Extended Reduction Malarplasty for Asians with Flat and Wide Faces: Comparison with L-Shaped Osteotomy.

Background: Reduction malarplasty is effective in correcting prominent zygomatic body and arch in Asian populations, but periorbital zygomatic bony protrusion may not be sufficiently improved. In this study, the authors present the extended reduction malarplasty procedures to correct it simultaneously and compare the outcome with that of conventional L-shaped osteotomy.

Methods: A retrospective review of consecutive patients who underwent reduction malarplasty between August of 2021 and September of 2023 at the authors' hospital was conducted. Computed tomographic images obtained before and after surgery were assessed to evaluate the facial skeletal changes, and to compare between the extended and conventional L-shaped malarplasty results.

Results: Twenty patients with extended reduction malarplasty and 23 patients with conventional reduction malarplasty were eligible for the study. Cephalometric analyses showed significant reduction in the zygomatic width in both groups, but the protrusion of the periorbital area was improved significantly more in the extended reduction malarplasty group. In terms of facial angulation, the extended reduction malarplasty also provided more horizontal convexity in the periorbital area, whereas the angular change in the caudal part of the zygoma was not significantly different.

Conclusions: The extended reduction malarplasty enabled reduction of the protrusion of the periorbital area and the prominent zygomatic body and arch, and provided more 3-dimensionality and horizontal convexity with the midface contour. It is a viable option for harmonizing the facial profile for Asian patients with flat and wide faces.

Clinical question/level of evidence: Therapeutic, III.