Zygomatic Osteotomy

Q: Dr. Eppley, Would a zygomatic osteotomy work on an individual with cheek asymmetry due to hemifacial microsomia? I am considering orthognathic surgery to fix my jaw and masseter muscle. I am also considering a procedure to enhance my cheek symmetry. I have heard implants can be unnatural when placed unilaterally even when custom made. I thought a zygomatic wedge osteotomy may be better. Because the eye and cheek are interrelated it could make eye look smaller?

A: What is best for your cheek symmetry would really require evaluation by pictures of your face and review of a 3D CT scan. But as a general statement, a zygomatic expansion osteotomy (which is what you mean by ‘zygomatic wedge”) only affects one dimension and that is cheek width. It can not change any other cheek dimension. In my experience in the hemifacial microsomia patients, the dimensional changes need to the cheek area are more than just that of width. Plus the bony edges of a zygomatic osteotomy and the plates and screws to hold it would ultimately be able to be felt and many be able to even be seen through the skin. It is not true that a custom implant would look unnatural and, because it is custom made and fits the bone in a smooth transition manner, would probably look more natural than any osteotomy/bone grafting procedure.

Any cheek augmentation procedure, by definition, may make the eye look smaller no matter what technique is used. Although that degree of orbital change may be aesthetically negligible.

These are general statements which are made with no specific knowledge about your case.

Dr. Barry Eppley

Indianapolis, Indiana