In short. Zygoma reduction is facial bone surgery that lowers the prominence of the cheekbone body, the high projecting point seen on the three-quarter view. It softens malar projection and narrows midfacial width, but the amount removed has to leave a supported cheek, because over-resection is unmasked by volume loss with age.
Key points
- Zygoma reduction lowers the malar body and can narrow midfacial width.
- The body drives three-quarter prominence; the arch drives frontal width.
- Burring suits mild prominence; osteotomy reduces projection and controls width.
- Over-resection is hard to reverse and is unmasked by age-related volume loss.
- Revision waits a year for swelling to declare the real contour.
What zygoma reduction changes
Zygoma reduction lowers the prominence of the cheekbone body, the high projecting point visible on the three-quarter view. In East Asian facial aesthetic practice it is one of the most requested contouring operations: a wide, projecting malar region reads as strong or wide in the frontal view, and softening it narrows the midface. The craft of the operation is how much to take, because the cheek pad that sits on that bone will one day need somewhere to live.
The zygoma has a body, the malar prominence felt over the cheek, and an arch, the bridge running back toward the ear. Prominence on the three-quarter view usually comes from the body; frontal-view width comes more from the arch, which is why the two are assessed, and often treated, together. The infraorbital nerve exits just below the eye and defines the safe upper working zone.
Who does it suit, and who should not have it?
It suits a genuinely prominent malar body in a healthy patient with realistic goals. It does not suit faces whose width is mostly soft tissue, such as buccal fat or masseter bulk, which are treated differently. It does not suit patients planning major weight loss, because the face will change again, or anyone seeking an extreme narrow look that the bone cannot give without premature hollowing.
The method and the amount of reduction
Burring down the prominent point suits mild prominence and is the most conservative option. Osteotomy, cutting and repositioning the malar body, often with arch infracture, reduces projection more effectively and controls width at the same time, using plate fixation. Most significant reductions combine both. The planning rule is to reduce to a softened, supported cheek, not a flat one, because volume loss with age will unmask over-resection in the forties and fifties.
| Approach | What it changes | Who it suits | What to plan for |
|---|---|---|---|
| Burring | Takes down the prominent point | Mild prominence | The most conservative option |
| Osteotomy | Cuts and repositions the malar body, often with arch infracture | Prominence that needs reduction with width control | Plate fixation |
| Combined | Uses both methods in one operation | Most significant reductions | A softened, supported cheek, not a flat one |
| Soft-tissue width | Bone surgery does not address it | Width mostly from buccal fat or masseter bulk | A different treatment |
| Extreme narrow look | Not something the bone can give | Does not suit this goal | Premature hollowing |
The operation and anaesthesia
Access is through an incision inside the upper lip, with a small incision at the sideburn, or behind the hairline, when the bone is approached from above. Surgery runs about two hours under general anaesthesia, with a one-night hospital stay.
What surgery can and cannot achieve
It reliably softens malar projection and narrows midface width. It cannot lift a descended cheek pad, fill the temple, or change skin quality. Those are adjacent problems that sometimes belong in the same overall plan but are not solved by bone reduction.
Recovery and the final contour
Cheek swelling is marked for the first two weeks and settles slowly. Expect visible swelling for one to two months and the final result at six months to a year. Upper-lip and cheek numbness from nerve bruising is common early and usually recovers. Most people return to desk work in two to three weeks.
Complications and revision
Named honestly: asymmetry, under- or over-correction, with over-resection being the feared and hard-to-reverse one; infraorbital nerve injury with cheek or lip numbness; infection through the intraoral wound; haematoma; and plate irritation requiring later removal. Revision, when truly indicated, waits a year for swelling to declare the real contour.
Preparation and follow-up
Preparation includes CT imaging of the zygomatic complex, photographic analysis from front and three-quarter views, and explicit agreement on how much reduction is planned. Follow-up runs to a year, because the malar soft tissue settles more slowly than the bone heals.
When should a problem be reviewed?
- Cheek or lip numbness that is dense, one-sided, or worsening after the early weeks.
- Fever, mouth drainage, or progressive painful swelling that suggests infection around the fixation.
- A cheek that feels unstable or clicks with chewing, because the osteotomy fixation needs assessment.
Sources
Internal links
Frequently asked questions
Why does over-resection of the cheekbone age the face?
The cheek pad that sits on that bone will one day need somewhere to live. Volume loss with age unmasks over-resection in your forties and fifties, so the planning rule is to reduce to a softened, supported cheek rather than a flat one.
My face is wide — is the cheekbone really the cause?
Not always. Width that is mostly soft tissue, from buccal fat or masseter bulk, is treated differently, and patients planning major weight loss should wait because the face will change again. Assessment establishes whether the malar body is genuinely prominent.
How long before the final cheek contour appears?
Cheek swelling is marked for the first two weeks and settles slowly, so expect visible swelling for one to two months and the final result at six months to a year. Most people return to desk work in two to three weeks. Upper-lip and cheek numbness is common early and usually recovers.
Risks & Limitations
- Bruising and swelling lasting weeks; after bone surgery, months pass before the final result is visible.
- Scars are permanent. They mature and fade over 6–12 months but never disappear.
- Numbness or altered sensation, which may be temporary or, after bone or nerve work, lasting.
- Asymmetry, under-correction or over-correction; final assessment is made at 6–12 months.
- Infection, bleeding or haematoma, which may need drainage or antibiotics.
- Breathing changes after nasal surgery, which may be temporary or require further treatment.
- Revision surgery carries higher risk and is less predictable than a first operation.
When to Seek Care
- Difficulty breathing or shortness of breath — seek emergency care immediately.
- Rapidly expanding swelling, or a tense, painful, tight area.
- Fever above 38 °C, spreading redness, warmth or pus.
- Bleeding that does not stop with gentle pressure.
- Any sudden change in vision after facial surgery or a facial injection.
References & Further Reading
- American Society of Plastic Surgeons (ASPS) — procedure and safety guidance
- International Society of Aesthetic Plastic Surgery (ISAPS)
- National Institute for Health and Care Excellence (NICE, UK) — relevant guidance
- Cochrane Library — systematic reviews in facial plastic surgery
This page is patient education, not medical advice, and it does not cite individual studies. Discuss your own case with a qualified clinician. To arrange an assessment at Chongqing West District Hospital, see Contact & Consultation.