What Is The Best Cheekbone Reduction Osteotomy Technique?

Q: Dr. Eppley, Thank you for the quick turnaround and spending the time to morph my pictures, much appreciated. Some feedback and follow-up questions:

1) I agree with the chin, I definitely wanted more projection both vertically and horizontally, and your initial morph there I think is very close to what I would like (I might have to play with it myself a bit to allow my mind to adjust to the drastic change haha). My questions here:

     a) Do you know about how many millimeters of a movement that would predicted to be?

     b) Is the width of the chin also changing here or just a chin movement? This questions is mostly to understand if the body of the chin needs to be change as I know I have some asymmetry there.

2) I think the cheekbones are a little trickier. I would like them a slimmer, but I also would like to maintain the current natural “curve” of the zygomatic body and arch I currently have. I am not intimately familiar with all the various cheekbone osteotomy procedures, but I know the ones popularized in Korea are the L and U shaped oseoteomies. I have also attached photos of people I think who have gotten such reductions that reflect the results I would like to achieve. I think my overarching goal there being to maintain the natural “curve” and protrusion of the cheekbones despite the reduction. My questions here:

    a) Which variation of cheekbone osteotomy (name in the literature) would you recommend so I can do more research? Pointers to any publications would be appreciated!

    b) Would your recommended procedure also affect my anterior cheekbone projection?

    c) Is there imaging and preplanning here to plan the cuts as to  protect the facial nerve?

3) As for risk factors: I know genioplasty is a relatively more common and well-practiced/studied procedure. It is also performed rarely, especially here in the states, as the procedure seems more nuanced. In my research, the main complications seem to be facial sagging and bone integrity issues (non-union) after cheekbone osteotomy. So my questions here are:

    a) As compared to genioplasty, how often do you perform of cheekbone osteotomies? 

    b) What is the relative complication/satisfaction rate for each?

    c) Has the technique for cheekbone osteotomy been changing recently or has it been the same technique used for a number of years? Based on the literature, it seems cheekbone osteotomy is a relatively recent technique that’s constantly undergoing new innovations, which makes me concerned about the stability of the outcomes.

Sorry for all the questions, and thanks again for the time!

A: In answer to your questions:

1) I would estimate the chin movements as 7mm horizontal and 5mms vertical.

2) Chin width never increases with sliding genioplasty. If anything it may  become slightly more narrow.

3) In cheekbone reduction osteotomies you never lose the natural curve of the zygomatic arch as the osteotomies are done in front of and behind the curve of the arch.

4) The L-shaped anterior cheek bone reduction osteotomy is the most common osteotomy pattern used.

5) I have performed many cheekbone reduction osteotomy surgeries in both Asian and Non-Asian patients. But by comparison chin osteotomies are more commonly requested and performed.

6) While there are many subtle variations in technique whose clinical relevance can be debated, the fundamental concepts of anterior zygomatic body and posterior arch osteotomies with plate fixation has remained the same.

7) A preoperative 3D CT scan is required before any form of facial bone surgery.

Dr. Barry Eppley

Indianapolis, Indiana