Cheekbone Reduction Complications

Q: Dr. Eppley, I underwent a cheekbone reduction procedure which involved an L osteotomy of the zygomatic body of 5mm. The back end of the cheekbone was cut via a preauricular incision and the whole cheekbone unit was pushed forwards, fixed with screws.

1) Is 5mm a large amount of resected bone for the zygomatic body? My surgeon assured me that it is within the normal range and that a large amount is considered 6mm of bone or more. The numbers being so close make me extremely nervous.

2) Will wearing the facial compression band at 4-5 weeks post op help prevent sagging in any way. My surgeon did not perform any preventative resuspension methods as you do, and this makes me extremely nervous about the potential sagging. Does this lack of prevention make my chances of sagging higher? In your experience, does a lack of preventative suspension of the cheek result in sagging usually?

3) Though it’s been almost 5 weeks, my midface is unusually swollen. I am in my early 20s and the area next to my nose is particularly swollen, essentially it looks like I have quite distinct malar fat pads. Is this a potential symptom of sagging or could it be swelling? If so, why would this area be so swollen and not the actual cheekbone area.

4) As I did my surgery overseas, I am unable to go to my check ups. I will have to undergo CT scans in my home country to ensure bone union. At what point should I expect bone union or non union to have occurred. When would I be able to start eating hard foods without worry?

A: In answer to your cheekbone reduction surgery questions:

1) A 4 or 5mm vertical wedge reduction is the typical amount of bone removed in the anterior cheek osteotomy.

2) No external compression wrap is going to help the cheek soft tissues heal better or prevent any sagging. The occurrence of soft tissue sagging after cheekbone reduction is not common even if preventative measures are not done. Whether you are at an increased risk for it I nor anyone can say. Time will answer that question.

3) Swelling and tissue contraction after this or any type of facial bone surgery takes a full six months to see the final result. So you are only 1/4 along in your full recovery.

4) You can start eating hard foods any time now. The value of postoperative CT scans is dubious unless a problem develops. (chronic pain/swelling, aesthetic asymmetries etc) It would be exceedingly rare that facial bone sites don’t heal. If you go on to have a satisfactory result then getting a CT scan is unnecessary. As a surgeon I love to see the before and after scans to see how I did, but it is not essential to check for bone healing in most cases.

Dr. Barry Eppley

Indianapolis, Indiana