Soft Tissue Sag after Zygoma Reduction

Q: Dr. Eppley, Zygoma reduction was a major surgery for me, and as much as I put my faith in my surgeon, I understand that there’s no guarantees with any surgery. I would like to keep a back up plan handy, in the case that things weren’t able to end favorably. In the case that sagging happens, I’m interested in getting cheek resuspension surgery or Endotine cheek lifting to lift the cheek tissues back up higher. My surgeon does not provide cheeklifting or endotine lifting surgeries, so my ultimate plan is to fly to your practice in Indiana. 

However, I’ve read on your blog, of someone else’s experience of zygoma reduction. ( With this individual’s experience, you stated that their tissues were scarred and atrophied from their cheekbone reduction, cheekbone reduction reversal, and endoscopic midface lift surgeries.

What do you mean exactly when you say their soft tissues have been ‘scarred’ or ‘atrophied’ from the surgeries?

I was wondering if this case would apply to me as well. I’ve already undergone zygoma reduction and lifted the cheek tissues up once. If I were to get the titanium screws removed (ideally I would), the cheek tissues would be lifted twice. If I were to undergo a third surgery (cheek resuspension) and lift the cheek tissues off the bone a third time, would this result in atrophied and scarred cheek tissues as well?

When the tissues are atrophied and scarred, what effect does this have on the external appearance of the face?

A: All surgeries in the face cause tissue damage and some degree of scarring and tissue atrophy. How relevant this effect is depends on many factors but is of greater relevance in facial bone reduction surgery than facial bone augmentation surgery. (unless you remove the augmentation) With less bone support the overlying tissues will contract as a natural part of healing. While everyone thinks that the tissues contract in a 3D fashion around the reduced bone (in, down and up, they may not and the tissue contraction may be more of a 2D effect. (in and down) The young age of the patient and good tissue elasticity makes it far more likely that a 3D tissue contraction effect will occur but this is not necessarily assured.

The more times you enter a surgery site the more scar that is created. Whether this scar is detrimental depends on what is being done. For plate and screw removal this dissection is such more limited so it is less likely to have any cheek sagging effect.

Dr. Barry Eppley

Indianapolis, Indiana