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Published in: Aesthetic Plastic Surgery 1/2017

01-02-2017 | Original Article

Revision Surgery for Zygoma Reduction: Causes, Indications, Solutions, and Results from a 5-Year Review of 341 Cases

Authors: Sang Woo Lee, Yeon Woo Jeong, Yujin Myung

Published in: Aesthetic Plastic Surgery | Issue 1/2017

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Abstract

Background

Many patients undergo a revision surgery after malar reduction, which is one of the most popular aesthetic surgeries in Asia. We reviewed the leading causes of revision for malar reduction surgery to establish proper indications for revision, seek adequate surgical strategies, and share the results from revision surgical cases.

Methods

A retrospective review was conducted involving 341 patients who underwent malar reduction reoperation between March 2010 and June 2015. Surgical strategies were decided based upon specific problems and complaints from the previous surgery. Facial photographs, cephalography, and computed tomography images were analyzed, and a patient satisfaction survey was conducted before and after the surgery.

Results

A total of 341 patients (321 women, 20 men; average age, 26.6 years, range 18–40 years) were included. The main causes of reoperations were subjective dissatisfaction and nonunion-related symptoms. Undercorrection of the zygomatic body and arch (n = 175, 51.3%) was the most frequent reason for dissatisfaction. The patients underwent revision surgeries via different techniques and strategies based on previous problems from primary surgery, and postoperative patient satisfaction was high. Complications occurred in 35 patients (10.3%) after revision.

Conclusions

Based on the results of this study, patient dissatisfaction with the procedure can be minimized beforehand through accurate goal identification and careful planning. Bone nonunion is usually due to excessive bone resection during zygoma reduction surgery. Careful selection of the reposition site and appropriate fixation based on a thorough understanding of masseter action are essential in ensuring satisfactory outcomes without adverse side effects.

Level of Evidence IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.​springer.​com/​00266.
Appendix
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Literature
1.
go back to reference Onizuka T, Watanabe K, Takasu K, Keyama A (1983) Reduction malar plasty. Aesthet Plast Surg 7(2):121–125CrossRef Onizuka T, Watanabe K, Takasu K, Keyama A (1983) Reduction malar plasty. Aesthet Plast Surg 7(2):121–125CrossRef
3.
go back to reference Uhm KI, Lew JM (1991) Prominent zygoma in orientals: classification and treatment. Ann Plast Surg 26(2):164–170CrossRefPubMed Uhm KI, Lew JM (1991) Prominent zygoma in orientals: classification and treatment. Ann Plast Surg 26(2):164–170CrossRefPubMed
4.
go back to reference Sumiya N, Kondo S, Ito Y, Ozumi K, Otani K, Wako M (1997) Reduction malarplasty. Plast Reconstr Surg 100(2):461–467CrossRefPubMed Sumiya N, Kondo S, Ito Y, Ozumi K, Otani K, Wako M (1997) Reduction malarplasty. Plast Reconstr Surg 100(2):461–467CrossRefPubMed
5.
go back to reference Choi HY, Lee SW, Lew JM (1999) True intraoral reduction malarplasty with a minimally invasive technique. Aesthet Plast Surg 23(5):354–360CrossRef Choi HY, Lee SW, Lew JM (1999) True intraoral reduction malarplasty with a minimally invasive technique. Aesthet Plast Surg 23(5):354–360CrossRef
6.
go back to reference Kim YH, Seul JH (2000) Reduction malarplasty through an intraoral incision: a new method. Plast Reconstr Surg 106(7):1514–1519CrossRefPubMed Kim YH, Seul JH (2000) Reduction malarplasty through an intraoral incision: a new method. Plast Reconstr Surg 106(7):1514–1519CrossRefPubMed
7.
go back to reference Mahatumarat C, Rojvachiranonda N (2003) Reduction malarplasty without external incision: a simple technique. Aesthet Plast Surg 27(3):167–171CrossRef Mahatumarat C, Rojvachiranonda N (2003) Reduction malarplasty without external incision: a simple technique. Aesthet Plast Surg 27(3):167–171CrossRef
8.
go back to reference Lee JG, Park YW (2003) Intraoral approach for reduction malarplasty: a simple method. Plast Reconstr Surg 111(1):453–460CrossRefPubMed Lee JG, Park YW (2003) Intraoral approach for reduction malarplasty: a simple method. Plast Reconstr Surg 111(1):453–460CrossRefPubMed
9.
go back to reference Lee YH, Lee SW (2009) Zygomatic nonunion after reduction malarplasty. J Craniofac Surg 20(3):849–852CrossRefPubMed Lee YH, Lee SW (2009) Zygomatic nonunion after reduction malarplasty. J Craniofac Surg 20(3):849–852CrossRefPubMed
10.
go back to reference Baek RM, Kim J, Lee SW (2010) Revision reduction malarplasty with coronal approach. J Plast Reconstr Aesthet Surg 63(12):2018–2024CrossRefPubMed Baek RM, Kim J, Lee SW (2010) Revision reduction malarplasty with coronal approach. J Plast Reconstr Aesthet Surg 63(12):2018–2024CrossRefPubMed
11.
go back to reference Lee JS, Lee JW, Yang JD, Chung HY, Cho BC, Choi KY (2015) A rare complication of reduction malarplasty. Aesthet Plast Surg 39(2):240–242CrossRef Lee JS, Lee JW, Yang JD, Chung HY, Cho BC, Choi KY (2015) A rare complication of reduction malarplasty. Aesthet Plast Surg 39(2):240–242CrossRef
12.
go back to reference Baek RM, Heo CY, Lee SW (2009) Temporal dissection technique that prevents temporal hollowing in coronal approach. J Craniofac Surg 20(3):748–751CrossRefPubMed Baek RM, Heo CY, Lee SW (2009) Temporal dissection technique that prevents temporal hollowing in coronal approach. J Craniofac Surg 20(3):748–751CrossRefPubMed
13.
go back to reference Baek RM, Kim J, Kim BK (2012) Three-dimensional assessment of zygomatic malunion using computed tomography in patients with cheek ptosis caused by reduction malarplasty. J Plast Reconstr Aesthet Surg 65(4):448–455CrossRefPubMed Baek RM, Kim J, Kim BK (2012) Three-dimensional assessment of zygomatic malunion using computed tomography in patients with cheek ptosis caused by reduction malarplasty. J Plast Reconstr Aesthet Surg 65(4):448–455CrossRefPubMed
14.
go back to reference Von Gralath Donati (1961) R. [Methods of reduction and fixation in maxillo-facial traumatology. II. Fractures of the malar bone and zygomatic arch]. Valsalva 37:276–284 Von Gralath Donati (1961) R. [Methods of reduction and fixation in maxillo-facial traumatology. II. Fractures of the malar bone and zygomatic arch]. Valsalva 37:276–284
15.
go back to reference Rinehart GC, Marsh JL, Hemmer KM, Bresina S (1989) Internal fixation of malar fractures: an experimental biophysical study. Plast Reconstr Surg 84(1):21–25 ; discussion 6–8 CrossRefPubMed Rinehart GC, Marsh JL, Hemmer KM, Bresina S (1989) Internal fixation of malar fractures: an experimental biophysical study. Plast Reconstr Surg 84(1):21–25 ; discussion 6–8 CrossRefPubMed
16.
go back to reference Guerrero R (2013) A new assisted fixation technique to prevent zygoma displacement in malar reduction. Aesthet Plast Surg 37(4):697CrossRef Guerrero R (2013) A new assisted fixation technique to prevent zygoma displacement in malar reduction. Aesthet Plast Surg 37(4):697CrossRef
18.
go back to reference Lee EI, Mohan K, Koshy JC, Hollier LH Jr (2010) Optimizing the surgical management of zygomaticomaxillary complex fractures. Semin Plast Surg 24(4):389–397CrossRefPubMedPubMedCentral Lee EI, Mohan K, Koshy JC, Hollier LH Jr (2010) Optimizing the surgical management of zygomaticomaxillary complex fractures. Semin Plast Surg 24(4):389–397CrossRefPubMedPubMedCentral
19.
go back to reference Manson PN, Glassman D, Vanderkolk C, Petty P, Crawley WA (1990) Rigid stabilization of sagittal fractures of the maxilla and palate. Plast Reconstr Surg 85(5):711–717CrossRefPubMed Manson PN, Glassman D, Vanderkolk C, Petty P, Crawley WA (1990) Rigid stabilization of sagittal fractures of the maxilla and palate. Plast Reconstr Surg 85(5):711–717CrossRefPubMed
20.
go back to reference Graham WP 3rd, Acker G, Rosenfeld K, Lehr HB (1970) Simple reduction of “zygomatic arch” fractures. J Trauma 10(10):874–876CrossRefPubMed Graham WP 3rd, Acker G, Rosenfeld K, Lehr HB (1970) Simple reduction of “zygomatic arch” fractures. J Trauma 10(10):874–876CrossRefPubMed
21.
go back to reference Czerwinski M, Lee C (2004) Traumatic arch injury: indications and an endoscopic method of repair. Facial Plast Surg 20(3):231–238CrossRefPubMed Czerwinski M, Lee C (2004) Traumatic arch injury: indications and an endoscopic method of repair. Facial Plast Surg 20(3):231–238CrossRefPubMed
22.
go back to reference Bansal N, Saha S, Jaiswal J, Samadi F (2014) Pain elimination during injection with newer electronic devices: a comparative evaluation in children. Int J Clin Pediatr Dent 7(2):71–76CrossRefPubMedPubMedCentral Bansal N, Saha S, Jaiswal J, Samadi F (2014) Pain elimination during injection with newer electronic devices: a comparative evaluation in children. Int J Clin Pediatr Dent 7(2):71–76CrossRefPubMedPubMedCentral
23.
go back to reference Varadharaja M, Udhya J, Srinivasan I, Sivakumar JS, Karthik RS, Manivanan M (2014) Comparative clinical evaluation of transcutaneous electrical nerve stimulator over conventional local anesthesia in children seeking dental procedures: a clinical study. J Pharm Bioallied Sci 6(Suppl 1):S113–S117PubMedPubMedCentral Varadharaja M, Udhya J, Srinivasan I, Sivakumar JS, Karthik RS, Manivanan M (2014) Comparative clinical evaluation of transcutaneous electrical nerve stimulator over conventional local anesthesia in children seeking dental procedures: a clinical study. J Pharm Bioallied Sci 6(Suppl 1):S113–S117PubMedPubMedCentral
24.
go back to reference Mu X (2010) Experience in East Asian facial recontouring: reduction malarplasty and mandibular reshaping. Arch Facial Plast Surg 12(4):222–229CrossRefPubMed Mu X (2010) Experience in East Asian facial recontouring: reduction malarplasty and mandibular reshaping. Arch Facial Plast Surg 12(4):222–229CrossRefPubMed
25.
go back to reference Zhang Y, Tang M, Jin R, Zhang Y, Zhang Y, Wei M et al (2014) Comparison of three techniques of reduction malarplasty in zygomaticus and massateric biomechanical changes and relevant complications. Ann Plast Surg 73(2):131–136CrossRefPubMed Zhang Y, Tang M, Jin R, Zhang Y, Zhang Y, Wei M et al (2014) Comparison of three techniques of reduction malarplasty in zygomaticus and massateric biomechanical changes and relevant complications. Ann Plast Surg 73(2):131–136CrossRefPubMed
26.
go back to reference Lin LX, Yuan JL, Wang YT, Huang Y, Wang P, Wang XM (2015) A new infracture technique for reduction malarplasty with an L-shaped osteotomy line. Med Sci Monit 21:1949–1954CrossRefPubMedPubMedCentral Lin LX, Yuan JL, Wang YT, Huang Y, Wang P, Wang XM (2015) A new infracture technique for reduction malarplasty with an L-shaped osteotomy line. Med Sci Monit 21:1949–1954CrossRefPubMedPubMedCentral
Metadata
Title
Revision Surgery for Zygoma Reduction: Causes, Indications, Solutions, and Results from a 5-Year Review of 341 Cases
Authors
Sang Woo Lee
Yeon Woo Jeong
Yujin Myung
Publication date
01-02-2017
Publisher
Springer US
Published in
Aesthetic Plastic Surgery / Issue 1/2017
Print ISSN: 0364-216X
Electronic ISSN: 1432-5241
DOI
https://doi.org/10.1007/s00266-016-0723-9

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