Is Augmentation Required to Correct Malar Deficiency With Maxillary Advancement?

Patients with maxillary hypoplasia also have malar deficiency; therefore, planning can include consideration for simultaneous malar augmentation. The purpose of this study was to compare pre- and postoperative profiles of patients who underwent Le Fort I advancement, with and without malar augmentation, to assess the subjective perception of changes in malar eminence projection.

Patients who had maxillary advancement and mandibular setback with and without malar augmentation were evaluated through a survey consisting of pre- and postoperative photographs that were assessed by professionals and laypersons, and a visual analog scale was used to assess the malar region. Next, pre- and postoperative images were shown side by side and participants were asked to indicate which patients had undergone malar augmentation. Statistical analysis used Wilcoxon signed rank test, independent-samples t test, Spearman rank order correlation, and Mann-Whitney U tests.

Of 43 patients, 23 met the inclusion criteria and only 7 of the 23 patients received simultaneous malarplasty. Patients in the 2 groups were perceived as having an increase in malar eminence projection postoperatively. In the malarplasty and non-malar cohorts, laypersons and professionals noted an increase in projection (P < .05). Laypersons tended to overestimate the number of malar procedures performed (sensitivity, 59.5%; specificity, 56.8%), whereas professionals were better able to accurately exclude malar augmentation (sensitivity, 44.2%; specificity, 69.9%).

Most patients with maxillary hypoplasia undergoing Le Fort I advancement can expect a subjective improvement in malar projection. The decision for malar augmentation at the time of maxillary advancement should be considered based on patient desires, but, in general, maxillary advancement alone might be sufficient for an optimal malar esthetic outcome.