The Rationale of Coronal Approach to Malar/Zygoma Reduction

Area of Science:

• Plastic Surgery
• Facial Aesthetic Surgery
• Reconstructive Surgery

Background:

• Malar/zygoma reduction reshapes broader, flatter faces into an oval contour.
• The intraoral approach is more common than the coronal approach due to perceived significant complications with the latter.
• This study compares the postoperative outcomes of both intraoral and coronal approaches for malar/zygoma reduction.

Purpose of the Study:

• To compare the postoperative effects and aesthetic outcomes of intraoral versus coronal approaches for malar/zygoma reduction.
• To evaluate the efficacy of each surgical approach in achieving an oval facial shape.
• To assess the complication rates associated with both intraoral and coronal zygoma reduction techniques.

Main Methods:

• A retrospective analysis comparing 150 intraoral cases (1994-1999) with 575 coronal cases (2000-2018).
• All patients were followed up for 3 years postoperatively.
• Outcomes assessed included facial shape, zygoma angulation, midface ptosis, and specific surgical complications.

Main Results:

• The intraoral approach frequently resulted in flat faces (60%) and high rates of partial malunion (94%) and midface ptosis (92%).
• The coronal approach achieved an oval facial shape in 90% of cases without acute zygoma angles.
• Complications of the coronal approach included visible scars (28%), temporary alopecia (81%), hematoma (2%), and temporary frontal facial nerve injury (5%).

Conclusions:

• The intraoral approach often leads to undesirable aesthetic outcomes like flat zygomas and midface ptosis.
• The coronal approach is more effective in achieving an oval facial contour.
• Key complications of the coronal approach are visible scars and temporary alopecia, which are generally manageable.