Summary
Background
Reduction malarplasty is one of the most popular aesthetic surgical procedures for
reshaping facial contour in oriental people. Especially for those who have a wide
midface and a prominent zygoma. Although malunion and cheek ptosis are known as major
complications in reduction malarplasty, but there have been few reports about their
causes and patterns. The authors experienced many revision reduction malarplasty using
the coronal approach to correct cheek ptosis with malunion and were able to categorize
the types of malunion by analyzing 3-dimensional CT imaging prior to revision surgery.
Methods
A total of 24 patients underwent revision reduction malarplasty with the coronal approach
to correct the unfavorable result after primary malarplasty. Most patients complained
of various degrees of cheek ptosis associated with malunion. In all cases, the status
of zygomatic malunion was evaluated through 3D CT imaging. The operative procedures
during revision surgery including repositioning of the inferolaterally displaced malar
complex to the appropriate position and obtaining bone-to-bone contact with rigid
fixation. If bony absorption at non-union margin was found during the operation, bihalved
calvarial bone was grafted into the bony gap. Midface and forehead lifts were also
performed when indicated.
Results
The types of zygomatic malunion could be categorized into four patterns according
to the shape of displacement. The degree of displacement was relevant to the condition
of the fixation in all cases. The higher the grade of malunion was evaluated in 3D
CT imaging, the more difficult procedures it required during revision surgery. The
postoperative results in all cases were satisfactory without any complications.
Conclusions
In reduction malarplasty, inappropriate fixation and the ignorance of repositioning
vector can lead to cheek ptosis and malunion by the action of masseter muscle. The
malunion types apprehended by the preoperative 3D CT scanning enabled precise operative
planning before revision surgery. In all grades of zygomatic malunion with cheek ptosis,
revision reduction malarplasty with coronal approach was a very useful solution because
it offers a wide surgical field, enables accurate repositioning along with firm fixation
and easily allows simultaneous midface lift.
Keywords
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References
- Reduction malarplasty.Plast Reconstr Surg. 1991; 88: 53-61
- Reduction malarplasty with a new L-shaped osteotomy through an intraoral approach: retrospective study of 418 cases.Plast Reconstr Surg. 2009; 124: 1245-1253
- Revision reduction malarplasty with coronal approach.J Plast Reconstr Aesthet Surg. 2010;
- Compared study of Asian reduction malarplasty: wedge-section osteotomy versus conventional procedures.J Craniofac Surg. 2009; 20: 1856-1861
- Reduction malarplasty by 3-mm percutaneous osteotomy.Aesthetic Plast Surg. 2006; 30: 333-341
- Infracture technique for reduction malarplasty with a short preauricular incision.Plast Reconstr Surg. 2004; 113 (discussion 62–3): 1253-1261
- Reduction malarplasty without external incision: a simple technique.Aesthetic Plast Surg. 2003; 27: 167-171
- Intraoral approach for reduction malarplasty: a simple method.Plast Reconstr Surg. 2003; 111: 453-460
- Reduction malarplasty using osteotomy and repositioning of the malar complex: clinical review and comparison of two techniques.J Craniofac Surg. 2003; 14: 383-392
- Reduction malarplasty through an intraoral incision: a new method.Plast Reconstr Surg. 2000; 106: 1514-1519
- Zygomatic non-union after reduction malarplasty.J Craniofac Surg. 2009; 20: 849-852
- Face lift with reposition malarplasty.Plast Reconstr Surg. 2009; 123: 701-708
- Temporal dissection technique that prevents temporal hollowing in coronal approach.J Craniofac Surg. 2009; 20: 748-751
Article info
Publication history
Published online: November 18, 2011
Accepted:
October 21,
2011
Received:
August 9,
2011
Identification
Copyright
© 2011 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Inc. All rights reserved.
