The facial appearance of some Asians typically of Mongolian, Northern Chinese, Korean and Japanese descent is characterized by high cheekbones (zygomas) and distinctive lower jaw (mandible) contour. These characteristics are unique for these Asians ethnic groups as their anthropometric features are often demonstrated by prominent zygomas and mandibular angles that upset the facial harmony, rendering the face overly flat, wide and square.

The perceptions of beauty for the Asians have changed dramatically over the decades. Facial shape is the essential key to facial beauty, with an oval face considered attractive and youthful. An oval face is characterised by a smooth egg-shaped curve outlining the perimeter of the face, with a smooth transition from the forehead through the temples, around the outside of the cheeks, preauricular region, angle of the jaw, and jaw line through to the chin, without indentations or projections in the line. In recent years, the demands for correction of zygoma and mandibular prominence have been on increasing trend especially in countries like in Korea, Japan, Taiwan and China to achieve these aesthetic goals.

The malar or cheek bone prominence can be classified into three types namely:
  • Type I or true malar prominence characterized by prominent zygomatic body and arch
  • Type II or pseudo- prominence due to deep temples and cheeks
  • Type III or combination of Type I and II prominence

Cheekbone reduction surgery or zygoma reduction surgery is a cosmetic surgical procedure to reduce the width of upper face essentially the cheekbone in order to make the face smaller, oval and more feminine. This surgical procedure is commonly done for patient who has a wide face due to large or prominent cheek bones. The approach for this surgery is either through incision made in the mouth or sometimes mouth incision combined with small external incision at side burn area or in front of ear canal. Prominent part of the zygoma is reduced either by shaving or cutting the prominent bony segment (zygoma). The surgically fractured zygoma is then carefully moved inward, backward and downward. Once the fractured zygoma is repositioned, it is secured by small plates and screws. Zygoma reduction surgery can be done as a single procedure or often done in combination with other facial contouring surgery such as mandibular angle reduction surgery to create an oval shaped facial appearance.

  • Having positive outlook, realistic expectations and specific goals in mind for improvement of facial appearance
  • Physically healthy with no active or serious pre-existing medical conditions
  • Patients who has prominent cheek bone or wide facial width
  • Patients who desire for slender or oval facial profile
  • Discussion about patients’ expectations and desired outcome
  • Blood investigations or a medical examination for fitness of anaesthesia and surgery
  • Evaluation of medical conditions, drug allergies and previous medical or surgical treatment
  • Avoid certain medications or adjust your current medications
  • Avoid taking aspirin or certain anti-inflammatory drugs or herbal supplements that may increase bleeding
  • Stop smoking or alcohol well in advance (2-3 weeks prior to surgery)
  • Examination of the face and its soft tissues
  • Radiological assessment (CT scan of face)
  • Preoperative assessment for general anaesthesia
  • Photography for preoperative and postoperative evaluation

It is essential for patients to understand that every surgical procedure has its own complications and risks involved. However, if a patient is assessed properly before the surgery and postoperative care is given adequately, these risks can be eliminated or reduced.

The risks involved in zygoma reduction surgery are:
  • Bleeding
  • Blood clot
  • Infection
  • Bruises and swelling around the cheek and eyes
  • Injury to the surrounding nerves, blood vessels, muscles or bones
  • Changes in the skin sensation over the cheek (temporary)
  • Bony contour irregularity
  • Asymmetry
  • Anaesthesia risks
  • Possibility of revision surgery

During the initial healing phase, patient may experience pain, numbness, bruises and swelling around the cheeks. Occasionally, patient may experience tightness during mouth opening. These symptoms are transient; usually last about 3-4 weeks. If there are any sutures on the side burn areas or in front of external ear canals, they are usually removed about 7-10 days after the surgery. Oral antibiotics and analgesics will be prescribed to reduce the risk of infection and postoperative pain respectively.

  • Follow the postoperative instructions given carefully
  • Head elevation especially when sleeping for 3-4 weeks
  • Take the prescribed medications as instructed
  • Compressive dressing around cheek for 3-5 days
  • Wound care for any external wounds
  • Regular mouth wash or gargle after every meal if there are any oral wounds
  • Soft diet for 2-3 weeks
  • Avoid strenuous physical activities for 3-4 weeks