How Can I Fix My Zygomatic Arch Asymmetry?

Q: Dr. Eppley, I was wondering if filler or fat transfer could be safely applied slightly below and above the zygomatic arch to conceal vertical asymmetry between the left and right arches? I was born with one zygomatic arch noticeably lower than the other (see attached CT scan image). 

I’m assuming the zygomatic arches cannot be safely moved up or down via osteotomy to correct the asymmetry, is this correct? 

If so I’m thinking the best bet would be to add some type of filler below the higher arch and above the lower arch to make them kind of match one another more. 

Unless this could be done with implants? 

Thank you for reading.

A:In answer to the management of your asymmetric zygomatic arches:

1) Injectable fillers or fat can be used as you have drawn on your 3D CT scan. Certainly this is the simplest approach albeit the most unreliable and/or non-permanent effect.

2) You have incorrectly assumed that zygomatic arch osteotomies can not be done to change their horizontal position. Whether this would be an effective approach depends on how much up or down movement of them is needed.

3) Zygomatic arch implants may also be an option depending upon what exact dimensional movements are needed.

In most cases of facial asymmetries of any kind there is often a good (preferred) side and a non-good side. Usually the higher side is the preferred side and this is almost always the case with cheek/zygomatic arches. If so, then the goal is to make the lower side match better with the higher side in which all three mentioned options are possible each with their own advantages and disadvantages.

Dr. Barry Eppley

Indianapolis, Indiana