Zygomatic Reduction Plasty

Zygomatic reduction plasty is similar to mandible reduction. However, the familiarity and comfort zone are different in roughly a hundred of bone reduction surgeons. Subsequently, there are one hundred different approaches to create completely different result.

In a more accurate way, the zygomatic reduction sculpture administered by Dr. Hsieh is known as “setback, backward and upward lift – reposition” zygomatic surgery. The zygomatic body and zygomatic arch are moved backward and upward besides being setback.

After zygomatic reduction plasty, the face will appear droopy? Is this true?”
For zygomatic reduction plasty, the most common question being addressed to Dr. Hsieh is, “I heard that after zygomatic reduction plasty, skin of the face will become droopy? Is this true?”.

“Yes, it is true. If the operated zygoma is not secured on the appropriate position or is not stably secured, this condition may occur after the surgery.””

In order to avoid the occurrence of this situation, Dr. Hsieh adopts the dual incisions through intraoral and temporal-preauricular. Subsequently, various mini titanium alloy screws and plates are used to secure the setback of zygomatic body and zygomatic arch which are moved backward and upward. The fixation of bone is extremely important because there is a strong and powerful muscle known as massater muscle attaching to the zygoma. With one end attaching to the zygoma, the other end of the massater muscle is attached near to the mandibular angle which is responsible for breaking down food into small pieces. In other words, the massater muscle may cause the downward movement of zygoma leading to droopy face if the appropriate fixation is not applied when the zygoma is being operated.

Dr. Hsieh, do you use endoscopic assisted facial bone reduction?
This is indeed an interesting question. Endoscope is applied in many surgeries and certainly has its own importance and advantage in various occasions such as forehead lift, arthroscopy and laparoscopy. Although it involves relatively small incision, there are various compensations for the small incision including limited field of vision (tunnel vision), difficulty in analyzing the symmetry, issue with hemostasis, and difficulty in establishing good fixation. Dr. Hsieh believes that this does not conform to the balance of risk-benefit ratio with the difference of incision by 1cm.

However, occasionally Dr. Hsieh will apply endoscopy in mandible reduction. Some patients have depressed mandibular angle, hence, endoscope is adopted to reach area concealed to the naked eyes besides improving the accuracy and symmetry of bone reduction.

In conclusion, challenges of maxillofacial surgery consist of the post-surgical symmetry, good fixation of bone, good hemostasis, and careful protection on important nerves and blood vessels. Dr. Hsieh will apply endoscopic assisted facial bone reduction when enhanced accuracy and symmetry are required, but not to reduce the size of incision or post-surgical swelling. Moreover, post-surgical swelling is associated with hypotensive anesthesia, surgical skills of surgeon, surgical duration, condition of hemostasis, and undoubtedly, the patients’ body constitution. These factors are not related to applying endoscope in facial bone reduction!

Dr. Hsieh, do you use laser assisted facial bone reduction?
Presently, Dr. Hsieh has not applied “laser” to cut bones. Dr. Hsieh adopts refined micro-bone-saw manufactured by Europe to cut facial bones. This question is similar to asking if Dr. Hsieh commutes to work with UFO. Dr. Hsieh currently thinks that car is the most stable transportation and certainly will not be riding a horse to work. Many people already claim that they will make UFO as their main transportation when it is still at a “research and development” stage.

On the other hand, Dr. Hsieh has participated in countless domestic and international conventions related to cranio-maxillo-facial surgery. Therefore, many related manufacturers will update surgeons with various new bone-cutting medical equipments. Currently, Dr. Hsieh believes that micro-bone-saw is the best tool in bone-cutting. Besides, there are various upgrades and enhancements for the tool in these few years such as ameliorating the cutting speed, reducing the generation of heat and improving convenience.

During meal gatherings with famous bone reduction surgeons from different countries, Dr. Hsieh will always seize the opportunity to understand the bone reduction trend in different countries. These experts have common consensus in using conventional micro-saw because it is after all the safest and most stable bone-cutting tool. “Laser Bone Cutting is just used for marketing purpose for some surgeons”, they said.