Why Is Male Cheekbone Reduction Surgery Different from Female Surgery?

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

Today, I’d like to talk about how male and female facial contouring surgery, especially cheekbone reduction surgery, are designed and performed differently.

The surgical method itself is not fundamentally different for men and women.

Because men generally have larger and thicker facial bones than women, the design and surgical approach are adjusted slightly differently.

(Left) Male cheekbone, (right) female cheekbone

As you can see in this CT image, the size of the cheekbones generally differs between men and women.

Of course, some men have smaller facial bones, and in those cases, the surgery is no different from female cheekbone reduction surgery.

So let me explain what is different.

Before and after male cheekbone reduction, square jaw surgery, and cortical osteotomy

First, in male cheekbone reduction surgery, the amount of osteotomy at the 45-degree area must be designed a little differently.

If the bone is cut using the osteotomy thickness typical of female 45-degree cheekbone areas, there are quite a few cases where the bone does not rotate backward.

I do not think that removing more bone necessarily leads to better results or greater reduction. In fact, for firm fixation, I think it is better to reduce the amount of removal a little. However, if too little of the male 45-degree cheekbone is removed this way, the bone may not move backward at all.

Therefore, I judge based on the patient’s height and also by looking at the CT scan.

It is not 100%, but in many cases, taller people have larger facial bones than shorter people, so I divide patients into groups such as those over 180 cm and those over 170 cm, and then decide the amount of bone removal together with the CT findings.

Generally, if the removal width in women is about 2–3 mm, in men it is around 4–5 mm.

(Left) Amount of bone removal in female cheekbones, (right) amount of bone removal in male cheekbones

Also, not only is the visible removal width different, but men’s bones are much thicker, so they need to be carefully and safely resected.

If bone remains on the inner side during resection, the bone may not rotate backward, so removing enough bone seems important for smooth fixation.

Before and after male 230-degree three-dimensional cheekbone reduction (posterior fixation)

The second difference is the amount of posterior fixation, which can be considered an indicator of how much the lateral cheekbone is moved inward.

I have been observing CT scans continuously for more than 15 years, and in women the average thickness of the cheekbone near the zygomatic arch is about 3–5 mm, whereas in men it is about 5–7 mm. Of course, this also varies not only by sex but also by the overall size of the facial bones, but there seems to be a difference on average.

Therefore, when bringing in the lateral cheekbone and performing posterior fixation, men need surgery using a larger bent plate.

In practice, there are many cases where a fixation pin of about 5 mm cannot fix the two bones at all.

There were even some men whose bone thickness reached nearly 1 cm, and in such cases, the step difference after surgery could become too noticeable, so I performed zygomatic shaving together. In this case, the bone can be sufficiently moved inward and the step difference can also be reduced.

Another difference in my surgery is whether posterior fixation is performed.

In the early days of cheekbone surgery, it was common to fix only the 45-degree area and not perform posterior fixation.

Recently, I also recommend posterior fixation. In women, the muscle force pulling the cheekbone is relatively weak, so I have often seen that the bone heals well with fixation only at the 45-degree area.

However, in men, the force pulling on the cheekbone is stronger, and there were cases where the pins fixing the cheekbone broke frequently.

So in my case, I try to make posterior fixation essential for men.

Before and after male cheekbone reduction

Before and after male square jaw surgery and chin surgery

Lastly, compared with women, men often have firmer and tougher tissues.

So during surgery, they often do not come into view well, and fixation can also be more difficult. In such cases, the incision needs to be extended a little more to secure visibility, and more force is needed to pull the retractor.

To be honest, male cheekbone surgery does require more effort than female cheekbone surgery.

But if we do exactly the same thing as we do for women, we cannot achieve good results, so we need to work harder.^^

Today, I explained from my perspective how male cheekbone reduction surgery differs from female cheekbone reduction surgery.

Broadly speaking, it is a cheekbone reduction procedure without major differences, but if we still consider and approach the small differences, I believe stable fixation without nonunion can be achieved.

Thank you.