Beyond Reduction Malarplasty: Analyzing Factors for Unfavorable Outcomes

BACKGROUND: In the Asian aesthetic facial profile, petite and youthful faces are highly valued. Various surgical techniques aimed at reducing the skeletal framework size-such as reduction malarplasty and angle resection-have been widely applied. However, these facial contouring surgeries sometimes yield minimal or insignificant effects. We have analyzed the patient group in which these procedures are less effective and propose practical strategies to differentiate surgical indications for narrowing facial width. METHODS: In this retrospective study, 110 patients who underwent reduction malarplasty for facial width narrowing were reviewed. Outcomes were evaluated using medical records, photographs, and facial bone computed tomography (CT) images. Data analysis focused on the following facial profiles: 1) facial soft tissue width, 2) bizygomatic width, 3) inter-coronoid distance, and 4) inter-condylion distance. RESULTS: The effectiveness of facial narrowing was associated with the inter-coronoid distance and inter-condylion distance. The coronoid/condylion width ratio (inter-coronoid distance divided by inter-condylion distance) was correlated with both the effectiveness of facial narrowing and patient satisfaction. In the group with a high coronoid/condylion ratio, the reduction in the distance between bilateral zygions did not efficiently translate into decreased facial soft tissue width. CONCLUSION: Reduction malarplasty can result in an aesthetically pleasing face. However, in patients with a high coronoid/condylion width ratio (indicative of a well-developed ramus and coronoid strut), the effectiveness of malar reduction is diminished. For these cases, correcting horizontal mandibular divergence is essential to reduce facial width. Orthognathic maxillo-mandibular surgery may serve as a more effective surgical modality for modifying overall facial features.