Augmentation of Cheek Bone Contour Using Malar Osteotomy

Abstract

Patients with a narrow face have often a defect in expansion of the maxillary-malar complex. A malar osteotomy, separating the malar-zygomatic complex from the orbit and the maxilla, allows an anterolateral cheek projection when performing an external rotation. This technique changes facial contour and improves facial aesthetics. During the past 5 years, 18 malar osteotomies have been performed; the external rotation was stabilized with interposed coral graft in six patients and with interposed bone graft fixed by a miniplate or with a stainless steel wire in 12 patients. Simultaneously septoplasty was performed in five patients, rhinoplasty in 13 patients, and genioplasty in two patients. Six patients had a face and neck lift, one patient had a forehead lift, and one patient had onlay iliac crest bone graft to treat atrophic maxillary alveolar ridges prior to implant placement. Stability was defined after 1 year follow-up. The increase in projection was correlated to the size of the graft. At least 5 mm were necessary to have cheek modification. Mucous inflammation, maxillary sinusitis, and relapse were observed with the use of interposed coral graft, but no complications were observed with bone graft. Malar osteotomy is a simple and safe procedure; it allows an anterolateral cheek projection and seems to be effective for treating transverse midface deficiency.

Zygomaticomaxillary “lateral swing” osteotomy for augmentation of midface deficiency

“…Their technique was essentially similar to Mommaerts’ osteotomy except that the horizontal cut involved the infraorbital margin. Layoun et al [18] modified Mommaerts technique to propose a malar osteotomy with graft interpositioning. The vertical osteotomy was performed from the maxillomalar buttress, cutting off both the anterior and posterior sinus walls, stopping 10 mm outside the infraorbital nerve and 10 mm below the infraorbital rim.…”

Secondary Repair of the Zygoma

“…44 Overall, aesthetic outcomes were favorable, and there was a low rate of significant complications. 44,45 Despite having better outcomes related to function compared with onlay grafting, 12 surgical planning and execution based purely on physical findings, both pre-and intraoperatively, are technically challenging. The increasing sophistication and application of imaging and preoperative surgical planning have significantly helped many practitioners overcome these issues and allow for better outcomes.…”

Advanced Adjunct Orthosurgical Esthetic Prodedures

“…Clinical evaluation: Oval shaped face with the key component of malar prominence is considered to be a sign of beauty and youth in Caucasians. [73] Many tricks using artificial highlighting and darkening are developed by makeup artists to accentuate the malar prominence. [73] Flattened cheeks and narrow face makes people look sad and prematurely aged.…”

“…[73] Many tricks using artificial highlighting and darkening are developed by makeup artists to accentuate the malar prominence. [73] Flattened cheeks and narrow face makes people look sad and prematurely aged. [73] This transverse midface deficiency can be addressed by widening the bimalar width.…”

“…[73] Flattened cheeks and narrow face makes people look sad and prematurely aged. [73] This transverse midface deficiency can be addressed by widening the bimalar width.…”