Secondary and Revisional Zygoma Reduction



Fig. 21.1
(Left) Blind osteotomy and no fixation of zygoma arch. (Right) Direct osteotomy and rigid fixation of zygoma arch



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Fig. 21.2
(Left) Preoperative frontal view. (Right) Postoperative frontal view




(B) Undercorrection of Zygoma Body: Malar Protrusion in Oblique View

A 26-year-old female who underwent reduction malarplasty through infracture technique. The patient complained that the body was still prominent. We reduced the body size and impacted zygoma medially with using medial impaction technique.

In infracture technique, greenstick fracture of body cannot effectively reduce the excess protruding body. Postoperative facial depression in the preauricular area was a common problem because only the posterior portion of arch was impacted medially.

In our technique, complete L-type osteotomy of body can effectively reduce the excess protruding body. And, balanced malar contours are achieved because we can freely control the degree of body impaction as well as arch impaction (Figs. 21.3 and 21.4).

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Fig. 21.3
(Left) Incomplete fracture and no fixation of zygoma body. (Right) Complete osteotomy and rigid fixation of zygoma body


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Fig. 21.4
(Left) Preoperative frontal view. (Right) Postoperative frontal view


(C) Undercorrection of Zygoma Body and Arch: Total

A 25-year-old female who previously underwent reduction malarplasty complained that the zygoma was still protruded and the midfacial width was not reduced. The patient wanted secondary zygoma reduction for aesthetic reasons. After a new body osteotomy was performed on medial side of the previous osteotomy, the arch was cut through sideburn incision. The osteotomized zygoma was impacted medially and fixed with plates and screws (Fig. 21.5).

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Fig. 21.5
(Above and center, left) Preoperative three-dimensional CT scan. (Above and center, right) Postoperative three-dimensional CT scan. (Below, left) Preoperative basal skull radiograph. (Below, right) Postoperative basal skull radiograph


(D) Asymmetry: Zygoma Malposition

A 29-year-old female patient visited our hospital for malar asymmetry and cheek drooping after primary reduction malarplasty. Right malar complex was displaced inferiorly by malunion and left zygoma arch was more protruded, resulting cheek drooping and malar asymmetry. After re-osteotomy and trimming at the previous osteotomy site, the right malar complex was shifted superiorly and medially. Two-point rigid fixation was performed with using plates and screws. More reduction of zygoma body and medial impaction of arch was made in the left (Fig. 21.6).
Jan 24, 2018 | Posted by in Aesthetic plastic surgery | Comments Off on Secondary and Revisional Zygoma Reduction
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