How Is Cheek Reduction Performed?

Q: Dr. Eppley, I am a 32 Chinese female who is interested in cheekbone reduction. More specifically, I find that my left zygomatic arch sticks out more than my right, so I want to reduce by a little bit to balance out my face. Can I you send you pictures to see if I am a good candidate for this procedure?
Also I have a couple of questions:
 1) I am very worried of sagging of the soft cheek tissue, what is the risk of this and what type of procedure is done to avoid this.
2)  Is this surgery common at your office? How much experience do you have doing cheekbone reduction?
3) Will is be possible to see pictures of your previous patients that have undergone cheekbone reduction at your office?
4) Since I am an out of town patient, how long will I have to stay in town for this procedure?

I have been contemplating this surgery for a very long time and I am very keen to do it.
Thank you for taking the time to answer my questions.

A: Thank you for your inquiry. Please send me some pictures of your face for my assessment. Cheek osteotomy reduction, specifically that of the zygomatic arch, is done by a combined anterior zygomatic osteotomy (from inside the mouth) and a posterior zygomatic arch osteotomy where it attaches to the temporal bone. (from a small temporal scalp incision) In answer to your questions:

1)      Soft tissue sagging is not a concern with this type of cheek osteotomy because the soft tissues are not detached from the arc bone during the procedure. They simply move inward with the medial movement of the zygomatic arch.

2)      This is a common aesthetic craniofacial procedure in my practice. It is done almost exclusively for Asian patients.

3)      Out of respect for patient privacy and their confidentiality, we do not send  out patient photographs to prospective patients.

4)      This is a type of facial osteotomy procedure in which you could return home within 48 hours after surgery.

Dr. Barry Eppley


Would Cheek Reduction Help Narrow My Face?

Q: Dr. Eppley, I am contacting you in relation to an inherited issue with width of the zygoma and my face more generally. When my face is viewed from a perpendicular angle it is quite clear to see that zygomatic area adds width of 1cm either side of the face. Now I am not sure whether this is to do with lateral projection but given that I have quite small eyes, it makes the facial features appear too small for the width of my face. I know that zygomatic width is an issue that people of Asian ethnicity usually suffer from and that a reduction malarplasty can to some extent tackle it. But my question is to what extent is that feasible given that the width of the face is an issue in relation to the forehead as well, is it the case that the skull base will likely simply be too wide or can the forehead be tackled simultaneously? Is what I am seeking actually capable of being done?

A: If I understand your inquiry correctly, your question is whether zygomatic arch reduction in your case would be beneficial. The zygomatic arch is a separate entity from the skull base so it can be reduced. The question is whether a 5mm to 7mm cheek (zygomatic)reduction per side would be beneficial. I would question that given that the temporal fullness is also adding width which can not be reduced. So in the spirit of an overall facial narrowing, I would not be enthusiastic that such an endeavor for you would be highly beneficial.

Dr. Barry Eppley

Indianapolis, Indiana


Will Cheek and Chin Reductions Make My Face More Oval?

Q: Dr. Eppley, I am Asian and interested in making my face more narrow. It is too wide in the cheek area. I also think my chin is too long and would look better if it was shorter. I woud like my face to be more oval and not so wide and square. Do you think cheek and chin reduction will achieve what I want? I have attached a picture for you to see my face from the front and show me what the changes would look like. Thanks!

A:I have done some imaging based on the single photo that you have sent me. It is a partial smiling photo so it is not ideal to use but it is acceptable to give you a general idea of the proposed changes. This predictive image is based on the following two procedures:

1) Cheek Reduction with osteotomies at the zygomatic body (front) and the temporal end of the zygomatic arch. (back) Your frontal facial photo shows a wide or bowed zygomatic arch from the cheek on backwards. This is best treated by total zygomatic arch narrowing as opposed to zygomatic body reduction. One would need a submental (vertex) x-ray before surgery to look at the extent of the bowing and determine how change (inward movement) of it could be done.

2) The chin reduction is a vertical shortening which is what I think you mean by chin reduction. I have no side view of your chin so I can not comment on any horizontal issues.

Dr. Barry Eppley

Indianapolis, Indiana


Can My Eye Socket (Orbital Rim) Be Reshaped So My Eyes Look Less Deep?

Q: I am currently faced with several problems. My face looks wide because I have prominent cheekbones. I have deep set eyes because of very prominent and bulgy orbital rims. It’s not so much the width of my face that bothers me but it brings everything out of place. Because of the small eyes and the rest of my face is pretty crowded together. When looked from the side, the orbital rim covers nearly everything of my eye while other people still have a part of the eye visible. My cheekbones are bulgy both in the front and the side. Is there any procedure to help me?

A: What you are referring to is prominent orbital rims which make up 3/4s of the orbital ‘box’ that encases the eye. When this outer circle of bone is prominent, it makes the eye seem deep or hidden. It is possible to reshape the orbital rims, particularly the brow bone (upper orbital rim) and the side. (lateral orbital rim) It is not so much whether it can be done but whether the trade-off for doing so is worth it. To surgically access this area, a scalp or coronal incision is needed. This allows the skin to be lifted to get to the area for reshaping. For many women this is not a rate-limiting consideration. But for many men it understandably is.

The width of the cheek bone can be narrowed by a vertical wedge bone removal right below the eye bone which is done from inside the mouth.

Dr. Barry Eppley

Indianapolis Indiana

How Can I Make My Cheeks Less Fat and Round?

Q: Hello Dr. Eppley. I’m a 25 yr old male who is dissatisfied with my cheeks. They are very round and full, and give me a infantile or boyish look, rather than a more angular, defined, masculine one. I’m pretty thin so weight loss is not an option.  I’m wondering what my surgical options are. Apparently plastic surgeons don’t think buccal fat reductions are a good idea. Would creating a cheek dimple help? What do you think?

A: Full cheeks do contribute to a more round facial shape although they are just one factor in creating that appearance. Depending upon how one defines the cheek area, a full cheek can be due to a prominent cheek bone, a large buccal fat pad, a thicker subcutaneous fat layer across the cheeks and face, or some combination of all three. It is obviously important to know what in the cheek area is creating that look when one tries to figure out how to change it.

From a practical standpoint, the only reliable method of ‘cheek’ fullness reduction is partial or complete buccal fat pad removal. While this is a very simple procedure, one has to appreciate what type of facial slimming effect that it will create. Buccal fat removal will create a soft tissue indentation below the cheek bone prominence. If you put your finger under the prominence of the cheek bone, this submalar or under the cheek location will be the area effect. The slimming effect will not go down or past the corner of the mouth.

For most patients, buccal lipectomies will create a mild reduction in cheek fullness in the submalar area, but never dramatic. It is a good procedure, in my opinion, in the properly selected patient. It has gotten a bad reputation because of poor patient selection and over aggressive fat removal. In patients with thin or lean body types, the short-term facial sculpting effect may not be worth the potential for a long-term facial atrophy look with aging.

In trying to create a more sculpted face, it is also important to look at other potentially useful procedures such as chin augmentation, neck liposuction, and maybe even mild cheek augmentation. When put together with buccal lipectomies in the right face, a signficant more defined facial look can be obtained.

Dr. Barry Eppley

Indianapolis, Indiana