Temporal and malar-zygomatic reduction and augmentation.

The temporal fossa, zygomatic arch, and malar-midface should be considered jointly when augmentation of the temporal area or reduction of the zygomatic arch are to be carried out. These anatomic areas relate so closely to one another that altering one affects the other. In addition, augmentation of the malar-midface area may be done if one of the other two procedures is to be considered, or if a brow lift, subperiosteal face lift, or other reason for using a coronal incision exists. Use of the coronal incision for malar augmentation is probably not justified because of the large amount of surgery required in spite of the lesser morbidity associated with this approach in terms of amount of infections, lip stiffness, and hypesthesia. Planning a surgical procedure must be done in the office, by examining the patient at eye level to determine the amount of zygomatic arch reduction and the amount of temporal fossa augmentation necessary. Similarly, the three zones of the malar-midface complex must be assessed, with the amount of augmentation of each zone determined prior to the day of surgery. The surgical procedure is then executed through a coronal incision, with the dissection extending down to the zygomatic arch. If the temporal muscle is to be elevated out of its fossa, it is cut on its anterior, superior, and posterior edges, elevating it out of its fossa so that a Proplast implant, typically 3 to 4 mm thick and finely tapered on its superior and posterior edges, with suturing done anteriorly, may be inserted. The muscle is then resutured to its aponeurosis on all three edges. If the zygomatic arch and malar-midface area are to be approached, the dissection is carried to the deep and superior edge of the zygomatic arch, and the periosteal elevator is used to elevate the soft tissue off the lateral and inferior edge. The arch and malar-midface are cleared of soft tissue, extending the tunnel to the upper buccal sulcus. The arch is then reduced with a contouring burr to the thinness desired. Alternatively, the malar-midface area may be augmented with synthetic material precisely positioned, with a suture around the zygomatic arch, holding it in position as measured from the lateral orbital rim. The incision in the temporal fascia is then resutured, and the coronal incision is closed.(ABSTRACT TRUNCATED AT 400 WORDS)