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Zygomatic Osteotomy Malarplasty, A Safe and Reporducible Alternative to Alloplastic Malar Augmentation in Transfeminine Patients
Anusha Singh
*1, Spencer Bennett
2, Christian X. Lava
4, Jerry W. Chao
31Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, ; 2George Washington School of Medicine, Washington, ; 3Plastic and Reconstructive Surgery, George Washington University Hospital, Washington, ; 4Georgetown University School of Medicine, Washington,
Background: Facial gender-affirming surgery (FGAS) is crucial to gender affirmation for many patients. Malar augmentation, customarily achieved with implants and/or fat grafting, can create a more feminine midface contour. Here we present an alternative technique, zygomatic osteotomy malarplasty (ZOM). Our study shows ZOM, compared to alloplastic malar augmentation, is efficacious and reproducible with unique benefits and lower complication rates. The technique is described, and a video demonstration of the critical steps is included.
Methods: A single-center retrospective review of 44 patients was conducted. Data for minor complications (infection, dehiscence, wound healing issues, asymmetry, transient numbness) and major complications (nerve injury, need for revision surgery) were collected. Systematic review of the literature on alloplastic malar augmentation for FGAS was also completed. Electronic databases were searched for qualifying articles. Studies reporting technique, aesthetic outcomes, and complications were included. Studies without adequate detail or follow-up were excluded. Statistical analysis was done with the Mann-Whitney U Test, p-values < 0.05 were significant.
Results: 44 patients underwent ZOM at a single institution. Procedures were bilateral, 88 ZOMs were analyzed. There were minor complications in 0.023% of procedures (dehiscence); no major complications. Meta-analysis of alloplastic malar augmentation revealed 6 studies with 117 patients and 234 procedures. Minor complications included dehiscence 0.009%, infection 0.013%, and asymmetry 0.004%; major complications included return to operating room 0.009%. ZOM had lower rates of dehiscence, infection, asymmetry, and return to operating room (p < 0.001).
Conclusion: ZOM requires a controlled greenstick fracture at the zygomatic and temporal bone junction. The fracture is distracted, and bone allograft or autograft is fixated into the gap with miniplates. While alloplastic implant placement is faster and less invasive, ZOM modifies the patient's own anatomy resulting in customized augmentation.
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