Cheekbone Reduction Gone Wrong? Restoring the Ogee Curve with a 7-Hour Zygoma Reconstruction

Sagging cheeks, a hollow midface, a longer face and a broken ogee curve after cheekbone reduction: a 7-hour zygoma repositioning and bone regeneration, with 3D CT and 3-month follow-up. I am Prof. Euiryong Lee, oral and maxillofacial surgeon in Seoul. This surgery truly took seven hours. Sincere thanks to the patient for allowing me to share it. ■ What can change after cheekbone reduction Done well, cheekbone reduction (reduction malarplasty) is a beautiful operation. But as skeletal support decreases, these may appear: · Nasolabial folds from cheek sagging · The "Indian line" mid-cheek groove · A step-off crease along the cheekbone · Lateral and anterior cheek sagging · Loss of the ogee curve Lateral sagging usually improves once the zygoma is repositioned. Anterior sagging does not always improve; I am developing a new approach for it. ■ What is the ogee curve? In a 45-degree view, the smooth S-curve from below the eye over the cheekbone into the cheek, a classic sign of youth that should not be lost early. ■ My principle: never resect the zygomatic body Facial width depends mainly on setting back the zygomatic arch, which has nothing to do with shaving the 45-degree zygomatic body. So I never resect the body; I fold it in at the osteotomy line. Projection decreases, yet the ogee curve stays. ■ The patient · 32-year-old woman, cheekbone reduction in January 2026 · Goals: bring the cheekbones back close to the original (slightly less), improve sagging, restore the ogee curve ■ Findings (T0 = before reduction / T1 = first visit) · A naturally long face now looked longer and narrower · Hollow lateral face, anterior cheek sagging · Right: the ogee peak had dropped, breaking the curve; an uneven contour reads as older · Left: lower sagging, ogee loss, a dent along the mandible · CT: the zygomatic body was heavily reduced and the zygoma shortened; much of the "malar wing" that supports soft tissue was gone · Worm's-eye view: the arch was set inward almost to the skull, leaving no visible space · T0/T1 superimposition showed the shortening and medial shift Narrowing the arch can be a valid option, but heavy reduction of the zygomatic body removes skeletal support. This is a limitation of the procedure type itself, not the fault of any individual surgeon. ■ Digital planning: can the zygoma go back to T0? Segmenting the zygoma on 3D CT and moving it back to T0 leaves a large bone gap. Filling it to restore full length is nearly impossible: · Block grafts big enough for both sides are hard to harvest from the hip · Titanium spacers are hard to fabricate and position precisely · Large blocks are hard to fix and prone to resorption and nonunion My approach: milled bone mixed with BMP, carried in a PCL scaffold. Less a graft than bone regeneration. ■ The surgery · The zygoma was spread as far laterally as possible and fixed with direct bone contact; some shortening is unavoidable, as explained beforehand, and the lower length is addressed later · Bone graft to the empty posterior arch to rebuild continuity · Challenges: very deep dissection, protecting the facial nerve branch that raises the eyebrow, fixing a small fragment · About 7 hours ■ 3-month CT · Zygoma repositioned laterally; the space under the arch is visible again · Graft taken well, bony continuity restored · Stable: almost no change from the immediate post-op CT, no downward displacement · Not fully back to T0, but clearly more lateral than T1 ■ Face at 3 months 2 weeks (some swelling remains) · The narrow, long face looks more balanced · The hollow lateral face has filled out · The ogee curve has re-formed and sagging improved · Right: the peak is back in place with a smooth, classic curve · One remaining area will be treated at plate removal ■ Take-home message · Sagging and ogee loss after cheekbone reduction often start from lost skeletal support; evaluate the bone first · Do not shave the zygomatic body; fold it in · To reverse over-resected cheekbones, repositioning with bone contact plus regeneration is more realistic than large block grafts · Not perfect, but a midface contour remarkably close to natural can be achieved Shared with the patient's consent for education. Individual results vary. Prof. Euiryong Lee | OMFS, Chung-Ang University Hospital, Seoul FACEDESIGNER · Digital-Bio Face Design Lab One Surgery, Zero Worry. #CheekboneReduction #ZygomaRepositioning #SaggingCheeks #CheekboneReductionGoneWrong #CheekboneReductionReversal #OgeeCurve #MidfaceSagging #HollowCheeks #ZygomaReconstruction #ReductionMalarplasty #FacialContouringRevision #BoneGraft #KoreanPlasticSurgery #FACEDESIGNER #이의룡교수