Zygomatic Sandwich Osteotomy

Q: Dr. Eppley, I would like to ask how the soft tissue of the face responds to implantation v. osteotomy. I am currently deciding whether to go ahead with zygomatic sandwich osteotomy for lateral projection of the cheekbones, or whether to achieve this change with implants. My decision mostly hinges on the soft tissue response. I want the augmentation to ‘stretch’ the soft tissue as much a possible. Am I right in saying that an cheek osteotomy will achieve this goal better? I say this because its true that a sliding genioplasty will mobilise the submental soft tissue more than a chin implant will (given equal amounts of augmentation). I have thin skin and low bodyfat, I just lack projection meaning that my soft tissue does not appear to wrap around the bone well.

A: If you want to stretch the cheek tissues as much as possible, an implant achieves that better than a zygomatic sandwich osteotomy. This is because by virtue of the implant placement the soft tissues must be elevated off of the bone first and then the implant placed. That does not occur in an osteotomy where more tissue adherence remains. Such a cheek effect from implants or an an osteotomy is not analogous to the chin where the submental area improves from a sliding genioplasty because of the attached muscle stretch not that of the overlying soft tissues.

Dr. Barry Eppley

Indianapolis, Indiana