A Systematic Review and Meta-Analysis of Complications among Various Reduction Malarplasty.

BACKGROUND: Reduction malarplasty is one of the most common aesthetic procedures to improve a wide bizygomatic width and a prominent zygomatic body. Although there are various kinds of modifications, any method is imperfect, while some complications may occur. The purpose of this review was to compare kinds of complications of reduction malarplasty to provide certain suggestions for clinical application. METHODS: A comprehensive computerized search of scientific literature was performed via the PubMed, Web of Science, and Library of Congress databases, involved in articles from January 1st, 1983 to February 28th, 2022. The outcomes were extracted and analyzed by 3 independent authors, including patient demographics, diagnoses, surgical techniques, postoperative outcomes, and complications. RESULTS: A total of 29 studies covering 6611 patients were included according to the inclusion and exclusion criteria. The L-shaped osteotomy may obtain a better effect when someone has both zygomatic body and arch protrusion. In the view of complications, our conclusion suggested that L-shaped osteotomy without bony resection reduced the zygomatic complex effectively with the lowest incidence of postoperative complications (0.02%). But the amount of bone resection is limited. If increasing bone resection is necessary, L-shaped osteotomy with long arm bony resection and L-shaped osteotomy with short arm bony resection are both preferable choices with lowest incidence of structural and functional complications, respectively. CONCLUSION: L-shaped osteotomy may obtain a better effect when a patient has both zygomatic body and arch protrusion. L-shaped osteotomy without bony resection reduced the zygomatic complex effectively with the lowest incidence of postoperative complications. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The importance of the mortice and tenon joint on the zygomatic arch in reduction malarplasty-a retrospective study.

The aim of this study was to compare two kinds of reduction malarplasty in terms of their bony consolidation. Patients that underwent reduction malarplasty were reviewed retrospectively. The medial movement of the zygomatic body and the zygomatic arch as well as the complications and satisfaction of patients were investigated. The surgical procedure entailed a classical or modified L-shaped osteotomy through intraoral and sideburn approaches. Two groups were distinguished, those for whom a mortice and tenon joint was formed on the zygomatic arch (Group I), and those that formed end-to-end bone contact (Group II). All the cases in Group I showed an improved facial contour with sufficient bone contact. A larger medial movement of the zygomatic arch was observed in Group I (4.54 ± 0.41 mm) than in Group II (2.72 ± 0.29 mm) (P = 0.016). More bone malunion was observed in six cases of Group II (P = 0.030) and four required a second operation. In conclusion, this study indicates that the mortice and tenon approach is preferable when the priority is bony consolidation.