What Are the Problems with the Non-Fixation Method in Zygomatic Bone Surgery?

Q.

I’d like to ask about the surgical method that uses fixation... I’m not an expert, so I have a lot of questions...

1. In fixation surgery, is the reason for fixation that the 45-degree zygoma, the front zygoma, and the side zygoma are cut?

2. If, instead of cutting the bone, a method of shaving down only the 45-degree zygoma is chosen, is fixation unnecessary?

3. If the method of shaving down only the 45-degree zygoma is chosen, are the side effects large? (Cheek sagging, nasolabial folds, etc.)

4. If I want surgery only on the side zygoma, and only the side zygoma is cut and moved inward, is fixation absolutely necessary? (I’ve heard it will stick well because of the periosteum.)

I’ve heard that most side effects, such as cheek sagging or malunion, happen because the 45-degree zygoma or the front zygoma is cut and moved, but fixation is not done or is not firm enough at that time.

If the 45-degree zygoma is shaved, it is not cut and moved, so I would think fixation is not needed...

I’m curious what the specialist thinks.

 

A.

 

Hello,

 

I am Director Jeong Jae-young of Zereum Plastic Surgery.

 

For a detailed consultation, you would need to visit in person and hear an explanation to understand it to some extent.

 

1. The reason fixation is absolutely necessary in zygomatic bone surgery is as follows, and I have explained it well on my blog.

 

To move the side zygoma inward, the front and back parts of the zygomatic arch that make up the shape of the side zygoma must be properly cut so that the zygomatic bone can move inward sufficiently, allowing the reduction effect on the side zygoma to be expected.

 

If the osteotomy is not done properly, the chance of nonunion of the zygomatic bone may be low, but there would be no reduction effect on the side zygoma at all.

 

2. If you do not cut the bone and only shave down the 45-degree zygoma, there is no reduction effect on the side zygoma at all.

 

Of course, even in my case, when only the front zygoma is being reduced, I sometimes use the method of shaving down only the 45-degree zygoma.

 

In such cases, the surgery takes about 40 minutes, the procedure is simple, and there is almost no swelling after surgery.

  3. In the case of the method that shaves down the 45-degree zygoma, there are almost no side effects.

 

Even a plastic surgery specialist with not much experience in zygomatic reduction surgery can perform it without much difficulty, and you can understand it as a very simple and comfortable surgery with no need to worry about side effects.

 

4. The claim that fixation is unnecessary because the periosteum remains intact during surgery in which the side zygoma is reduced by cutting the bone and moving it inward is, frankly, a rather exaggerated excuse.

 

The reasons are the following two points.

 

First, the periosteum is an extremely thin tissue that surrounds the bone and has almost no elasticity.

 

In order to move the side zygoma inward by nearly 10 mm, or even up to 15 mm, on one side, the periosteum cannot maintain continuity as it is.

 

Second, if the periosteum remains intact and therefore fixation is unnecessary, then even when osteotomy is performed in other parts of the body, there would be no need for fixation either.

 

Saying that osteotomy can be done while preserving the periosteum is somewhat far-fetched.

 

If you decide to undergo surgery after hearing such an explanation, be sure to have 3D-CT scans of the zygomatic bone before and after surgery at a radiology specialist clinic as a condition for proceeding with the operation.

 

Because I have seen too many cases of damage caused by non-fixation after zygomatic bone surgery, the final point I would like to emphasize is the following.

 

Therefore, if you are not planning to have surgery using a clear and proven method, I think it may be better not to have the surgery at all.

 

Since the person who left the inquiry has not disclosed any personal information at all, and also posted it as a public post,

 

it should be okay for me to quote the inquiry and my reply on my blog, right?

 

Anyway, I hope you have a good day^^

 

Zygomatic bone surgery is not a procedure where time is of the essence, and if the surgery goes wrong even once, it can create a condition that is difficult to reverse, so please decide carefully.