A Complete Summary of 6 Complications After Cheekbone Surgery: Sinusitis, Recurrence, Hollow Cheeks, and Sagging Cheeks

Hello, this is Dr. Jo Hyun-woo from 입체성형외과.

These days, I seem to receive more inquiries about revision surgery than about cheekbone surgery itself.

Even after cheekbone reduction surgery, many people seem to consider revision surgery for reasons such as not feeling the effect, the osteotomy site not being properly fixed after surgery, or nonunion occurring.

So today, I will organize all possible side effects of cheekbone surgery, along with real cases.

Is sagging after cheekbone surgery inevitable?

To begin with the conclusion, all surgeries that shave bone are accompanied by sagging.

However, under the condition that the surgery was performed properly, the sagging is at a level that is not noticeable to the naked eye.

When bone is shaved, an empty space naturally forms where the bone used to be.

Then the tissue left in that space will sag due to gravity.

But the sagging that occurs at this time is very slight, so in reality it is difficult to confirm with the naked eye.

So why do people say they developed sagging cheeks after cheekbone surgery?

In most cases, when people feel sagging after cheekbone surgery, it is because the surgery was not performed accurately.

Here, not performed accurately means either 1) the cut bone was not properly fixed, or 2) the bone was dissected more than necessary.

I will show you the CT image of a patient who visited us with a sagging-cheek problem after cheekbone surgery at another hospital.

[입체성형외과] Side effect of cheekbone surgery, sagging cheeks

If you look at this CT, you can see at a glance—even without being a specialist—that the gap in the cut cheekbone is wide open, showing that the surgery was done incorrectly.

In this patient’s case, it was because proper fixation was not performed during surgery.

If proper fixation is not done, it may look as though the bone is fixed at the time of surgery, but as time passes, the gap between the cut bones widens and the cheekbone moves away from its original position.

As you can see, when the cheekbone moves downward, the skin and muscles attached to the cheekbone naturally move downward as well, making the skin look saggy.

Dissection of more bone than necessary is also a serious problem.

The retaining ligaments that support the skin of our face can be cut, and the periosteum can also be torn, which can cause sagging of the skin.

If surgery is performed incorrectly like this, you may not notice it immediately after the operation, but side effects gradually appear starting about 1 to 2 years later. That is when you feel that sagging cheeks have developed after cheekbone surgery.

Saying that the cheeks sagged because of cheekbone surgery is the result of an incorrect operation, and if the bones are fixed correctly in the proper position, there is no need to worry.

This patient underwent 3D cheekbone surgery and square jaw surgery at 입체성형외과, and 1 year and 6 months had passed.

We check not only whether the surgery was performed accurately, but also whether there are any side effects through thorough follow-up for more than a year after surgery.

What is nonunion?

In cheekbone reduction surgery, nonunion means that the cut cheekbone does not join together, as in the CT image you saw earlier.

In fact, a more serious side effect than sagging cheeks is nonunion, and when nonunion occurs, sagging cheeks naturally accompany it.

Recently, many hospitals have been performing non-fixation surgery.

Non-fixation cheekbone surgery requires a higher level of skill than fixation surgery.

At this time, if the bone is simply cut without the special know-how of a specialist, nonunion can occur, in which the bones do not join and instead separate further.

As a result of nonunion, the patient experiences not only sagging cheeks but also pain in the area where the bones have not joined, and feels the bones moving when chewing food.

Then is fixation cheekbone surgery okay?

Even with fixation, there are cases where nonunion occurs because the fixation pin breaks.

[입체성형외과] Side effect of cheekbone surgery, nonunion

This patient had fixation cheekbone surgery at the first hospital, but came in with nonunion after the fixation pin broke.

In such cases, the patient must visit the hospital as soon as possible and have the bone re-fixed so that it can join again.

[입체성형외과] Side effect of cheekbone surgery, nonunion

Regardless of whether fixation is used, these problems occur when experience is insufficient.

Therefore, the most important thing is to accurately understand bone movement and perform proper fixation so that nonunion does not occur in the first place, using a specialist’s know-how.

I’ve also heard that cheekbone surgery can recur...

This is also one of the most frequently asked questions during consultations.

In fact, fixed cheekbone reduction surgery has almost no chance of recurrence.

Most people who visit because of recurrence are those who had quick cheekbone reduction surgery.

As mentioned earlier, quick cheekbone reduction surgery is a non-fixation procedure that requires advanced skill, so I can say that this is also the result of improper fixation.

[입체성형외과] Side effect of cheekbone surgery, recurrence

This is a CT image of a patient who had cheekbone surgery at another hospital a few years ago and recently visited because the cheekbones seemed to have become larger again.

On CT, it can be confirmed that the cheekbone has returned to its original position.

[입체성형외과] Side effect of cheekbone surgery, recurrence

When the cheekbone recurs like this, if the outer cheekbone is pushed back in and fixed again, the chance of returning to the original position again is close to 0%.

I think this problem is also unnecessary if proper fixation had been done from the beginning.

Again, if only proper fixation in the proper position is maintained, cheekbone surgery will not be a problem at all.

These photos are CT images of a patient who underwent 230-degree 3D cheekbone reduction surgery.

At 입체성형외과, we perform not only 3D cheekbone reduction surgery but also a procedure called 230-degree 3D cheekbone reduction surgery.

Since 230-degree 3D cheekbone reduction surgery does not involve complete osteotomy at the 45-degree cheekbone area, only the outer cheekbone area needs to unite well.

Therefore, we perform partial osteotomy at the 45-degree cheekbone area and firmly fix the outer cheekbone area with fixation pins to promote rapid union.

Will cheekbone surgery fix hollow cheeks?

There is something many people misunderstand.

They think that having cheekbone surgery will solve hollow cheeks, but hollow cheeks and cheekbone surgery are separate issues.

Generally, people think that if the protruding cheekbones are reduced, the hollowness of the cheeks will naturally become less noticeable. However, if the cheekbones move inward after surgery, the originally existing cheeks may appear even more hollow, making the problem look worse.

Therefore, this is something that must be addressed before surgery, and during consultations I check patients’ hollow-cheek condition in advance and explain it to them.

For those with severe hollowness, I recommend treatment with fat grafting or filler in the area where the hollowness appears.

[입체성형외과] Side effect of cheekbone surgery, improvement of hollow cheeks

This photo shows a patient who underwent cheekbone surgery and fat grafting together.

Through fat grafting, you can see that the uneven feeling under the cheekbones was also improved.

Can nerves be damaged after cheekbone surgery?

Simply put, the area where cheekbone surgery is performed is not a location where important nerves pass through.

The nerve that can be affected during cheekbone surgery is the zygomaticofacial nerve.

[입체성형외과] Side effect of cheekbone surgery, facial contour nerve damage

In this CT image, can you see the small little hole in the cheekbone area?

Because of the location of the zygomaticofacial nerve, there is a possibility that it may be damaged during surgery.

Since the location where the nerve emerges differs from patient to patient, if the surgeon lacks experience, the nerve may occasionally be stretched or damaged.

But even if an injury does occur, there is no need to be too alarmed.

[입체성형외과] Side effect of cheekbone surgery, facial contour nerve damage

This nerve is responsible for sensation in a very small area, as shown above.

Even if it is damaged, nearby nerves usually take over and sensation returns soon.

Therefore, the chance of nerve damage from cheekbone surgery is low, and even if damage occurs, your original sensation naturally returns after a certain recovery period, so there is no need to worry too much.

What is sinusitis?

This is the last possible side effect of cheekbone surgery.

Sinusitis means inflammation that occurs in a body area called the sinus during surgery.

[입체성형외과] Side effect of cheekbone surgery, sinusitis

The sinus can be thought of as a space inside the nose that is filled with air.

If the sinus is opened too much during cheekbone osteotomy, the likelihood of inflammation increases significantly.

If this condition continues, the fixed bone can dissolve and ongoing inflammatory reactions may occur.

If, after cheekbone surgery, the face becomes excessively swollen or pus comes out through the nose, you must undergo another operation and have the sinus washed with antibiotics.

It is a very rare case, but knowing about it may help you get treatment quickly if those symptoms appear.

There is no surgery in the world without side effects.

This is true not only for plastic surgery, but also for common procedures like LASIK and general surgery performed because of illness.

Even so, the reason people undergo surgery is that, when done correctly, the side effects are so minor they can hardly be called side effects, and the results obtained through surgery are overwhelmingly significant.

In reality, side effects that become a problem can be described as a kind of accident attributable not to the surgery itself, but to the surgeon.

Therefore, it is most important to meet a specialist whose skills are guaranteed by many years of experience in the specific field.

Before surgery, I recommend visiting two or three hospitals and making a proper decision through sufficient consultation.

Thank you.