If the malar area (upper cheek bone) or the zygomatic arch (the cheek's bony arch heading towards the ear) are overly prominent, they can be surgically reduced by
• bone shaving or burring with a drill (very mild effect), or
• (diagram) cutting through the zygomatic arch at two spots (dotted red arrows) and then fracturing and repositioning the bone inward (solid black arrow) , backwards, and downwards (much larger effect).
Effect of in-fracturing the zygomatic arch
Skull viewed from below (jawbone not shown)
Treatment is most effective in patients with big cheeks but an otherwise narrow face. If the skull base is diffusely wide (orange line), the slimming effect will appear smaller.
Prior to treatment, X-rays and CT scans are analyzed to determine where and how much bone requires surgery.
The incision to approach the bone is usually in the scalp and/or inside of the mouth between the lip and teeth. If an endoscope is used, the incision may be only a few millimeters wide.
Fracture and repositioning of the arch can result in significant bruising and swelling. There is a small risk of nerve damage as well as an imbalanced final result.
Patient satisfaction rates are high.