Will cheekbone reduction surgery also make the face smaller? : Learn about how to reduce prominent cheekbones with real surgical cases

Hello, I’m Dr. Cho Hyun-woo of Insati Plastic Surgery.

Today’s topic is one many people may be curious about.

How much smaller does the face get after cheekbone reduction surgery?

This is the question I always hear when I consult with patients, and the one I hear most often.

Many people come in for consultations to make their faces smaller and more refined, so it is only natural that how much it will be reduced is an important issue.

Strictly speaking, cheekbone reduction surgery is not a resection procedure like square jaw surgery, where the amount to be cut can be planned in advance. Rather, it is a surgery that reduces the width of both cheekbones by rotating the cheekbone arch.

To put it another way, with square jaw surgery, if you plan to cut 1 cm, you can do that for every patient (as long as the nerve line is not positioned too low),

but with cheekbone reduction surgery, the amount the bone moves inward is determined by the thickness of the patient’s bone.

If you measure the thickness of the cheekbone arch before surgery, as in the schematic on the left, you can estimate in advance how much the cheekbone can move inward after surgery, as shown on the right.

As in the schematic on the right, the inner side of the cheekbone arch after it has been moved inward must fit exactly against the original bone for the bones to unite properly after surgery and avoid nonunion.

Even in a CT image of an actual patient who underwent surgery, you can see that the bones unite after moving inward by exactly the thickness of the bone, as shown in the photo above.

During consultations, I sometimes meet patients who come in after being told at another hospital that too much bone would be moved inward. However, that is likely not an accurate explanation.

In general, the thickness of the cheekbone arch is about 3–5 mm in women and 5–7 mm in men.

Therefore, for women, the total width reduction on both sides can be said to be up to about 1 cm.

When I explain this to patients, many respond by saying, “Only 1 cm?”

But 1 cm on the facial bones is by no means small. For example, if a woman’s facial width is roughly 17 cm, a reduction of 1 cm brings it down to 16 cm.

As another example, if a person who is actually 170 cm tall were to become 160 cm tall, that would be a very large change in proportion.

So on the facial bones, 1 cm can by no means be called a small amount.

I’ll show you a real patient case.

(Left) Before surgery (Right) After surgery

On the preoperative CT, the bone thickness was measured at about 5 mm, and on the CT taken 6 months after surgery, you can see that the bone had moved inward by exactly that thickness and united.

If a more accurate prediction is made with 3D CT and the surgery is performed accurately and safely, cheekbone reduction surgery can produce predictable results.

(Left) Before surgery (Right) After surgery

Another question that comes up often is:

“I heard that if the back side of the cheekbone is fixed, it can be reduced more. Is that true?”

Of course, if fixation pins are used on the posterior side, the bone can be rotated and fixed more than the actual thickness of the cheekbone arch.

In fact, there are various types of fixation pins, ranging from 5 to 8 mm, and they can all be used.

However, as you can see in the CT above, if the bone is pushed in too much, the two bones will not meet properly and a solid union cannot form.

Of course, since fixation pins are in place, there would be no concern that it will move, and other surrounding tissues would fill in the gap. But this cannot be considered the correct surgery.

At this time, if cheekbone overcorrection occurs, the inwardly reduced cheekbone may compress the muscles or coronoid process, causing difficulty opening the mouth or pain in the temporalis muscle.

Overcorrection from cheekbone reduction is when an excessive focus on cosmetic goals ends up causing functional problems.

Therefore, I do not recommend forcing the cheekbone too far inward using fixation pins.

(Left) Before surgery (Right) After surgery

So far, we have looked at how much the cheekbones can be reduced through cheekbone reduction surgery.

Taking a CT of your own face and reviewing it will help establish an accurate surgical plan.

Thank you.