Intracranial Hemorrhage After Reduction Malarplasty: A Narrative Review Focusing on Surgical Technique

Reduction malarplasty (RMP) is performed frequently in East Asia. Although various complications of RMP have been reported, intracranial hemorrhage has been described only rarely. Although intracranial hemorrhage is an extremely rare complication, it is a catastrophic event that should not occur in esthetic plastic surgery. In this review, I describe the occurrence and prevention of this serious complication through a detailed analysis of intracranial hemorrhage following RMP. Evaluation of RMP surgical techniques was performed. A search of PubMed and Google Scholar was conducted to identify studies reporting cerebral hemorrhage following RMP. The search strategy combined the terms "cosmetic surgery" OR "plastic surgery", AND "cerebral hemorrhage". The two major surgical approaches to RMP are the coronal and intraoral incisions. In the coronal approach, osteotomy is performed under direct visualization, which allows precise bone cutting. There is no risk of penetrating the intracranial cavity during RMP performed via the coronal approach. Two reported cases of intracranial hemorrhage occurred during RMP performed via the intraoral approach due to inappropriate instrument handling. There is a potential risk of injury to the middle cranial fossa by a reciprocating saw or chisel during osteotomy of the zygomatic body. When performing an osteotomy on a zygomatic body using a reciprocating saw in RMP via the intraoral approach, surgeons should avoid inserting the saw too deeply to prevent injury to the middle cranial fossa.