Zygomatic bone revision surgery methods for unsatisfactory results after zygomatic bone surgery - overview

Zygomatic bone revision surgery 

 

1)     Causes that lead to considering revision surgery

Cases where the contour of the lateral cheekbone did not decrease at all after zygomatic reduction surgery

-       The zygomatic bone is a structure that determines the contour of the midface (the central part of the face), and it is composed of the body of the zygomatic bone, which forms the contour of the anterior cheekbone, and the zygomatic arch, which determines the contour of the lateral cheekbone.

-       In surgery that changes the contour of the zygomatic bone, if the zygomatic arch, which is responsible for the contour of the lateral cheekbone, is not moved inward accurately and fixed, and only the anterior cheekbone area is cut and fixed, the width of the face may not decrease at all, resulting in only the anterior cheekbone becoming flat. (Fig. 7) Zygomatic bone revision surgery

 

Cases where a line appears in the area connecting the anterior cheekbone to the lateral cheekbone after zygomatic reduction surgery

-       If, after cutting part of the anterior cheekbone during zygomatic reduction surgery, it is not properly fixed in the correct position, the cut area may not join, leaving a gap in the bone, or the bone may sag downward. (Fig. 8)  Zygomatic bone revision surgery

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Cases where the front cheek appears significantly sagged after zygomatic reduction surgery

-       In general, after zygomatic reduction surgery, between 3 and 6 months, swelling may make the front cheek look a bit fuller or the nasolabial folds may appear more prominent, but between 6 months and 1 year, it returns to normal.

-       The following are cases in which a bone problem occurs due to technical issues during zygomatic reduction surgery.

If, during zygomatic reduction surgery, part of the anterior cheekbone is cut and the posterior zygomatic arch is also cut, and it is not securely fixed in the correct position, the masseter muscle's downward pulling force can cause the zygomatic bone to sag downward, making the cheeks appear drooped. (Fig. 9)  Zygomatic bone revision surgery

 

 

2)     Preparation when considering revision surgery  Zygomatic bone revision surgery

Because zygomatic reduction surgery, like square jaw surgery, is performed mainly through the inside of the mouth, performing the surgery under general anesthesia is essential for safety.

The zygomatic bone has a much more three-dimensional structure than the lower jaw, so with ordinary planar X-ray examinations, it is difficult to accurately assess the bone's three-dimensional shape.

Therefore, a three-dimensional CT scan (a computer tomography scan reconstructed in 3D) is essential to determine how the zygomatic bone position changed after the previous surgery.

 

 Zygomatic bone revision surgery

 

 

 

3)     Revision method

Cases where the contour of the lateral cheekbone did not decrease at all after zygomatic reduction surgery

-       First, through a three-dimensional CT scan, it is necessary to check whether the anterior cheekbone area is properly joined or whether there is any bone defect (an area where the bone is not joined) in the zygomatic arch area.

If there is no problem in the anterior cheekbone area, cutting the most posterior part of the zygomatic arch (the area connected to the skull) and moving it inward can reduce the facial width by up to about one finger-width on one side. (Fig. 10)

 

Cases where a line appears in the area connecting the anterior cheekbone to the lateral cheekbone after zygomatic reduction surgery

-       After confirming the extent of the bone defect (an area where the bone has not joined and has been resorbed, leaving a gap) in part of the anterior cheekbone through a three-dimensional CT scan, it is necessary to cut the posterior part of the zygomatic arch and fix the anterior zygomatic body in a stable position using wire fixation or metal fixation. (Fig. 11) Zygomatic bone revision surgery

 

Cases where the front cheek appears significantly sagged after zygomatic reduction surgery Zygomatic bone revision surgery

-       If the nasolabial folds became deeper or the front cheek looks fuller simply because of soft tissue swelling after zygomatic reduction surgery, waiting for time alone will improve it, at the latest within 1 year.

-       However, if the zygomatic body and the two posterior points of the arch are cut and not fixed, the masseter muscle pulls the zygomatic complex downward, causing the bone to sag overall and making the face appear drooped.

-       In such cases, the sagging zygomatic bone must be lifted upward and fixed through an intraoral incision and an incision in the sideburn area so that the bone can heal properly. (Fig. 12)

 

The above content is the material I presented at the "2005 Autumn Conference of the Korean Society of Plastic and Reconstructive Surgeons" and the "2008 Symposium of the Association of Private Practice Plastic Surgeons"

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