True intraoral reduction malarplasty with a minimally invasive technique

In the Orient, faces are usually wide and short. This physical characteristic is often undesirable in many Asian cultures. Consequently, reduction malarplasty is one of the most common aesthetic procedures performed in the Orient. Previously described techniques for malar reduction such as intraoral chiseling or the burring-down of the zygomatic body and arch often result in minimal invasiveness, with no external scarring. However, they are less effective techniques. Other techniques, such as osteotomy and repositioning of a prominent malar complex by means of a coronal approach also proved fallible, by often resulting in a prominent, visible scar. Furthermore, a combined approach, using both the intraoral and the external (preauricular or sideburn) routes, often results not only in an external scar, but also in possible facial nerve (frontotemporal branch) damage. Thus, we performed a true intraoral osteotomy and reduction malarplasty through upper buccal sulcus incisions, resulting in minimal tissue damage without external scarring. Aesthetic facial contouring surgery has been performed in increasing numbers over the past decade, especially for malar and mandibular angle protrusion. The prominence of the malar area varies according to differences in the inherited bony structure. Essentially, Orientals are mesocephalic, whereas Caucasians are dolichocephalic; the face is wider and shorter in the former than in the latter. An even greater prominence of the zygoma among Orientals, which causes the face to be wider and shorter, is widely regarded as an unattractive feature in the Oriental culture [1,2]. In contrast, a flat cheek bone in Caucasians makes the face appear masculine, in addition to making the nasal and chin prominences more noticeable. Of the previously described techniques for malar reduction, shaving and contouring by the intraoral approach, without the external approach [1,4] is often less effective due to the limitations of shaving. Likewise, osteotomy and repositioning of a prominent malar complex by the coronal approach can result in an extensive visible scar [2,5,6,12]. Additionally, the combined approach by means of the intraoral and external (preauricular or temporal, sideburn) routes [4,7] can result in an external scar and the distinct possibility of facial nerve damage [8]. Therefore, our team created a simple and effective way of conducting a true intraoral osteotomy and reduction malarplasty without external scarring and the instigation of facial nerve damage.