Q: Dr. Eppley, I already had several consultations with other surgeons, but nobody seems to understand my “problem”. I would like to have cheekbone augmentation, but I already have high and prominent cheekbones.But in my opinion there is a difference between the body of the zygomatic bone (where the cheekbone goes around the corner and what is usually called “the cheekbone”) and the arch of the zygomatic bone (the very lateral part of the cheekbone that extends to the ear and looks like a rather thin bow). My surgeons always acted like I was crazy after I explained that difference to them and that I only would like to have an augmentation of the arch of he zygomatic bone. They told me they have never heard of this kind of augmentation and there are even no implants out there that could address this problem. Then I found out, that there is a very popular kind of surgery around South Koreans.Many South Koreans have very wide zygomatic archs that stick out of the sides of their face although they often have a rather flat body of the zygomatic bone. For some reason (I think because they prefere a more western look) many Koreans don´t like this wide zygomatic arch and get zygomatic arch reduction surgery. It is a reduction osteotomy of this bone, that is done through an incision just in front of the ear. (like a face lift incision). I thought if it is possible to reduce the zygomatic arch, it should be also possible to augment this area. After I told this another surgeon, he said that this is called a preauricular incision that is only done in superficial layers, for example to do a face lift, but it is not possible to have a safe access to the bone via this incision, because the facialis nerve lies there. But I don´t belief him, because I have seen many pics on the Internet of this kind of incision that goes right down to the bone. It is used for correction of a fractured zygomatic arch or for operations on the temporomandibular joint. Does this sound crazy to you, Dr. Eppley?
Is there a way to augment only the arch of my zygomatic bone? Is it possible to carve impants for this area? I know that midface implants are usually placed through the mouth, but it seems logical to me that it would be easier to put a “zygomatic arch implant” through a praearuicular incision. Is it possible to have save access to the bone through this incision?
A: I think you have a very good grasp on what you are trying to achieve. Can you just augment the zygomatic arch with an implant…absolutely yes. While wide zygomatic arches are reduced by osteotomies, expanding or augmenting the arch requires an implant not an osteotomy. Since they are no specifically designed zygomatic arch implants, they would have to be fabricated by either modifying an existing stock implant (such as by using the wings or flanges from an anatomic chin implant) or hand-making custom ones. Which implant technique would be better depends on how much augmentation you are desired the exact location on the arch. When it comes to placement, zygomatic arch implants could be put in either through the mouth (anterior access) or from a preauricular incision. (posterior approach) Which method of access would depend on the shape and thickness of the implant, although I would likely prefer the posterior approach because the implant could be secured to the bone much easier this way.
In conclusion, your request for zygomatic arch augmentation is very uncommon but most certainly not crazy. One should not confuse unfamiliarity with impossible.
Dr. Barry Eppley