Zygoma Revision Surgery: Resolving Step Deformity and Asymmetry

Step deformity or asymmetry that occurs after zygoma Surgery can cause significant stress for patients. Revision Surgery, in particular, is much more complex and difficult than the initial Surgery, making precise diagnosis and delicate approach by an experienced Medical Team essential. This case study is about the revision Surgery process to resolve step deformity and asymmetry that occurred after previous zygoma Surgery.

Diagnosing Problems from Previous Surgery

The patient had previously undergone zygoma reduction Surgery but was experiencing asymmetry in both cheekbones after Surgery, along with a 'step deformity' where a specific area appeared sunken. A precise analysis through 3D CT Scan revealed several problems.

• Problem with Fixation Pin Position: The fixation pins used in the previous Surgery were located too far forward on the cheekbone. Dr. Oh Myung-jun explained, "These fixation pins were cut too far forward, and there's a significant difference between the two sides," pointing out that this led to an imbalance in both cheekbones and exacerbated the asymmetry.
• Cause of Step Deformity: The phenomenon where the osteotomy site of the cheekbone does not connect smoothly but appears to bend like a step usually occurs due to incomplete osteotomy or fixation failure. The CT images clearly showed the zygomatic arch bending like a step. Dr. Oh Myung-jun added, "When it looks sunken and shadowed, we call that a step deformity."
• Difficulty in Removing Fixation Pins: The pins fixed to the existing zygomatic arch were very difficult to remove. This posed a significant constraint in establishing the Planning for revision Surgery, making a highly difficult Surgery unavoidable, where new fixation had to be added while maintaining the existing pins. Dr. Oh Myung-jun emphasized, "Removal of pins fixed to the zygomatic arch is impossible; it's a highly difficult Surgery that requires revision Surgery while maintaining them."

Revision Surgery Planning and Progress

Considering the patient's unique case, Dr. Oh Myung-jun sought ways to improve the shape of the cheekbone and fix it firmly while maintaining the existing fixation pins as much as possible.

1. Zygomatic Arch Correction and New Fixation Method

CT analysis confirmed that the osteotomy was performed a full 11mm in front of the intended cutting position. Dr. Oh's explanation, "And it was cut 11mm in front of where it should have been cut," clearly shows the problem with the previous Surgery. In such cases, simply removing the existing pins is not enough; it is important to stably reposition the bone through a new fixation method.

• Maintaining Existing Pins and Adding New Fixation: If the existing fixation pins are firmly maintained, a method of adding new fixation pins on top of them to correct the cheekbone in a straight line is used, rather than removing them. Dr. Oh Myung-jun explained that the procedure would be "checking both sides, and if the fixed area is firm, not removing it, but connecting here and here with new fixation."
• Resolving Step Deformity: As Dr. Oh's diagnosis states, "This area in the photo is the stepped zygomatic arch, and it can be resolved by making the stepped zygomatic arch straight," the key is to make the bent zygomatic arch into a smooth, straight line. This requires complex techniques that go beyond simply shaving the bone, involving precise trimming of the bone connection points and firm fixation in a new position.

2. Improving Midface Volume

By moving the cheekbones sufficiently inward through revision Surgery, the overall volume of the midface can also be improved. In the pre-Surgery CT scan, the cheekbones protruded more than the skull, but after Surgery, they naturally moved inward, making the face appear smaller and more three-dimensional.

"Before Surgery, the cheekbones protrude more than the skull, but after Surgery, you can see them moving inward more than the skull, right? And you can also see the midface changing three-dimensionally, right?" As Dr. Oh Myung-jun explained, revision Surgery aims for a three-dimensional change that considers the overall harmony of the face, beyond simply reducing protruding cheekbones.

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Surgery Results and Patient Satisfaction

Despite being a difficult revision Surgery, successful results were achieved thanks to Dr. Oh Myung-jun's diverse know-how and precise Planning. Post-Surgery CT scans confirm that the step deformity was perfectly improved, and both cheekbones were symmetrically and smoothly reduced. The patient also expressed high satisfaction with the improved facial contour.

Revision Surgery involves more considerations and is more difficult than the initial Surgery, but satisfactory results can be achieved if an accurate diagnosis and customized Planning are established through sufficient Consultation with an experienced specialist.

O.N Clinic | Last reviewed 2024-07-30