Malar Reduction Techniques: A Review of Surgical Approaches and Clinical Considerations

Abstract

The zygomatic complex plays a fundamental role in determining midfacial contour, projection, and overall facial width. Excessive prominence of the malar eminence can result in a broad or square facial appearance, which many patients perceive as aesthetically undesirable. Consequently, reduction malarplasty has become an increasingly performed procedure in facial contour surgery, aimed at decreasing the prominence of the zygomatic body and arch while preserving facial harmony, skeletal stability, and soft-tissue support. Over the past two decades, advances in osteotomy design, fixation techniques, and digital surgical planning have significantly improved the precision, safety, and predictability of malar reduction procedures. Several operative techniques have been described to address malar prominence, including L-shaped osteotomy, I-shaped osteotomy, isolated zygomatic arch reduction, intraoral approaches, coronal approaches, and minimally invasive endoscopic techniques. Selection of the appropriate technique depends on the degree and location of malar prominence, the patient’s facial morphology, and the desired aesthetic outcome. Recent integration of three-dimensional imaging, virtual surgical planning, and patient-specific cutting guides has further enhanced surgical accuracy and intraoperative control, allowing more precise repositioning of the zygomatic complex. Despite these technological advances, reduction malarplasty remains a technically demanding procedure because of the complex anatomy of the zygomatic region and its close relationship with important neurovascular structures, including the infraorbital nerve and branches of the facial nerve. Inadequate surgical planning or fixation may result in complications such as midfacial ptosis, sensory disturbances, asymmetry, infection, or nonunion of osteotomized segments. This review aims to provide a comprehensive overview of contemporary malar reduction techniques, surgical approaches, clinical considerations, complications, and outcomes.