Harmony is key
When we look at a face our minds eye defines within a split second if we like this face or or not, the key to pleasant facial features is harmony between all components making up the face. The ratio between te width of the eyes, the width of the malar bones,the width of the jaw angle and facial height will make up for a more or less nice balance.
When the midfacial skeleton is underdeveloped, harmony will be disturbed. This will lead to paranasal flatness, an unsupported nose, deep nasolabial folds and drooping or bulging of the eyes. In many cases there is a relation between the underdevelopment of the upper jaw and the zygomatic bones and an osteotomy of the upper jaw and malars are combined in one procedure.
A malar osteotomy can restore facial balance and add definition to the malar bones. In contrast to implants, we do not need to introduce a foreign element into the body. The lifespan of silicone implants is inherently limited with a risk of long- and short term complications such as infection and encapsulation.In mire complex cases with large defects I will use a titanium implants made to measure specifically for the patient.
Since it is a bony deformity that needs to be corrected it is most logic to attack the problem on bony level, this will lead to the most natural looking and permanent results.
Patients who have bulging eyes and seek correction for it can be helped in most cases by a combination of malar osteotomy and fat removal from the orbit.
True a small incision inside the mouth, completely hidden under the lip, the malar bone can be visualised and prepared. Two cuts are made at the median side of the malar bone where it attaches to the upper jaw. It is gently loosened and pushed open in a lateral manner. Projection is evaluated and the bone is fixed in the new position using plates and screws.