Facial Contouring Causes Cheek Sagging 100%? Complete Summary of Zygoma Surgery Side Effects | Part 1

Hello, this is Dr. Jo Hyun-woo of IB Plastic Surgery.

Recently, phrases like “If you have facial contouring, cheek sagging will come 100%” and “If you undergo facial contouring surgery, you have to live getting lifting procedures for the rest of your life” have been circulating, and cheek sagging seems to have become a natural tag line attached to zygoma surgery and other facial contouring procedures.

Even among those who come for consultations about zygoma surgery and facial contouring, more than 90% ask about this cheek sagging.

So today, I’d like to explain cheek sagging after facial contouring, as well as side effects of zygoma surgery. To explain it in more detail, I’ve prepared this as a two-part series, Part 1 and Part 2. I’ll explain it as clearly as possible within my ability.

Does cheek sagging occur after zygoma surgery or facial contouring?

First, as I mentioned in a previous side effects post, any surgery that pushes bone inward or removes bone is accompanied by sagging. This is because when bone is pushed inward or removed, an empty space is created where the bone used to be, and the remaining tissue descends into that empty space due to gravity.

A procedure is done to become prettier, so if the cheeks sag, it would be a surgery you should not have done. However, in reality, under the condition that there are no exceptional problems with the skin tissue and the surgery was performed properly, the sagging referred to here is usually at a level that is difficult to confirm with the naked eye.

The “facial contouring cheek sagging” that people talk about likely refers to a state in which the skin visibly droops downward after surgery.

The causes of this noticeable facial contouring cheek sagging are

1. cases where the surgical procedure itself went wrong, and
2. cases where the patient’s skin tissue condition made cheek sagging highly likely, but it was not predicted in advance.

Facial contouring cheek sagging: when surgery went wrong

A case where zygoma surgery went wrong means that a) the cut bone was not properly fixed, or b) the retaining ligaments and muscles were dissected more than necessary.

In zygoma surgery that cuts the 45-degree zygoma, the cut zygoma must be firmly fixed after surgery.

If it is not properly fixed, the cut zygoma cannot fuse, and as time passes after surgery, the gap between the cut bone segments gradually widens, causing the zygoma to move out of its proper position. In this case, the surrounding skin and muscles descend along with the bone, making the skin appear sagged downward.

Revision zygoma surgery patient, cheek sagging

This is a photo of a patient who visited for revision surgery after surgery at another hospital. As you can see, cheek sagging appears in the left side of the face, around the tear trough area and the nasolabial fold area.

Side effect of zygoma surgery, nonunion, cheek sagging

If you check the CT scan, you can see that the zygomatic bones are not fused together and have fallen downward apart from each other.

In fact, when the bone does not fuse after facial contouring surgery, called “nonunion,” the problem is more serious than cheek sagging. Through revision surgery, the fundamental cause—the bone—must be put back into its proper position.

When nonunion occurs, pain is felt at the separated area, and because it feels as if the bone moves when chewing, you must visit the hospital as soon as possible to have it properly fixed so the bone can fuse again.

Also, fixing it only from the side, or fixing it after lowering it downward, may not secure it properly, which can also lead to cheek sagging.

When the face’s retaining ligaments and muscles are dissected beyond a certain extent during surgery, that is also a serious problem. To put it simply, the muscles and retaining ligaments serve to attach our skin to the facial bones. If they are damaged, the force that pulls the skin upward becomes weaker. Therefore, care must be taken not to damage the retaining ligaments and muscles during surgery, and if they are dissected more than necessary, cheek sagging is likely to follow.

When is cheek sagging more likely to occur?

Cheek sagging can also occur depending on skin elasticity. If the skin’s elasticity is weak, it is often already sagging, and the likelihood of sagging after surgery becomes greater.

In patients who develop cheek sagging after facial contouring zygoma surgery, the area above the nasolabial folds, above the tear trough lines, and the cheek tissue usually droops downward. By checking the condition and elasticity of the skin tissue in these areas before surgery, it is possible to assess the likelihood of sagging afterward.

I’ll show you a real patient photo.

Facial contouring cheek sagging, before zygoma surgery

This is a photo of a patient who had zygoma surgery this summer. If you look at the preoperative photo, you can see that the area I mentioned above, the tear trough line area and the nasolabial fold area, is already sunken in. If the skin is already sagging before surgery, there is a greater risk that sagging will become more severe after facial contouring surgery.

What should be done in cases where sagging is likely to occur?

In this patient’s case, during zygoma surgery we performed upward tight fixation that pulls the muscles and periosteum together, and we combined it with deep buccal fat removal and lifting procedures.

Facial contouring cheek sagging, after zygoma surgery

This photo was taken when the patient visited for a 6-month follow-up after zygoma surgery. It can be confirmed that the overall facial sagging seen before surgery improved significantly due to the lifting and deep buccal fat removal. Because the muscles and periosteum were pulled together, there is no visible sagging in the zygoma area either.

If the skin’s elasticity is reduced like this, combining procedures such as liposuction or laser tightening can help address cheek sagging and tissue sagging problems.

For those who would like a more detailed explanation, I recommend referring to the video.

Today, we first looked at facial contouring cheek sagging and nonunion, which are among the side effects of zygoma surgery. In the next post, I will explain nerve damage and cheek hollowness. Thank you.

The link is a page that separately collects reviews written directly by patients who underwent zygoma surgery. ^^