as unattractive. Until recently, operations to reposition prominent zygoma have been performed by means of a coronal incision or a combined approach, using both the intraoral and the external(preauricular, temporopreauricular or side burn) incision. Such incisions have shortcomings such as external scars, long operative time, and the possibility of facial nerve or artery injury. Intraoral incision alone is associated with problems such as cheek drooping, limited exposure in the area of zygomatic arch, and difficulty in making symmetry of the cheek. During the past 4 years, we performed a reduction malarplasty without internal fixation through an intraoral incision alone in thirty-six patients who have prominent zygoma, mainly lateral projection of the zygoma. Osteotomy of the zygomatic arch was done posteromedially using a 120 degrees-angled oscillating saw, 1cm anterior to the articular tubercle and then osteotomy of the zygomatic body was done using a reciprocating saw. After complete osteotomy and posteromedial reduction, fixation using miniplate or wire was not done. The patients were followed for 14 months, with satisfactory results and few complications. We conclude that this technique is a simple and effective method of conduction an intraoral osteotomy and reduction malarplasty without internal fixation.

Correction of Nonunion of Zygoma Body after Aesthetic Reduction Malarplasty

The Asian face is generally shorter and wider than western face whose face is dolichocephaly. Therefore the reduction malarplasty is one of the common aesthetic surgery performed in Asians. As the number of cases of aesthetic reduction malarplasty including osteotomy technique of zygoma body increase, the complications related to the osteotomy also increase. Among the various complications, if the ostotomized zygoma body does not heal or reunite, it may cause a serious problem not only to the surgeon but also to the patients. From June 2002 to July 2003, the authors experienced 5 patients whose zygoma body did not reunite after reducing their malar prominence at other clinic. Their major complains were subjective discomfort at the operated site, depression on malar eminence, abnormal click sound on mouth opening, etc. None of them had any evidence of rigid fixation on their osteotomy of the zygoma body. The Rib bone was harvested and grafted to the bone gap due to the nonunion of zygoma body. All grafted bones were rigidly fixed and survived. In conclusion, bone to bone contact without soft tissue impingement should be preserved for the bone healing after zygoma body osteotomy. Therefore the rigid fixation method of osteotomy is the fundamental element during the operation. The rib bone interpositional graft can be one of the solution methods in the unfortunate nonunion cases.

Osteoma after Reduction Malarplasty

Osteoma is a benign tumor arising from cancellous or compact bone. Frontal sinus is the most common site, followed by the ethmoidal sinus, maxillary sinus, sphenoidal sinus, maxilla and mandible. Very few cases involving the mandible have been described. A 26-year-old woman who had a limited range of mouth opening was reffered to our clinic. The limited opening had been gradually increasing in severity after first operation(reduction malarplasty and angle resection). Computed tomography images showed a radiopaque mass between left mandibular notch and zygomatic arch. After surgical removal of mass, diagnosis of mass was osteoma from clinical pathology. The postoperative course was uneventful, the patient could open the mouth about 40 mm, 5 months after the operation.

Facial Rejuvenation Surgery Combined with Malarplasty or Angleplasty

In general, Oriental people have thicker facial skin with more subcutaneous adipose tissues than Caucacian people. These differences result in characteristic Oriental aging face combined with squared facial contours. Conventional face lift essentially consists of facial wrinklinges and reducing flaccidity of facial skin but squared facial contouring is not considered. Flat and squared face can be improved by reduction malarplasty and mandibular angleplasty, thoses are the common facial bone contouring surgeries performed in the Orient. If patients, who have aging face, also have flat and squared face, it is necessary to be performed face lift and facial bone contouring surgery simultaneously. We have experienced 18 cases of patients with aging face and squared face who were operated face lifting procedures combined with maloplasty or angleplasty(from Apr.1997 to Mar. 2001). And We have satisfactory results on most patients(16 cases of patients were satisfied with results).

Reposition and Fixation in Reduction Malarplasty

Reduction malarplasty is one of the common aesthetic procedures performed in the Asia. Several surgical techniques for malar reduction have been reported. In reduction malarplasty, 'reposition of mobile malar complex to more cosmetically beneficial point' is more important than making flat malar complex. 'Fixation of bone on body and arch' is important for considering the action of attached masticating muscle to zygomatic bone. We have performed reduction malarplasty which consists of lateral orbital osteotomy and oblique osteotomy on zygomatic arch, reposition of mobile malar complex to more cosmetically beneficial point, and fixation of bone on body and arch with wires through bicoronal incisions over 700 patients from January, 1984 and through preauricular and intraoral incisions in 30 patients from December, 1997 to December, 2001. Preauricular and intraoral approaches can be indicated in most cases of mild to moderate prominence and malposition of malar complex, and bicoronal approach can be indicated in cases of severe prominence and malposition of malar complex and need of combined procedures such as face lift, frontal and orbital contouring. We have obtained satisfactory results with using reposition and fixation in reduction malarplasty.

The Analysis of Perioperative Photogrammetry in Reduction Malarplasty Patients

Facial contouring surgery is a one of the most common and popular procedure in the field of plastic surgery. The aim of this study is to evaluate the effectiveness of photogrammetric analysis by measuring preoperatively and postoperatively in the patients who were undertaken reduction malarplasty. From January 1995 to May 1999, from thirty patients of reduction malarplasty, Photography of life size - frontal view, lateral view, worm's eye view - were taken. The photograph was analyzed by the same surgeon to reduce an analytic error. The distance between both malar eminences and both zygions was the anatomical landmarks. The differences between pre- and postoperative photographic distance represented the results of the operation. The distance between both malar eminences (ME): preop/postop = 94 - 105 mm/89 - 99 mm. The distance between both zygions(ZY): preop/postop = 125 - 141 mm/ 120 - 135 mm. The reduction values of ME-ME/ZY-ZY are 3 -13 mm / 4 - 12 mm. The photogrammetric analysis of reduction malarplasty was very practical in measuring postoperative changes. We may assume that photogrammetric analysis may be very useful tool on preoperative diagnosis, plan and analysis of result of operation.

Reduction malarplasty with bone ostectomy & repositioning only using intraoral approach