Three-dimensional facial soft-tissue changes after L-shaped reduction malarplasty: A pilot retrospective study

Reduction malarplasty (RM) is a common facial contouring aesthetic procedure in East Asia. However, there is a lack of data on the postoperative changes in soft tissue and patient-reported outcomes. This retrospective study aimed to evaluate the soft-tissue changes and surgical outcomes following L-shaped RM.

Fifty-five patients who underwent L-shaped RM were enrolled and 55 patients who underwent genioplasty were enrolled as controls. The soft-tissue changes in relation to the underlying skeletal tissue were analyzed using computed tomography (CT) and three-dimensional (3D) stereophotogrammetry images. Patient's satisfaction and surgical outcomes were investigated using the FACE-Q and Wrinkle Severity Rating Scale (WSRS).

In the RM group, the soft tissue in zygoma (S2), zygomatic arch (S3), and upper cheek (S5) regions showed a significant inward reduction postoperatively (p<0.001), while the paranasal region (S4) showed a significant outward augmentation (p<0.001). Compared with the control group, the postoperative soft-tissue changes in S2, S3, S4, and S5 demonstrated significant differences in the RM group (p<0.001). The postoperative skeletal-tissue changes in the upper zygoma (B2), zygomatic arch (B3), and lower zygoma (B5) regions exhibited a significant decrease (p<0.001). Significant correlation was observed between the soft and hard tissue changes in B2, B3, and B5 regions (p<0.001). Additionally, patients demonstrated significant postoperative improvement in satisfaction with appearance, although 6 patients' WSRS grade increased by one-grade.

Following RM, the soft tissue in surgical regions showed inward depression, while the paranasal soft tissue protruded outward, indicating that the soft tissue exhibited a certain degree of sagging. Although the severity of nasolabial folds increased in some patients, the patient's self-evaluation of aesthetics remained unaffected. The findings suggest that surgeons should consider skeletal and soft-tissue changes when planning RM, and patients should also be informed about the potential postoperative soft-tissue changes to effectively manage their expectations.