Your Questions
Your Questions
Q: Dr. Eppley, The post cheek reduction X-rays look pretty even but the cheekbones seem off and there’s some hollowing I wasn’t expecting. I’m not sure how much is due to swelling. It’s been almost five months since the procedure. Some areas of skin seem to be very loose. And one cheekbone does seem to be farther forward facing than the other one. I’m not sure if a cheekbone or temple implant could fix this. I’m worried they took too much off my cheekbones.
A: These post cheekbone reduction issues are not rare. The execution of the operation is not easy in terms of bony symmetry and loss of structural support will cause some amount of soft tissue laxity/sag.
You are correct in that implant augmentation is how these issues are treated for which improvements are usually obtained. The only question is whether these should be standard or custom cheek implants.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I am interested in cheekbone reduction. I am a 24years old female. I would like to have Zygoma reduction. (by intraoral route if its possible) I want to do this surgery to have more slim face. Do you do on the CT face scan analysis and do you use melting screw? Do you do Anterior segmental osteotomy surgery? Looking forward to hear from you. Thank you.
A: Cheekbone reduction osteotomies for facial narrowing is usually done with an intraoral anterior osteotomy of the posterior zygomatic body combined with a posterior osteotomy of the zygomatic arch where it connects to the temporal bone with a very small incision in the hairline. Small 1.5mm titanium plates and screws are used for bone fixation. While resorbable plate and screws can be used they are much more expensive than titanium and do not work as well. While an anterior osteotomy of the posterior zygomatic body can be done alone, it does not create as much facial slimming as when a posterior zygomatic arch osteotomy is done as well. I usually like to see a 3D CT scan before surgery to determine how much inward movement can be obtained with cheekbone reduction osteotomies.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in cheekbone reduction surgery. I am a 26 year old male and I am quite self conscious about my cheekbone width. They span almost 16cm and I am wandering if it would be possible to take about half a centimeter off on each side to make my eyes (pupilliary distance of about 65mm) more proportional to my face.
A: Your fundamental premise is that if the width of the face was less wide, your eyes would not look too close together. Since you can’t move your eyes this leaves only the cheekbone width to be changed. Cheekbone reduction surgery works by moving in the zygomatic arches of the zygomatic complex. These arches are what makes up the width of the middle part of the face. The inward movement of the cheeks usually is no greater than 5 to 7mms per side due to the location of the temporals muscle which lies underneath it. The bone should not ‘pinch’ the temporals muscle as this could interfere with the workings of it which is to help open and close the mouth. Usually it is a good idea to get a 3D CT scan before cheekbone reduction surgery to look at the anatomy of the zygomatic arches and see how much reduction is possible.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in cheekbone reduction or recontouring. I’m wondering if there is a possible solution to my low cheekbone contour, by this I mean the ‘hollow’ shadow line that you see in many male models or those with high cheekbones. From looking at my face at the front is the cheekbone insertion too low or are my cheekbones just too large in length size? I ask this because the cheekbone seems to start at a high position i.e. just under my eye but seems to extend a lot length wise down my face. Any possible solutions to this would be appreciated.
A: Interestingly, while many men seek to obtain the cheek look that you have (and can’t) yours appears to be a question as to how to change your high and wide cheekbone prominence. Your cheek look is a function of both the high and wide shape of your cheek bones as well as the lack (or minimal amount) of facial fat. As a result you have a very classic pattern of ‘cut out’ cheek bones whose pattern can be seen very clearly on your face. Since a face like yours is very unlikely to maintain any injected fat, the only possible solution is to recontour your cheek bones. A reduction in your cheekbones (cheekbone reduction) to reduce its width, and possibly adding a small submalar implant (to fill out the submalar hollows), would be the one way I can see to modify your cheekbone shape.
Cheekbone reduction surgery is often about modifying the shape of the cheekbones as opposed to just pure bone removal.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have rather under defined but wide cheeks. I’m interested in undergoing both Cheekbone Reduction and Cheek Implant surgeries. I saw your answers on RealSelf and wanted to know more about your experiences in these surgeries. Also, how much would it cost to perform both surgeries? Thank you a lot in advance.
A: You have the classic wide cheekbones (technically zygomatic arches) that do not have much anterior projection over the body of the zygoma. (malar prominence) Hence your description of ‘underdefined but wide cheeks’. As you already know improving this type of cheekbone anatomy requires cheekbone reduction surgery (technically inward respositioning of the zygomatic arches) and implant augmentation. (anterior cheek augmentation) The most challenging aspect of this surgery is in the cheek implant design. There is no standard cheek implant made that achieves the type of cheek augmentation that you need. Fortunately I have treated enough Asian patients who desire this exact type of cheek change that I have designed specific cheek implants to achieve this anterior projection but which create no lateral projection or width increase.
I will have my assistant pass along the cost of the surgery to you on Monday.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’m interested in cheeckbone reduction and maybe jaw reduction to make my face smaller and oval shape. My question is, do I need a jaw reduction or the cheeckbone reduction is enough to slimmer my face? Also, I had a rhinoplasty done about ten years ago. The tip is very visible. It looks like a small pimple on my nose, probably because my skin was thin. I’d like to have a revision. Please let me know what you recommend.
A: When it come to narrowing the wide Asian face, one procedure or changing one facial area is rarely enough to have a significant effect. Combining cheekbone reduction with jawline reduction (jaw angle, masseter muscle and chin elongation) is the most effective approach. Of course each patient must be individually assessed to determine if one of these facial changes would be the most dominant and, in your case, there most certainly is. The width of your cheek bones is by far the widest part of your face and would be the one procedure (cheekbone reduction) you would absolutely do if there was only one procedure you wanted to do.
From a visible nasal tip standpoint, which I assume may be from prior tip graft or implant,the tip can be either modified (tip point reduced) or over grafted. (cartlage graft on top of the tip) It would be helpful to know what exactly was done from your rhinoplasty now 10 years ago.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have a very particular question regarding cheekbone reduction fracture. I had cheekbone reduction abroad where they pushed the sides of the arch of my cheekbones in to make my face narrower. However, the posterior end of the arches somewhat move outward on and off a bit, making my face wider. I was wondering if it was possible to place plates on the posterior ends of the zygomatic arches to keep them in. Thank you.
A: When it comes to cheek bone reduction osteotomies, the posterior end of the zygomatic arch is cut and moved inward. Many times a small plate with screws is placed to keep it positioned inward. This may not be necessary if a larger plate with screws is placed on the anterior cheek osteotomy. But if there is persistent mobility and rocking of the posterior segment, it can be stabilized secondarily. The best fixation method to stabilize it inward is to make a small step plate and secure wit with a screw to the remaining temporal process of the zygomatic arch. The bent step plate is then used to push the posterior end of the zygomatic arch inward and keep it from moving back outward.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in getting head width reduction surgery, cheekbone reduction surgery as well as surgery to augment the back of my head. The first photo I attached is in regard to head width reduction and cheekbone reduction surgery. From the info on your website, I see you do removal of the muscle after the yellow line in my photo. I am curious to know if you can do removal of muscle after the red line in my photo. Also, I will always have very short hair on the side, since it make my head looks smaller. How visible will the scar be after the width reduction with my short hair?
I had a cheekbone reduction before but my surgeon didn’t reduce any more cheekbone after the first blue line in my photo due to concern of nerve damage. Since most of the width of my face is in between the two blue lines. The cheekbone reduction i had is largely ineffective in making my face more symmetrical and narrower. I was wondering if you are able to reduce the cheekbone between the two blue lines where my previous surgeon was concerned with nerve damage
Lastly is in regard to the augmentation of back of my head, my current head shape is similar to the baby in the second pictures. I am curious in getting a custom implant to make my head look more normal.I consulted with a craniofacial he advised me against a custom implant because of high risk of infection. How high is the infection rate of these implants, and How much will total cost of this specific surgery be including getting a 3d CT scan, a custom implant made, and all the other fees including surgeon fee?
A: When it comes to temporal muscle reduction, the actual line of reduction is from the top of the ear angling upwards to just behind the temporal hairline along the forehead, so it is in front of the red line that you have drawn. Most of the incision is behind the ear and it is done largely endoscopically above it.
The cheek bone a you are illustrating is the tail end of the zygomatic arch where it attaches to the temporal bone. If this part of the cheek bone is not fractured inward with the front part, little change in cheek bone width will result. An osteotomy is done in that area through a small incision at the junction of the beard skin and non-hairing skin. The temporal branch of the facial nerve runs in front of this incision so there is no risk of nerve injury. This is actually a standard approach to cheek bone reduction osteotomies as both the front and back ends needs to be cut and moved inward.
I have done many custom occipital skull implants as well as many other implants for other skull augmentation areas. I have yet to see an infection so the claim that they are prone to a high rate of infection has not been my experience.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am inquiring about the possibilities regarding slimming down my face. It is just long and wide and does not look proportional to my body at all. What could be done to reduce the size of my face? I obviously see that there are limits of what can be done. Whereas I for instance could have jaw reduction and/or cheek cutting. But what sort of experience do you have here?
A: In facial reshaping surgery, slimming the face can be done by three different approaches depending on the dimensions involved. Normally the face could be vertically lengthened to make it look less wide. The face could also be made less wide (width reduction) without changing the vertical length. Lastly, a combination of vertical lengthening and width reduction can be done which often is the most effective.
Your facial dimensions and concerns (‘long and wide’) leave you with only facial width reduction options as you have noted. Cheekbone narrowing and jaw reduction would be the logical procedures of cboice. Whether this would include vertical chin reduction to help with the long face can be debated since vertical facial shortening works against facial width efforts.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I wanted to restore my cheekbones and the saggy soft tissue with an endoscopic midface lift after cheekbone reduction. I found a very good maxillofacial surgeon and a plastic surgeon who worked together to bring my zygomatic bone to the old anatomic position and lifted the sagging soft tissue. That surgery was exactly six weeks ago. I know that swelling from jaw surgeries are extreme and lasts a long time but I am very afraid because I still can’t see the Ogee curve and high cheekbones that I had before the zygoma reduction. There is an improvement but not so much. I don’t know if it is because of the swelling that are all around my mouth, nasolabial folds and upper lip or if he didn’t lift enough or what could be the reason for that? I know I have to wait six months until one year to see the result but what can I do if my surgeon didn’t lift enough. ( I trust him but I know that my case was difficult because of the cheekbone restoration at the same time) Is it possible to lift the fat pad again after one or two years or is it too difficult? Otherwise I don’t know what to do, it still look a little bit saggy (maybe because of swelling)
A: With the scarred tissue from these two surgeries (cheek bone reduction and cheek bone elevation and fixation), it is highly unlikely you will get significant improvement with any type of attempts at midface or cheek lift. The tissues are both scarred and atrophic and their elevation will be both difficult and limited. While you need to let the swelling subside so you can judge the final result, I doubt it will be much different than before surgery. (remember the result is going to look worse as all swelling subsides.
Any effort at cheek sagging improvement in the future can only use the approach of adding volume to lift the sagging tissues…but that is exactly what you were looking to avoid from the beginning. (too much cheek fullness) I am afraid you have reached the point where the cheek result you have is as good as it is going to get unless you are willing to acccept other trade-offs.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Hello! I am sending this request with my photos. As you may notice, the right side of my face is “larger” than my left, I feel its mostly the cheek bone. Hence I wanted to inquire about “cheek bone reduction” for my right side. I know it is not that simple, but to not make this very long I am writing in the most general way possible. I understand perfect facial symmetry with surgery is realistically impossible, I just wish to find a way that my facial cheek bones may be more proportioned, (with out the use of an implant or fillers), this cheek bone asymmetry is an insecurity I have when people look at me. I look forward to hearing back and thank you for taking time to read.
A: I can see the asymmetry in your cheek area and, for now, we will assume this is due to a difference on the zygomatic (cheek) bones between the two sides. Right-sided cheek bone reduction can be done but it would be very important to know where the differences in the bones are so that the right bone reshaping technique can be used. In make that assessment, a 3D CT scan of the face is needed so that exact location and magnitude of the cheek bone differences can be seen and the right surgical plan done. Whether yours would be a ‘typical’ cheek bone reduction (anterior and posterior bone cuts) or just anterior awaits what the 3D CT scan shows.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am 28 year-old Asian make who is very interested in having cosmetic surgery performed for overall facial reshaping. As you offer a wide range of procedures which may be relevant to my goals, I hope to receive advice on the achievability of my goals.
First of all, I am very conscious in photos of the roundness and wideness of my face. (especially when smiling, at which point my cheeks appear very round and prominent) In addition, I would like to reduce the fullness of my lower face and make it thinner.
Secondly, I was wondering if a sliding genioplasty was advisable, as my chin appears to be relatively normal sized. I wish to make my jawline less round, and increase the vertical dimensions of my face to alleviate the aforementioned wideness.
Thirdly, I was wondering if procedures were available to create a more ‘deep-set’ look for my eyes. This, in addition to rhinoplasty to reduce the hump and raise the nose bridge, to reduce the ‘flatness’ of my face in profile.
I realize that not all of my expectations will be realistic nor all procedures advisable, so thanks for your time and expertise in advance.
A: A wide collection of procedures are available for facial reshaping as you are aware. In addressing all four areas of your facial concerns from top to bottom, I can make the following initial comments as they relate to your face.
1) I am now using performed or custom brow bone implants to build up the brow ridges. They can be placed through a limited incision endoscopic technique. That is the most effective way to create a more deep-set look to your eyes.
2) Your rhinoplasty would include a humor reduction, radix augmentation and some slight increased tip projection.
3) Cheekbone narrowing is the only way to provide some reduction in the mid-arch bizygomatic distance of probably 4 to 5mms per side.
4) I would consider paranasal augmentation, I have a new paranasal implant that I am really happy with that can not be felt and adds about 5mms projection to the nasal base.
5) I do think that a vertical lengthening genioplasty (which may have to be widened in a male) will help narrow the jawline. You do not need a horizontal advancement but when opening the vertical distance of the chin it does rotate it back a few millimeters so I would do a small advancement as well.
These are some initial thoughts. Computer imaging needs to be done to see how such facial reshaping procedures would look on you.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I would be pleased if you could tell me if in my case whether an endoscopic midface lift would help to get rid of the sagging face after cheekbone reduction?
A: I have read through many explanations of facial sagging and its causes and treatments after cheekbone reduction surgery and find very little of substance there that is helpful. It only tells what is already known…that if the osteotomized bone segments are not stabilized by plate and screw fixation (particularly at the zygomatic body) the natural contraction force of the masseter muscle will pull the entire cheek segment downward including the attached soft tissues. In addition, over release of the masseter tendon from the zygomatic body will have the same effect even if the bone is properly stabilized in an inward and superior position. Fixing this type of msuculofascial sag is not going to be helped by any overlying skin repositioning maneuvers such as any type of facelift procedure that merely pulls on the skin. Thus, while any sort of midface lift may be of some help, it does not fully address the root cause of the facial sagging…musculofascial contraction.
For all intents and purposes, it is not really possible to reattach or lift scarred masseter muscle. This is why some form of skeletal cheek augmentation is usually needed with the lift to volumize the submalar cheek zone. This could be done with either implant or fat augmentation.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have a question about cheek bone reduction. I hope you can help me because I am very afraid. I had a zygoma reduction with the L-osteotomy. Now my cheeks are sagging. I can see it because of the swelling look around my mouth. Now my surgeon told me that he will do a midface lift and Medpor implants. Will that help or not? I am afraid because I read on some pages that it is very difficult to fix this problem. Is that right? Please help me, I don’t know what to do.
A: One of the well known risks of cheek bone reduction is loss of soft tissue support or cheek soft tissue sagging. Since the cheek bones act as attachments and support for the midface tissues, it is no surprise that in some cases with some cheek bone techniques that the cheek tissues may sag afterwards. It is not a universal complication of every cheek bone reduction but it definitely can occur. It is for this reason that I like to perform cheek tissue suspension at the same time as the cheek bone reduction.
Now that you have it, and I presume you are at least 3 or 6 months from the procedure, the treatment would be the reverse of what caused the problem. At the least the cheek soft tissues need to be elevated and this could be done through a combination temporal and intraoral suspension approach. While adding bony projection with a cheek implant can be an adjunctive procedure to a cheeklift, it seems counterproductive to add back cheek prominences when you went through the original operation to get rid of them.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am an Asian female who is 27 years old and want to have a more narrow face. I’m interested in jaw reduction, chin reduction(v-line) and cheekbone reduction surgeries. What are the possibilities of side-effects such as nerve damage and sagging skin? Is it possible to do all 3 surgeries at once?
A: As you undoubtably know, narrowing of the Asian face by bone reduction is a common request and collection of procedures. All three facial bone reduction procedures are commonly done together including cheek bone reduction and jawline narrowing. The most common side effect, albeit not a complication, is the protracted facial swelling (4 to 6 weeks) until you see the beginnings of the results of the procedure. Generally permanent nerve damage (sensory nerves, infraorbital and mental nerves) does not occur although there will be a period of some lip numbness. The bigger risk is with the mental nerve as the jawline reduction goes right beneath it and some stretch on the nerve does occur. Sagging skin is also not usually an issue either and this is more of a concern in the cheek area rather than the jawline.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had cheekbone reduction using the L method. Now cheeks are really low. I want to ask can you put an implant on top of the cheekbones which have been cut and screwed in a lower position? Or is this not possible as it may make the already cut cheekbones move position or fall off??
A: Your cheek bone prominence can be restored by the placement of an implant on the cheekbone. Even though the face of the cheekbone has changed, cheek implants are screwed into position so there is no chance of shifting or falling off of the face of the cheekbone. Having a prior cheekbone reduction does not preclude the placement of cheek implants later.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dear Dr. Eppley, I have a question about cheek and orbital rim implants. I have fairly wide cheek bones that I am considering reducing via osteotomy, but the frontal cheek area directly beneath my eyes seems deficient. Are there cheek implants (or fillers) that can push out this area under the eye (a slightly near the transition of the nose)? Can the results of such cheekbone implants make a wide/flat face look less wide and more defined? Also, does cheekbone reduction cause sagging skin/prejowl?
I have fairly large eyebrow ridges, which I am generally happy about, but the ridge area close to my radix is deficient compared to the prominent ridge area near my temples (I think it pushes my eyebrows up vertically near the side of the temples). Is there a way to augment the area near the radix so that it more smoothly matches the rest of my eyebrow ridge? Would the only way to do this be to have an open-scalp incision? What would be the complications of such a procedure?
A: It is common in wide cheek or zygomatic widths to have anterior infraorbital rim deficiency. This is part of the wide midface look. There are specific infraorbital-malar implants that augment this area exclusively. They come in a variety of styles and sizes although my preference is to custom carve implants out of a Gore-tex block at the time of surgery, particularly when the amount of rim/tear trough augmentation is small.
I don’t know if you would call a combined cheekbone reduction with infraorbital rim implants making the face more defined. But it will change its shape and proportions acroos the midface area to look less wide. Calling it increased facial definition is a stretch.
Building up the radic of the nose can be done with either injectable fillers or fat for a minimal or non-invasive approach or can it be bult up with either a very small implant or cartilage from an intranasal approach. A scalp incision would never be needed.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in getting cheekbone reductions and fat injections at the same time. I think with the cheek reductions I don’t want my face to be too narrow, long and look too old. Does this make sense to you? Also where are the incisions for the cheek reductions? I know that these are uncommon surgeries for Americans so what is your experience with them?
A: My recommendation is that you wouldn’t do fat injections at the same time. That would be counterproductive. The reason is cheek bone reduction, at its best, can never make your face too long or sunken in. The procedure never overshoots the goal, at best it will underachieve. There is a limit as to how far the cheek and zygomatic arch can be moved inward…it is known as the masseter and temporalis muscles. That is what lies underneath the width of the arch so they are a rate-limiting step as to how much facial narrowing in this area can be achieved. Therefore, I think the idea of simultaneous cheek fat injections is both presumptuous and unnecessary This is a good example of the plastic surgery principle…let the results prove that you need more surgery.
Cheekbone reductions, as I have described, are done from two approaches. The front part from inside the mouth and the back part from a small incision in the temple hairline.
You are correct in assuming that almost all cases of cheek bone reductions are in Asians. (although I have done one Caucasian patient to date) No one’s experience in the U.S. is extensive with this procedure since the demand is so low. But this is a cosmetic procedure that has its origins in cheek bone fracture repair and reconstruction of which a plastic surgeon with extensive craniomaxillofacial experience is very familiar.
Dr. Barry Eppley
Indianapolis, Indiana
Q: How is cheek shaving done and what effect does it have on the face?
A: Cheekbone reduction is done to either reduce a prominent anterior zygomatic prominence or to help narrow the width of the face in the cheek area. It can be done through either a cheek shaving technique or cheek (zygomatic) osteotomies. Cheek shaving is best used to reduce an isolated anterior zygomatic prominence. While it will result in some narrowing of the front part of the cheek, it is not a good procedure to make a big difference in the width of the face which is composed of the body of the zygoma and the entire length of the zygomatic arch. Cheek shaving is done from an intraoral incision and a burr is used to take down the projection of the zygomatic buttress from the lower lateral edge of the orbital rim down to the lower edge of the zygomatic buttress where the masseteric tendon attaches. Conversely, cheek osteotomies are more extensive and use a ‘front to back’ approach. Bone cuts (osteotomies) are made through the zygomatic buttress anteriorly and the attachment of the back end of the zygomatic arch to the temporal bone. This requires a small incision in the temporal scalp as well as from inside the mouth. This allows the whole length of the zygomatic bone to move inward, thus creating a narrowing effect in the width of the face. These two cheek procedures use different surgical techniques that result in degrees of cheekbone reduction. The selection of either technique is based on the anatomy of the patient and what their specific midface goals are.
Dr. Barry Eppley
Indianapolis, Indiana
Q: I want to thin out my face and am thinking of having a facelift to initially tighten my skin and then my cheekbones (zygomas) cut and narrowed. The reason I am considering zygomatic reduction and face lift is to first “trim” excess skin for maximum tightening of the jowls, nasolabial region, cheeks and neck. Then narrow my face with zygomatic reduction, perhaps including the arch and the zygomatic body itself. I was hoping to improve skin definition below zygomatic arch and angularity of the jaw first, than schedule second surgery afterwards. Do you think it is a good plan for my case? Thank you kindly.
A: While I don’t have the advantage of looking at your facial pictures, I think your plan is fundamentally fine but it is planned in reverse. You want to do any skeletal or underlying foundational surgery first. The reason being is that such surgery causes a fair amount of external swelling which will stretch any tightened skin, potentially reversing some of the effects of any skin tightening procedure. Maximum tightening of the jowls cheeks and neck (facelift) should, therefore, be done after the bone foundation has been treated.
When considering zygomatic reduction, it is important to know if it will produce much of effect. This can be assessed by locally at plain film x-rays, particularly a submental and/or a water’s view. These simple films give a visual assessment of how significant the curve is on the zygomatic arches. That will have to be ordered through a hospital or any free-standing x-ray facility where the appropriate equipment exists.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Hi! I have been searching for this kind of procedure for cheekbone surgery or reduction. I am glad to have found this site. I come from a family which we have strong cheekbones, but in my case I have been in a violent incident where I was injured and I think I broke or deformed a bit of my jaw. Now I have some asymmetry in my cheekbone as it seems to have become more prominent after this injury. I would really like to know if it would be possible to reduce them. I used to have a lot of charisma when I was young before my violent incident. Since then it has totally changed me. I would like to know more details in this procedure, time of recovery, possible complications, etc. Thank you.
A: Cheekbone reduction is about narrowing the width of the body of the zygoma and the zygomatic arch. It is a common procedure for those whose face is naturally a little flatter and more wide as exists in certain ethnicities. It can also be used to treat a cheekbone fracture where the body of the zygoma has been pushed back which wides the zygomatic arch, making the cheek area have less prominence and more width.
Your description of your cheekbone problem is a it confusing to me. On the one hand, you state you have naturally strong cheekbones (forward prominence) but, after an injury, they have become more prominent. That would be very unusual given how the cheekbone fractures. For this reason, it would be best to send me some photos of your face for my assessment before I could provide any recommendations, specifically whether cheekbone reduction surgery would be benefical to you.
Dr. Barry Eppley
Indianapolis Indiana
Q: When I was younger, around 14 years old, I was punched on the left side of my cheek which caused my left side (cheekbone) to be larger than my right side. I did not notice this until my ex-g/f, then current, informed me of this. It’s maybe 4 to 6mms bigger than the right side. I didn’t get it fixed since I didn’t realize there was a problem until the bones had already repaired itself. I suspect a lot of it is bone growth making my cheekbone larger. Could you tell me if this is possible to fix?
A: This is an unusual reaction to a traumatic facial injury. Usually the cheekbone would have gotten fractured causing the opposite problem long-term, cheek indentation or flattening. The observation that it got bigger would indicate that an actual fracture of the bone did not occur.
It is more likely that you sustained a traumatic hematoma (blood collection) to the tissues. This could result in either extra bone being deposited on the outer surface of the cheekbone (appositional bone development with blood as the stimulant which could happen in a growing bone such as a teenager) or scar tissue which has thickened the soft tissue.
The question is how do you make that determination as to which it is? A plain x-ray (Water’s view) would be a simple and useful diagnostic test. Or you could just treat the problem the only way you can which is cheekbone reduction. Even if it is soft tissue thickening, bone reduction would still be the treatment method. Through an incision inside the mouth, the outer surface of the cheekbone would be burred down. If the difference was greater, a cheekbone reduction osteotomy could be done. But for 5mms or less, simple outer cortical burring of the cheekbone is the best way to go. Because it is done through the mouth, there would be no scarring and just a temporary period (four to six weeks) before you would see the final result,.
Dr. Barry Eppley