Revision reduction malarplasty with coronal approach.

BACKGROUND: Although reduction malarplasty is one of the most popular aesthetic surgical procedures in Asia, there have been a few reports of complications or unfavourable results. A poor understanding of the repositioning vector of the malar segment or improper fixation can result in unsatisfactory outcomes, such as non-union or inferolaterally displaced malunion of the malar complex. The authors present some revision malarplasty cases of patients with unfavourable or complicated outcomes to emphasise the importance of accurate repositioning and firm fixation of the malar complex in reduction malarplasty.

METHODS: A total of 20 patients underwent revision malarplasty by the coronal approach after an unfavourable primary reduction malarplasty. The major complaints included cheek drooping, depression, asymmetry and overcorrection. After repositioning the inferolaterally displaced malar complex to the appropriate position and obtaining bone-to-bone contact, rigid fixation was performed with a plate and screw. The calvarian bone was grafted to the bony gap. Midface and forehead lifts were also performed when indicated.

RESULTS: Most patients had satisfactory results without severe complications. Two patients required a secondary revision due to asymmetry and non-union. Three patients developed frontal palsies, which were all temporary.

CONCLUSION: Precise repositioning of the malar complex and firm fixation are essential for reduction malarplasty. The coronal approach is recommended when encountering unfavourable results or complications because it offers a wide surgical field for repositioning and fixation of the malar complex.