Revision malarplasty guided by strategic categorization.

BACKGROUND: Esthetic reduction malarplasty is popular in East Asia, where a small and balanced facial profile is considered a desirable characteristic. Various surgical techniques have been applied; however, several complications can impact the bony structure and final esthetic appearance. We examined the outcomes of revision malarplasty with regard to strategic assessments to achieve facial balance and skeletal stability.

METHODS: This retrospective study reviewed 97 patients who underwent revision malarplasty between December 2014 and November 2016. We analyzed the indications of revision and categorized the patients into three surgical groups. Dual bone flap procedures utilizing new osteotomies were performed to achieve a natural malar contour in certain cases. In addition, zygomatic arches were fixed in a lifted position to revise both bony dehiscence and soft tissue drooping. Postoperative results were assessed using medical records, photographs, and facial bone computerized tomography images.

RESULTS: The major reason for revision malarplasty was undercorrection that required additional repositioning. The zygomatic body and arch with a bony gap (5-7 mm) necessitated additional osteotomy and repositioning to achieve zygomatic continuity and natural curvature. Significant bony defects and segmental resorption were addressed with reconstructive bone grafts.

CONCLUSION: The causes of complications after malarplasty should be cautiously evaluated before revision procedures. We categorized patients on the basis of strategic analysis considering reposition vector and the necessity of additional osteotomy. Unstable zygomatic segments were revised to obtain structural stability, and the zygomatic arch lifting technique using an intraoral approach can be used to achieve promising and predictable outcomes in revision malarplasty.