Why Is Revision Zygoma Reduction Surgery Done?

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

Today, I’d like to talk about revision zygoma reduction surgery.

As I always say, compared with other surgeries such as eye or nose surgery, the revision rate for facial contouring surgery is not very high.

But as with any surgery, revisions do happen. So then, for what reasons do people come in for revision zygoma surgery?

Dissatisfaction

One of the most common reasons patients come in after zygoma reduction surgery is because they want to reduce it a little more.

Of course, if the first surgery went well, in most cases there is no further room to reduce the cheekbone.

However, when we take CT scans of people who had surgery more than 10 years ago, we sometimes see cases where the side cheekbone has come back because it was not fixed, or cases where the 45-degree cheekbone was not pushed inward or was removed too little, leaving a large amount of volume.

A case where the side cheekbone recurred because it was not fixed, and

A case where the 45-degree cheekbone still retained its volume because too little was removed

As mentioned earlier, people who had surgery recently have usually had their cheekbones reduced as much as possible.

In such cases, there is often almost nothing more that can be reduced, so many are sent back without further surgery.

However, if the side cheekbone has come back, revision surgery can be performed in several ways.

When there are no pins in the cheekbone

In this case, revision surgery can be done simply through the 230-degree 3D zygoma reduction procedure.

For patients whose side cheekbone was barely reduced, performing surgery comparable to the first operation can produce a sufficiently satisfying result.

A patient who underwent revision zygoma surgery through the 230-degree 3D zygoma reduction procedure

When there are pins in the cheekbone

In this case, the surgery requires reopening the inside of the mouth and performing 3D zygoma surgery.

The previously fixed cheekbone pins are removed, and then the bone is cut again and re-fixed.

Because the bone that had not been moved is brought inward, there are many cases where patients can clearly feel the difference before and after surgery.

A patient who underwent removal of existing fixation pins and revision 3D zygoma reduction surgery

When the patient wants to reduce only the 45-degree cheekbone

In fact, this seems to be the most common type of revision surgery these days.

There are patients whose side cheekbone has been reduced well, but who feel that the 45-degree cheekbone is still a little lacking.

In such cases, I usually recommend removing the pins and shaving the 45-degree cheekbone area.

If shaving lowers the height by about 2 to 3 mm, the volume of the 45-degree cheekbone decreases, and patients seem to be a little more satisfied.

A patient who underwent 45-degree cheekbone shaving through an incision inside the mouth

A patient who underwent pin removal surgery and 45-degree cheekbone shaving

Overcorrection of the cheekbone

The second group of patients who want revision zygoma surgery are those who want to restore the cheekbones.

Patients often vaguely think that reducing the cheekbones will make the face look prettier, but reducing the width of the cheekbones does not automatically make the face look better.

Depending on the patient’s face, having a certain amount of cheekbone can be attractive.

In such cases, cheekbone restoration is performed.

In cheekbone restoration, how much of the 45-degree cheekbone can be restored depends on how much bone was removed.

If a large amount of bone was removed, it is honestly difficult to restore it to 100% of the original state without bone grafting.

However, if the amount removed was not large, it may be possible to restore the cheekbone to some extent.

In the case of the side cheekbone, it can be cut again and lifted back to its original position, and for the 45-degree cheekbone, the degree to which it was pushed inward can be somewhat recovered.

A patient whose pushed-in cheekbone was restored

As you can see in the case above, 100% restoration may be difficult, but it may still be possible to restore more than 90%.

However, if a large amount of bone was removed or if there is nonunion, bone grafting or another method may be needed. In such cases, it would be best to take a CT scan and make a judgment based on that.

Nonunion or sinusitis

Lastly, there are patients who want revision zygoma surgery because of nonunion or inflammation of the cheekbone.

In fact, patients who want revision surgery for nonunion usually seem to do so at the hospital where the first surgery was performed.

Sometimes people come because they want surgery at a hospital other than the original one, and in such cases, surgery is performed to correct the nonunion.

(A case where a pin broke) A patient who underwent surgery to correct nonunion

Sometimes the pin breaks, and sometimes the bone is widely separated from the beginning.

In such cases, I say that unless there are symptoms, even if nonunion is seen on CT, it is not necessary to conclude that it is definitely nonunion.

Since CT scans are not 100% accurate, if there are no symptoms such as bone movement or pain, in most cases when we go into surgery, the bones are already fully united. Therefore, when performing revision surgery for nonunion, I always place great importance on symptoms and proceed with surgery accordingly.

In cases of inflammation, sinusitis may occur.

In such cases, if the area is not thoroughly irrigated and replaced with new pins, the bone may resorb, so it is best to carefully observe the condition before operating.

A patient whose sinusitis was irrigated

Today, I explained in what cases revision zygoma reduction surgery is performed.

Some people want further reduction, while others want restoration.

There can be various cases, but in most cases, the reason patients come in is that the initial consultation was not done accurately, so the expected results were not obtained.

Therefore, rather than having to undergo contouring surgery twice, which is difficult even to do once, better consultation from the beginning may help you achieve good results without revision surgery.

I hope today’s column was helpful.

Lunar New Year is coming soon, and I wish everyone a very happy New Year and a year full of happiness.

Thank you!