Homepage Star of September 2013
There are many ways to reduce the size of the malar from the early method of bone filing to latterly developed numerous patterns of osteotomy. Malar filing down is suitable to those who do not expect a major change of facial type. The high rate of post surgical hypertrophy of the malar bone limits the prevalence of this procedure. Among various osteotomy approaches the popular front end or both front and posterior end osteotomy can not change the curvature of the zygomatic arch and has a bad reputation of causing facial soft tissue sagginess, which frustrated many patients. When Dr. Fushun Ma focused his research on malar reduction decade ago he eva luated all known method of zygomatic bone osteotomy malar reduction surgeries available and invented his own way of malar reduction surgery, named Combined Zygomatic Arch Osteotomy Malar Reduction. A procedure that could effectively reduce the curvature of the zygomatic arch and prevent soft tissue sagginess at the same time. Consequently a minimal invasive natural structure preserving reduction called the Feathering or Smooth Reduction Malar Plasty is provided by Dr. Fushun Ma. Then biological malar reduction is achieved under minimal invasive intervention.
The before and after surgery photos in this page described the changes caused only by the zygomatic bone and zygomatic arch reduction surgeries, not other facial surgeries involved. The operation this girl received is Feathering Reduction Malar Plasty with intro-oral and inside hairline incisions. This surgery can not do much for simple zygomatic bone protrusion. However it is a perfect selection for zygomatic arch protrusion or combined protrusion of zygomatic bone and zygomatic arch. In the before surgery photo this girl looked bony, thin and older because of the protrusion of the malar bone and the zygoamtic arch. A simple malar reduction surgery made this girl’s face look younger and energetic.
Feathering Reduction Malar Plasty changes the bony face to a full and energetic one.
After feathering reduction malar plasty the indentation below the zygomatic arch disappeared because of the level off of the augmented zygomatic arch.
The high light reflection on the augmented zygomatic arch area diminishes after the surgery.
The character change in this girl’s font view photo is the disappearance of the bony look on her face. This is her most wanted achievement regarding her motivation of doing this surgery. In the before surgery photo the over growth of the zygomatic bone and zygomatic arch made her malar area protruding to the side of her face and the outline of her face curved in and out. The protruding zygomatic bone and zygomatic arch produce the relative indentation of her cheek below the malar, giving a look of mouth suction posture even in calm position. The protrusion malar gives a bony face and the mouth suction appearance makes her face look older. Compared to the before surgery photo the after surgery face is fuller and smoother and the lateral outline is more regular. This fuller effect didn’t achieved by actual volume increase of the facial soft tissue but by the relative soft tissue increase after the bone reduction.
The other main change is the width of the jaw. If we focus our attention only on the jaw we could say that the width of the jaw is wider in the after surgery photo. Actually this is a misguided impression. As stated above this girl didn’t do any surgery on the jaw and the physical width remained the same after surgery. The narrow down effect of the middle face after malar reduction made the jaw looks relatively wider.
Though the inferior zygomatic arch indentation appears on both the lateral and oblique view photos it is more obvious in the oblique view. In the area below the zygomatic arch and in front of the ear the cheek is indented remarkably so that there is big piece of resistant gray area in the photo. The gray area could help to make a vivid photograph. However in real life the story is different.The gray and dark areas on the face under certain direction of light often express an icy posture. The Feathering Reduction Malar Plasy pushed the zygomatic arch inward, so protruding malar was corrected for this girl. Basically there is no gray areas anymore in her after surgery photo. This indicates that her cheek indentation was leveled off by surgery.
Not only the cheek problem, the zygomatic arch protrusion also cause indentations on the temporal area. The temporal indentation can always give an impression of narrow forehead in the frontal view.??A narrow forehead and narrow lower face plus wide middle part of the face constitute a diamond shape facial outline. Malar reduction surgery alone can solve all these problems and change the diamond face to a longitudinal square one. After the protruded zygomatic arch been reduced the relative temporal indentation also disappeared. Again the temporal augmentation effect is cause by the relative lower down of the zygomatic arch, not because the real volume of the temporal region is surgical expanded.
During pre surgery consultation Dr. Ma is frequently asked that if a temporal augmentation surgery is needed prier to the malar reduction surgery in order to fill the indented temporal region. Take this case as an example we could figure out that no temporal augmentation is needed before the malar reduction because most malar reduction surgery could make the temporal region full enough just by making the protruding zygoamtic arch flat. On the other hand if a pre surgery temporal augmentation is done the implanted prosthetic material or the autologus tissue may get leaking out, dislocated or injured during the following malar reduction surgery. If the temporal region is still not full enough to satisfy the surgery taker a temporal augmentation surgery may be done after the recovery of the malar reduction.
If we study the facial outline changes of aging we could find that the human face looks bonier year after year. It seems that the facial bone gets bigger and bigger as people aging. However the size change of the facial bones is not big enough to make the face look bonier as one getting older in adulthood. On the contrary the atrophic change of the soft tissue in the face dominant the aging process of the human face. The volume loss of the facial soft tissue makes the facial bone stick out causing the face look old. So in order to make a bony face look younger different strategies should be applied. For younger people the facial bone volume should be reduced. For senior candidates the volume of facial soft tissue should be increased.