New Technique for Zygoma reduction Minbum Kang,M.D. Romian Plastic Surgery Clinic, Department of Craniofacial surgery, Seoul, Republic of Korea. minbum.kang@gmail.com | Background Zygoma reduction is commonly performed in Asia because a broad face is considered stubborn in appearance and unattractive. Consequently, a number of different techniques have been developed for zygoma reduction, but no consensus has been reached on the optional method; the majority of these techniques involve simple manipulations. In the present report, we introduce a new method involving ostectomy and fixation that enables a three-dimensional approach to zygoma reduction. | Methods From 2007 to 2013, 221Korean patients (39 men, 182 women) underwent zygoma reduction with this technique.The bone was accessed via an intraoral and preauricular incision and removed in the body area using a small L-shaped osteotome through bone cutting in the arch area. The zygoma was moved forward, inward, and upward and then fixed with miniplate and screws. [Table 1] Classification of patients based on age and gender Age(years)/Gender Male Female Total <20 4 21-30 23 84 107 31-40 11 60 71 41-50 25 29 51-60 9 >60 1 39 182 221 [Fig.] Schematic simulation of the three-dimensional approach for performing the zygomatic reduction technique. [Table 2] Patient classification according to the surgeries performed concomitantly with the zygoma reduction No concomitant surgeries 167 Angle resection, Tubercle resection 6 Angle resection 14 Rhinoplasty 33 Angle resection, Rhinoplasty 1

| Results In total, 215 patients(97.3%) were satisfied with this surgical method. Four (1.8%) required undercorrection and underwent reoperation but were eventually satisfied. Two patients(0.9%) experienced overcorrection with a sunken area around the zygoma, which was corrected with autologous fat grafting after 6months. Two patients complained about sensory changes around the upper lip, which resolved within 6 months. Two patients experienced dizziness, temporomandibular joint pain, infection, and/or cheek drooping. [Table 3] Complications during the postoperative period. Complications (<6months) No. of patients Treatment Bleeding Admission for 1 day TMJ pain 1 None Dizziness(tinnitus) 2 Transfer to ENTclinic Infection Daily IV anti treatment for 3days Sensory change Revision (undercorrection) 4 Revision Cheek drooping Bone nonunion Overcorrection Fat graft | Case 1 A 25-year-old woman presented to our clinic and complained of a broad face that resulted in a masculine appearance. She was recommended to undergo angle resection with tubercles excision concomitant with zygoma reduction. She underwent these surgeries and received a satisfactory result. | Case 2 A 32-year-old woman complained of a prominent zygoma and facial angle, an anti-mongolian slant and epicanthus, and a flat forehead. She underwent mandible angle resection with tubercles excision, lateral canthoplasty, medial canthoplasty, and autologous fat graft on the forehead and nose. She was satisfied with the results. | Conclusion This new surgical technique causes less frequent and pronounced cheek drooping and requires less bone stepping, resulting in greater patient satisfaction.