Can A Zygomatic Osteotomy Increase Anterior Cheek Projection?

Q: Dr. Eppley, Happy new year! I hope you’re well. Your website is an incredible resource, I have some more questions about Facial Feminization.

I had an extensive mandibular osteotomy at another clinic and pursued a deep plane facelift with a platysmaplasty a year later to address jawline definition and redundant laxity. Due to the vector of the lifts in this case being more lateral than vertical, I still have a problem with my midface area which appears broad due to large/flat zygomas. I prefer a softer aesthetic and am seeking to avoid adding extra lateral projection, favoring more forward. To this end, as I consider zygoma reshaping (rather than reduction), I wondered what the differences are between a zygomatic sandwich osteotomy and a malar rotation (as performed more commonly in South Korea)?

That and whether any buccal fat pad movement, as a consequence of cheek bone adjustments can be mitigated by a mid-face lift?

A: Neither a zygomatic sandwich osteotomy which increases lateral cheek width nor a zygomatic reduction with malar rotation which decreases lateral cheek width will create more forward projection, only an implant can  make that happen. There is no bony osteotomy that effectively pulls the cheekbone forward.

Dr. Barry Eppley

World-Renowned Plastic Surgeon