Combined Intraoral and Endoscopic Approach for Malar Reduction.

Malar reduction is one of the most solicited aesthetic surgeries in Asia,1,2 where wide broad cheek bones and/or prominent anterior malar projection are considered masculine causing an aged appearance from illusory temporal and buccal hollowing. Most Asian women prefer a slim oval face with smooth malar-to-cheek transitioning.3,4 Increasingly, these patients desire minimally invasive malarplasty with short downtime to create the ideal profile. When evaluating for malar reduction it is vital to determine which specific areas of the zygoma are causing concern.5 Patients may specify the exact area of malar prominence that they want corrected. Some have facial widening due to an excessively curved zygomatic arch and many techniques can correct this.6-19 Conversely, if the malar body is anteriorly prominent, correction should entail re-positioning of the entire zygoma complex . Thus a technique versatile enough to correct any part of the malar anatomy is desirable. The earliest described reduction malarplasty was bone-shaving,3 and subsequent techniques entailed zygomatic arch resection, arch infracture,4 or osteotomy and repositioning of the entire zygomatic segment.20 Several effective malarplasty procedures – each with their pros and cons - can be categorized into intraoral approaches, external approaches, and a combination of both (Table 1). The technique we present avoids problems associated with previous methods2,9,21-23 through the major advantages of using a combined intraoral and external-endoscopic approach. View this table: Table 1. Pros and Cons of Different Malarplasty Approaches Any facial asymmetry, deviation or deformity was fully documented and communicated to the patient using preoperative photographs, since these may be corrected during the procedure or postoperatively become more obvious. Posterior-anterior and inverted Towne’s view cranial radiographs and 3D facial computed tomographic (CT) scanning were done - the latter particularly important for analyzing asymmetrical malar …