[Deep Dive into Plastic Surgery Side Effects] Nonunion after Zygoma Reduction
[Deep Dive into Plastic Surgery Side Effects] Nonunion after Zygoma Reduction
  • 글·심지선 기자│번역·김성혜 인턴기자 (js.shim4880@gmail.com)
  • 승인 2020.05.21 15:37
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CARD 1. What is facial contouring surgery?

Compare to the past, popularity in cosmetic surgery and the interest in facial contouring surgery for a smaller face has increased in Korea. Although it requires a determination due to a comparatively expensive cost, long recovery time, and fear of removing bones only for beauty purposes, the possible side effects of the operation can be fatal.


CARD 2. A reported case of side effects from zygoma reduction after facial contouring surgery

After having a square jaw reduction and zygoma (cheekbone) reduction five months ago, Ms. H, a 22-year-old woman, is suffering from the pain in her cheekbones, and the difficulty in opening her mouth along with the clicking sound, keeping her from living an ordinary life. The clinic in Sinsa-dong, where she received the operations, claims of no inflammation or structural problems, and it's that Ms. H is just sensitive.


CARD 3. Ms. H’s side effects, possible to check via CT

The side effects Ms. H is suffering from commonly occur due to sinusitis and nonunion (it is when zygoma does not attach in the process of cutting and pushing the bone inwards) after zygoma reduction. Many patients tend to complain of side effects when they are unhappy with their new shape saying, "it hurts" and "it’s uncomfortable," and the causal relationship between patient’s subjective claims and the surgery can be checked often through computed tomography (CT). Besides, the treatment history of the temporomandibular joint and the presence of abnormalities need to be checked as well before the operation.


CARD 4. Conditions to check via CT scan after the surgery

Due to swelling and tissue normalization from the surgery, it’s hard to see the exact results for months, so a CT scan is necessary for periodic progress observations to examine these followings:

▲Was the operation performed according to the preoperative plan?

▲Is the gap extent of the surgical site within a normal range?

▲Is it accurately adjusted to support the zygoma?


CARD 5. Reason for recommending CT scan when consulting for reoperation

Some hospitals may settle the cost of counseling for facial contouring surgery with CT scanning, but other hospitals may not have CT data operated or may need to install new programs. This is because equipment familiar to medical staff makes diagnosis and surgical planning effective. CT, which is used in general plastic surgery, has low radiation exposure, giving no harm no matter how many times you take it.


CARD 6. Does Ms. H need a reoperation?

Through CT scans, if the cheekbone fracture is observed to be more than 3mm wide, or more than a third of the cheekbone is not attached, then the cause is nonunion in which by re-extracting and resetting the cheekbones can bring improvement in symptoms. However, reoperation is more complicated than the initial surgery, and it is better not to do it as much as possible because there are many cases where the post-operative improvement in symptoms or shape is unsatisfactory, but if you insist, touching up a little on less corrected parts is enough.


CARD 7. Reoperation method for Ms. H

Methods depend on the extent of the bone reduction, but if there are sufficient bones, removing a few cheekbones through a mouth incision and fixing it firmly is one way. However, if the bone is insufficient due to overcorrection, a difficult surgery such as bone transplantation and reconstruction through scalp incision (coronal incision) might be necessary.


CARD 8. Do side effects worsen if no reoperation?

It's unlikely to get worse. However, if you don't continue to use temporomandibular joints, they may harden, so having temporomandibular joint rehabilitation therapy (mouth opening exercises) is essential. If the symptoms are severe, you should seek medical treatment from oral medicine or temporomandibular joint clinic. Most pain or various symptoms improve over time, not due to the disappearing of underlying causes, but because the body gets used to it.


CARD 9. Advice for facial contouring surgery patients who are considering reoperations

Since face contouring reoperation can be carried out after at least a year of progress, it is necessary to think more carefully about reoperation while alleviating symptoms with proper rehabilitation, professional treatment, and surgical area massage. In the third month of reduced swelling and appearing of shape, you become stressed out with the shape, being sensitive to pain or various symptoms, and you may end up considering unnecessary reoperation. Therefore, it is vital to get less stress from your appearance.


CARD 10. How to minimize side effects from zygoma reduction?

Zygoma reduction is cutting off a part of the overlapping bone in the process of pushing the bones inside after the incision of smoothing out the protruded cheekbones, instead of cutting the bones to make the cheekbones smaller. Hence, it is significant to prevent overcorrection by accurately checking your conditions such as occlusion and temporomandibular before surgery. Above all, the best way to prevent side effects is to carefully think about whether you really need a zygoma reduction, and then operate only as much as you need and minimize stress from shape after surgery.


CARD 11. Recommendation from Lee Sang-Woo, Director of the DA Plastic Surgery

“Face contouring surgery like zygoma reduction should be carefully decided after being checked on the conditions such as occlusion and temporomandibular by a specialist before surgery. It is important not to overcorrect your face, considering a harmonious face ratio. And if you've had side effects after surgery, you need to get CT scans to determine the cause and then choose whether to have a reoperation or not."

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