Definition & Overview
Malar reduction, also known as reduction malarplasty, is a cosmetic surgical procedure used to reduce the size of the malar, or the cheekbones. While well-defined cheekbones are known to create an aesthetic appearance, some people, especially those with East Asian backgrounds, are prone to have excessively prominent cheekbones that do not look proportional or balanced with the rest of their facial features. This makes the face look too wide or too square in shape. Malar reduction surgery can effectively correct this problem and create a more balanced, more aesthetic appearance.
Who Should Undergo and Expected Results
Malar reduction surgery is for individuals who have overly prominent cheekbones. This may be due to a high malar body or high malar arch, both of which can make a person’s facial features look disproportionate. The result is usually a mandibular angle that is prominent on the frontal view, the lateral view, or both. When the bone is laterally prominent, it causes the face to appear too wide.
Thus, to qualify for the procedure, patients are first evaluated based on their facial symmetry, skeletal proportion, and their degree of zygomatic prominence. Their facial nerves status is also reviewed.
Patients who qualify for malar reduction are usually those with the following features:
- Broad face
- Fierce appearance
- Flat facial appearance
- Unsightly space below the malar
The procedure can involve the following:
- Resection or cutting the most protruding part of the zygomatic arch
- Bone fixation
- Buccal fat removal
- Moving the positions of the muscles, fat, and tiny nerves in the cheeks
How is the Procedure Performed?
There are numerous cheekbone reduction techniques that can be used to achieve the goal of the procedure. Most of them are performed under general anaesthesia administered via nasotracheal intubation with local infiltration of 0.5% lidocaine with adrenaline. The available techniques include:
- Intraoral approach/L-shaped osteotomy
- Scalp approach
- Rotation technique
One common technique is creating an L-shaped osteotomy of the zygomaticomaxillary junction using the intraoral approach, in which the incision is made near the mucous membrane inside the mouth. Once the 2-cm incision has been created, the body of the zygoma is cut with a special saw into an L shape. The arch is then held into a lifted position using pre-fabricated U-shaped microplates and screws. Studies show that this technique can achieve generally satisfying results with a low risk of complications, although it does require a follow-up period of 6 to 18 months.
Another technique is called zygoma reduction through the scalp approach method, in which the incision is made in the scalp above the ear (if the zygoma body has to be reduced) or in front of the ear (if the zygoma arch has to be reduced). This is effective in cases wherein the cheekbone protrudes frontally and laterally.
The size of the cheekbones can also be reduced using the rotation technique. In a traditional procedure, the lateral cheekbone is merely cut. However, this technique, although still commonly used nowadays, can sometimes cause bone instability due to the damage the bone suffers when it is cut. This is performed through the mesial-clockwise rotation of the zygomaticomaxillary complex, which can improve bone contact and thus reduce the malar volume. This technique can achieve the goals of a malar reduction procedure while also reducing the risk of cheek drooping due to bone instability.
If an incision is made, the wound will be sutured at the end of the procedure. The patient will then be given a follow-up schedule so that the doctor can check on the wound as it heals. In most cases, absorbable sutures are used, which means they no longer have to be removed.
Nowadays, malar reduction surgery can also be performed using both endoscopic and 3D techniques. Endoscopic malarplasty is known to cause less scarring and swelling due to the smaller incisions it requires. This also effectively speeds up recovery time.
Possible Risks and Complications
As a facial contouring procedure that requires facial incisions, a malar reduction surgery can put patients at risk of bleeding and infection. In a study performed on 54 patients who have undergone a reduction malarplasty using the zygomatic arch-lifting technique, at least 3 of them developed minor wound infections following the procedure. They were, however, easily treated with antibiotics.
Scarring is rarely a problem as malar reduction surgeries are performed using intraoral incisions or endoscopic techniques. However, patients can expect to experience some swelling and pain during the recovery period.
Other complications that have been associated with malar reduction include:
- Buccal branch facial nerve injury
- Protracted trismus
- Inadequate bone contact
- Bone instability
Harii Kiyonori. “Plastic, Reconstructive and Aesthetic Surgery: Reduction Malarplasty: A New Approach to Malar Bone by Double Incision.”
Mahatumarat C., Rojvachiranonda N. “Reduction malarplasty without external incision: A simple technique.” Aesthetic Plastic Surgery. June 2003; 27(3): 167-171.
Mu X. “Experience in East Asian facial recontouring: reduction malarplasty and mandibular reshaping.” Arch Facial Plast Surg. 2010 Jul-Aug;12(4):222-9.