The facial appearance of some Asians typically of Mongolian, Northern Chinese, Korean and Japanese descent is characterised by high cheekbones (zygomas) and distinctive lower jaw (mandible) contour. These characteristics are unique for these Asians ethnic groups as their anthropometric features are often demonstrated by prominent zygomas and mandibular angles that upset the facial harmony, rendering the face overly flat, wide and square.

The perceptions of beauty for the Asians have changed dramatically over the decades. Facial shape is the essential key to facial beauty, with an oval face considered attractive and youthful. An oval face is characterised by a smooth egg-shaped curve outlining the perimeter of the face, with a smooth transition from the forehead through the temples, around the outside of the cheeks, preauricular region, angle of the jaw, and jawline through to the chin, without indentations or projections in the line. In recent years, the demands for correction of the zygoma and mandibular prominence have been on increasing trend especially in countries like in Korea, Japan, Taiwan and China to achieve these aesthetic goals.

The malar or cheekbone prominence can be classified into three types namely:

  • Type I or true malar prominence characterised by prominent zygomatic body and arch
  • Type II or pseudo- prominence due to deep temples and cheeks
  • Type III or combination of Type I and II prominence

Cheekbone reduction surgery or zygoma reduction surgery is a cosmetic surgical procedure to reduce the width of upper face essentially the cheekbone to make a face smaller, oval and more feminine. This surgical procedure is commonly done for a patient who has a broad face due to large or prominent cheekbones. The approach for this surgery is either through an incision made in the mouth or sometimes mouth incision combined with a small external incision at sideburn area or in front of the ear canal. The protruding part of the zygoma is reduced either by shaving or cutting the prominent bony segment (zygoma). The surgically fractured zygoma is then carefully moved inward, backward and downward. Once the fractured zygoma is repositioned, it is secured by small plates and screws. Zygoma reduction surgery can be done as a single procedure or often done in combination with other facial contouring surgery such as mandibular angle reduction surgery to create an oval-shaped facial appearance.

Ideal candidates for zygoma reduction surgery:

  • Having a positive outlook, realistic expectations and specific goals in mind for the improvement of facial appearance.
  • Physically healthy with no active or severe pre-existing medical conditions
  • Patients who have prominent cheekbone or wide facial width
  • Patients who desire for slender or oval facial profile

Preoperative evaluations and preparation for zygoma reduction surgery include:

  • Discussion about patients’ expectations and desired outcome
  • Blood investigations or a medical examination for fitness of anaesthesia and surgery
  • Assessment of medical conditions, drug allergies and previous medical or surgical treatment
  • Avoid certain medications or adjust your current medications
  • Avoid taking aspirin or certain anti-inflammatory drugs or herbal supplements that may increase bleeding
  • Stop smoking or alcohol well in advance (2-3 weeks before surgery)
  • Examination of the face and its soft tissues
  • Radiological assessment (CT scan of a face)
  • Preoperative evaluation for general anaesthesia
  • Photography for preoperative and postoperative evaluation

The risks and safety information on zygoma reduction surgery

It is essential for patients to understand that every surgical procedure has its complications and risks involved. However, if a patient is appropriately assessed before the surgery and postoperative care is given adequately, these risks can be eliminated or reduced. The risks involved in zygoma reduction surgery are:

  •  Bleeding
  •  Blood clot
  •  Infection
  •  Bruises and swelling around the cheek and eyes
  •  Injury to the surrounding nerves, blood vessels, muscles or bones
  •  Changes in the skin sensation over the cheek (temporary)
  •  Bony contour irregularity
  •  Asymmetry
  •  Anaesthesia risks
  •  Possibility of revision surgery

Postoperative expectations

During the initial healing phase, the patient may experience pain, numbness, bruises and swelling around the cheeks. Occasionally, the patient may experience tightness during mouth opening. These symptoms are transient; usually, last about 3-4 weeks. If there are any sutures on the sideburn areas or in front of external ear canals, they are usually removed about 7-10 days after the surgery. Oral antibiotics and analgesics will be prescribed to reduce the risk of infection and postoperative pain respectively.

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Postoperative care

  • Follow the postoperative instructions given carefully
  • Head elevation especially when sleeping for 3-4 weeks
  • Take the prescribed medications as instructed
  • Compressive dressing around cheek for 3-5 days
  • Wound care for any external wounds
  • Regular mouth wash or rinse after every meal if there are any oral wounds
  • Soft diet for 2-3 weeks
  • Avoid strenuous physical activities for 3-4 weeks

How much will a zygoma reduction surgery cost?

Cost is always a consideration in elective surgery. The cost of zygoma reduction surgery can vary widely. Cost may include:

  • Surgeon’s fee
  • Hospital or surgical facility costs
  • Medical tests (blood and radiological investigations)
  • Cost of plates and screws
  • Anaesthesia fees
  • Prescriptions for medication

Zygoma reduction surgery is a cosmetic surgical procedure. Therefore, most of the health insurance companies do not cover cosmetic surgeries or their complications.