Q: Dr. Eppley, I have a question regarding cheekbone reduction. I know that cheekbone reduction is often performed in patients seeking to reduce the width of the face. However my issue is slightly different. Essentially I have low set cheekbones that project, both forward and laterally. To me this gives a very feminine look, and the reason behind it is that the zygomatic prominence is too low down on the face, causing the ‘bulge’ of the cheek to be too low. So I was wondering whether it would be possible to reduce the projection of the cheek in not only both the forward and lateral directions but also in the vertical dimension. My thoughts are that we would flatten down the projecting part of the cheek and then remove the bone forming the inferior border of the zygoma. Will we be able to achieve these objectives? If it proves to be impossible what is the closest we can come to achieving them?
A concern I have is that the soft tissue may not react well to reducing the size of the bone. I am worried that reducing the bone would just leave hanging soft tissue. Are my concerns on this matter valid? If so, can we do anything to help such as a midface lift to reposition the soft tissue against the new bone contours?
A: The type of cheekbone reduction you have described can be done and is known as a zygomatic-maxillary corner ostectomy. That would address the bony ‘deformity’ that you have astutely ascertained. The concern about soft tissue sag is not without its merits although the superior zygomatic bone structure remains intact. To proactively address this potential concern one would do a soft tissue bone suspension of the cheek tissues at the time of the ostectomies.
Dr. Barry Eppley