[Paper Review] The Extended Zygoma Reduction Surgery Recently in Vogue in Japan

Hello, this is Dr. Jae-hun Cho of Obje Plastic Surgery.

I mentioned before that I had gone on a business trip to Japan and was seeing patients there.

These days, many Japanese patients ask about the 'extended zygoma reduction surgery' that has become popular in Japan.

Today, I would like to review a paper about this type of surgery.

This paper was submitted by a Japanese doctor named Yoshitsugu to PRS, the most authoritative journal in plastic surgery.

In the paper, the author compares this procedure with the conventional L-shape zygoma reduction surgery under the title, 'Extended Reduction Malarplasty for Flat and Wide Asian Faces.'

Asian faces often have more prominent zygomas and a wider, flatter facial shape compared with Western faces.

Because these features are culturally considered to give a 'strong impression' or a 'masculine impression,' malarplasty is widely performed.

In contrast, Western patients often lack cheekbone projection, so zygoma augmentation is common.

However, the conventional L-shaped osteotomy had a limitation: while it reduces facial width, it does not adequately correct the prominence of the periorbital area.

To address this, a research team at Tokyo Lila Duan Plastic Surgery proposed a new method called 'Extended Reduction Malarplasty.'

This surgery aims to create a more three-dimensional and harmonious facial shape by correcting not only the main body of the zygoma but also the bony prominence around the eye area.

From August 2021 to September 2023, a retrospective comparative study was conducted on 43 female patients who underwent zygoma reduction surgery at Tokyo Lila Craniofacial Clinic.

• Extended reduction malarplasty group: 20 patients

• Conventional L-shaped osteotomy group: 23 patients

All patients underwent pre- and postoperative 3D CT scans to analyze changes in facial bone structure.

In addition, surgery time, blood loss, and the occurrence of complications were also recorded.

• Extended zygoma reduction surgery (blue)

The bone is approached through small incisions inside the mouth, near the sideburn area, and at the outer corner of the eye.

Compared with the conventional surgery, there is one additional incision site, but the advantage is that the protruding cheekbone around the eye area can also be reduced.

After the bone is cut, the zygoma is moved backward and, if necessary, lightly shaved to maintain symmetry and smoothness.

• Conventional L-shaped osteotomy (yellow)

After making incisions inside the mouth and near the sideburn area, the bone is cut in an L shape and moved inward.

This method is effective for reducing facial width, but it has limitations when it comes to adjusting the three-dimensional contour around the eye area.

As a result of the surgery, facial width (zygoma width) was significantly reduced in both groups.

However, periorbital protrusion improved much more in the extended reduction group, and facial curvature (three-dimensionality) also increased significantly in the extended surgery group, resulting in a more natural, 3D facial shape.

There was no significant difference between the two groups in terms of surgery time or blood loss, and complications were rare.

The paper also presents one case showing a significant reduction in the cheekbone area.

The research team emphasized that 'surgical design that considers the facial characteristics of Asians is important.'

Western faces tend to be three-dimensional because the nose, chin, and forehead are more prominent, whereas Asian faces are often flatter and have relatively more prominent cheekbones.

They concluded that rather than simply pushing the bone inward, an approach that adjusts the entire midface in a three-dimensional manner, including the eye area, improves aesthetic satisfaction.

They also explained that the extended procedure can make small eyes appear larger and create a softer, more feminine impression than the old method of shaving only the cheekbones.

However, this surgery may leave a small scar from the incision near the eye, and the procedure is somewhat complex.

Even so, recovery after surgery is fast, and most patients were able to be discharged on the same day.

Extended zygoma reduction surgery is a new approach that effectively improves the prominence around the eye area, which was difficult to correct with conventional methods, while enhancing the overall three-dimensionality and harmony of the face. For Asians with flat and wide facial shapes, it may be a useful option for creating softer, more three-dimensional facial contours.

That is the conclusion of the paper.

In my opinion, if the cheekbone surgery is expanded a little more and there is more bony development around the eye area than with the conventional High-L osteotomy, it could produce very dramatic results. It seems like a surgical method I would like to try someday as well. ^^

I hope today’s content was also helpful to you.

Thank you.