Is A Zygomatic Sandwich Osteotomy A Good Cheek Augmentation Method?

Q:  Dr. Eppley. I am seeking your opinion on the use of a zygomatic sandwich osteotomy (ZSO) versus (infra) zygo implants for aesthetic zygo augmentation in Caucasian patients.

In your experience, which technique generally provides the better aesthetic result, and why? Do you consider ZSO to be a good option for enhancing cheek/zygo projection, or do you usually prefer implants? What are the main advantages and disadvantages of each approach in terms of appearance and long-term results?

Thank you very much for your time. I would greatly appreciate your opinion.

A: While a zygomatic sandwich osteotomy has its autologous appeal, it has major aesthetic disadvantages. It is essentially a unilateral dimensional procedure that only adds lateral cheek width. It cannot provide any anterior projection to the cheek and most certainly does not do anything for the infraorbital area. Therefore by comparison to a custom infraorbital-malar implant, it is woefully inadequate for the vast majority of patients who need enhanced skeletal support in the upper mid facial area.

It is never a question as to which procedure I prefer, as I can perform both of them, but what are the exact dimensional needs that a patient requires to achieve their aesthetic outcome. When you use the term enhance cheek/zygos you would have to put some dimensional qualifications as to what that means. Once I know what the end target is, then I can tell you which of these two procedures could best achieve it.

Dr Barry Eppley

Plastic Surgeon