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Cheekbone Reduction (Small Face Surgery)

The zygomatic bone is located at the inferolateral rim of the orbits, which connect the nasal bone at the medial side with the alveolar bone (maxilla bone) at the inferior side and form a slender zygomatic arch at the lateral side extending to the front of the ears. The structure of the zygomatic bone consists of the anterolateral zygomatic body and posterolateral zygomatic arch. As the cheekbones comprise the important components of the entire midface, whether too big or prominent, they can make the front face look wide, which is the so-called “pancake face.” The main reason causing too high or too wide cheekbones is the familial heredity of face shape. Considering that the overdevelopment of the zygomatic bone in the horizontal direction usually starts slowly from adolescence (middle school stage) and does not stop even until the age of 20 years, it is better if patients with a congenital wide face take decisions in adulthood on whether they need to undergo zygomatic bone reduction. Besides the hereditary etiology, other factors can also cause overdevelopment of the zygomatic bone, such as trauma on the face in childhood, sleeping on the side, or teeth malocclusion. Such patients often have an asymmetrical face shape or cheekbones; if necessary, they will have to undergo combined procedures such as teeth correction or mandible reduction to obtain symmetric and perfect small faces.

There is no absolute measurement medically available for the width of the cheekbones, and the extent of reduction should also take into account the head circumference or the ratio between face lengths and eye distance. In general, if the frontal width between the cheekbones is more than the width between the bilateral outer margins of the brow ridges, it is considered as a sign of excessively wide or prominent cheekbones. In addition, different protrusive parts will cause different facial appearances. If the zygomatic body is obviously protrusive frontward, it can give rise to high cheekbones and facial contours at a 45° side view would show an obvious convex “S” shape. The lower margin of the cheekbones or zygomatic muscles is also more likely to present different degrees of sagging. From the traditional sense of beauty, this facial appearance makes women look too manly or too pushy. Further, the zygomatic arch, if overtly protruding sideward, will cause wide or pancake faces and will also induce the depression of temples (Marriage Palace, namely eye tails as called by physiognomists, which refers to the skin from the eyebrows to the temples) and cheeks superior and inferior to the cheekbones, rendering the patient’s face too bony and the lack of a feminine smooth contour of the face. Some people can have either the zygomatic arch or a body protrusion, but most patients have both; thus, they have to consider undergoing appropriate zygomatic bone reduction to improve the too wide or high cheekbones.

These days, cheekbone reduction is still the only solution for too wide or prominent cheekbones. The primary goal of this surgery is to reduce the width of the face and make it look smaller (also called “small face surgery”). In addition, this surgery can make the facial contour soft and smooth and can synchronously improve the hollowness of the upper face (temples) and lower face (lower cheeks). It can also provide synergistic effects that make patients look younger. According to the individual facial characteristics and type of cheekbone protrusion, Dr. Chuang provides three procedures for zygomatic bone reduction:

Zygomatic Arch Reduction

Zygomatic Body with Arch Reduction

Zygomatic Bone Shaving

Comparison of various surgical options for zygomatic bone reduction

Zygomatic arch reduction Zygomatic body with arch reduction Zygomatic bone shaving
Ideal candidates Wide face with mild or moderate cheekbone protrusion Obvious wide face with moderate or severe cheekbone protrusion Normal face width with mild cheekbone protrusion
Anesthesia General anesthesia General anesthesia IV sedation or general anesthesia
Intraoral incision Yes Yes Yes
Incision in front of the ears 1cm 1cm None
Bone screw fixation Yes Yes None
Bone healing 8 weeks 8~12 weeks 4 weeks
Recovery fast slow Fastest
Reduction results Good Maximum Fair
Face width/side diminution 0.5–0.8 cm 0.8–1.0 cm <0.5 cm
Cheek sagging Little More None
Bone regrowth No No Possible