Zygoma Reduction Surgery and Cheek Sagging

​One of the biggest concerns and misconceptions among people considering zygoma reduction surgery is, in my view, the understanding of cheek sagging related to zygoma surgery.

 

In fact, even many board-certified plastic surgeons who perform these operations in clinical practice often seem to have a somewhat inaccurate understanding of cheek sagging associated with zygoma surgery. As a result, I think there are far too many mistaken ideas among the general public who consult about and 고민 (consider) zygoma surgery.

 

This is based on my own experience, so it is not something that has been fully verified or broadly agreed upon, but I am posting it because I felt it should be stated honestly and clearly.

 

Based on my experience, the conclusion is that the cheek sagging associated with zygoma surgery is caused by complete osteotomy of the body of the zygoma.

 

Even 10 years ago, I used a method in which the anterior part of the zygoma body and the posterior part of the zygomatic arch were completely cut, and the two cut areas were fixed.

 

The advantage of the method of making two osteotomies and fixing them was that it was easy, simple, and did not take much operating time.

 

At that time, the surgery time required from the start to the finish of zygoma reduction surgery was about 40 minutes.

 

Until as recently as four years ago, I would occasionally use the method of completely osteotomizing and fixing the anterior body of the zygoma depending on the case.

 

However, there are two reasons I no longer use such a method.

 

First, I came to understand through long-term follow-up results that even if the zygoma body is completely osteotomized and fixed as far upward as possible, cheek sagging inevitably occurs and does not improve over time.

 

Second, if the zygoma body is completely osteotomized, a step-off deformity may occur at the osteotomy site of the outer bony area near the eye corner, and partial gaps can form, disrupting the continuity of the bone.

 

 

 

I think the misconceptions about cheek sagging that occurs after zygoma surgery are as follows.

 

First, cheek sagging inevitably occurs after zygoma surgery.

 

• Based on my experience, when zygoma surgery (zygomatic reduction surgery) involves complete osteotomy of the anterior zygomatic area (the zygoma body or the 45-degree zygoma area) or removal of part of the bone, cheek sagging can inevitably occur. However, if the anterior zygomatic area is partially osteotomized, my conclusion is that once time passes and the swelling subsides, there is no cheek sagging.

 

 

Second, cheek sagging occurs because too much dissection is done during zygoma surgery.

 

• Of course, if an unnecessarily wide area is dissected during zygoma surgery, cheek sagging can occur. However, experienced surgeons dissect only within a range that preserves the retaining ligaments connecting the zygoma to the skin, so in reality this does not become a direct cause of cheek sagging related to the surgery.

 

 

Third, during zygoma surgery, cheek sagging can be prevented by lifting the cut zygoma upward and fixing it.

 

• After analyzing 3D CT scans of several people who came to me for revision surgery after having undergone zygoma reduction surgery elsewhere and being dissatisfied with the results, I reached the conclusion that when nearly more than half of the zygoma body is cut away and fixed upward, cheek sagging actually occurs more severely.

 

Fourth, to prevent cheek sagging that can occur during zygoma surgery, the operation must be performed through a scalp incision.

 

• In zygoma reduction surgery, the direction in which the soft tissue covering the bone moves is toward the area where the bone is moved the most. Therefore, if the posterior part of the lateral zygoma is moved as much as possible, the postoperative soft tissue movement will be in a posterosuperior direction.

As a real example, in cases where I performed revision surgery for people who had previously undergone zygoma reduction surgery through a scalp incision and whose facial width had not decreased very much, I was able to achieve results that made the face look younger after surgery.