Liposuction of the Zygomatic Arch Area Facilitates Correction of Temporal Depression
Temporal depression, characterized by a height disparity between the concave temporal region and the lateral projection of the zygomatic arch, poses both aesthetic and structural challenges in facial contouring. Traditional corrective approaches focus on augmenting the depressed temporal region through fat grafting. However, this study introduces a novel method combining zygomatic arch liposuction with temporal fat grafting to address the height discrepancy more effectively. By reducing the protrusion of the zygomatic arch, the technique aims to minimize the volume of fat required for temporal augmentation while achieving harmonious facial proportions.
Study Design and Methodology
The study involved 20 female patients (40 temporal depressions) treated between 2015 and 2018 at a single institution. Patients were divided into two groups: Group GL underwent fat grafting to the temporal region combined with liposuction of the zygomatic arch, while Group G received fat grafting alone. All procedures were performed by three certified plastic surgeons with expertise in both liposuction and fat grafting.
Surgical Technique
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Donor Fat Harvesting:
Fat was primarily harvested from the abdomen, thighs, or arms using tumescent infiltration. A 3-mm multi-hole blunt cannula attached to a 20-mL syringe extracted fat from the deep subcutaneous layer. The aspirate was filtered through gauze and cotton pads to remove fluids, then transferred into 1-mL syringes for injection. -
Zygomatic Arch Liposuction (Group GL):
Prior to fat grafting, the zygomatic arch’s lateral projection was treated with a small volume of tumescent solution. A 1-mm multi-hole blunt cannula connected to a 5-mL syringe was used for superficial liposuction, ensuring minimal trauma to underlying structures. -
Temporal Fat Grafting:
The temporal depression was overfilled with tumescent solution to determine the required graft volume. A 1.5-mm single-hole blunt cannula injected fat into the temporal region at 130% of the tumescent volume to account for resorption.
Outcome Measures
- Fat Volume: The amount of grafted fat and lipoaspirate was recorded.
- Surface Area Analysis: Pre- and postoperative frontal photographs were analyzed using ImageJ software (NIH) to quantify temporal depression areas.
- Patient Satisfaction: Patients self-evaluated outcomes using a 4-point scale (1: very dissatisfied; 4: very satisfied).
- Clinical Evaluation: Three surgeons assessed outcomes using the Global Aesthetic Improvement Scale (GAIS: 0–4, from “worse” to “very much improved”).
Results
Fat Volume and Surgical Efficiency
Group GL required significantly less grafted fat (2.0 ± 0.1 mL per side) compared to Group G (2.9 ± 0.2 mL; P < 0.001). Liposuction of the zygomatic arch removed an average of 1.2 ± 0.3 mL of superficial fat per side.
Temporal Depression Correction
Preoperative temporal depression areas were comparable between groups (GL: 37.5 ± 3.8 cm²; G: 36.9 ± 3.2 cm²; P > 0.05). Postoperatively, both groups showed significant reductions in depression area (GL: 16.1 ± 4.0 cm²; G: 17.0 ± 3.3 cm²; P < 0.05 vs. baseline). However, the percentage improvement did not differ statistically between groups (P > 0.05).
Subjective and Clinical Evaluations
Patient satisfaction scores were similar between groups (GL: 3.4 ± 0.5; G: 3.3 ± 0.6). Surgeons rated GAIS scores as 3.2 ± 0.4 (GL) and 3.1 ± 0.3 (G), indicating “much improved” outcomes in both cohorts.
Clinical Implications and Technical Considerations
The dual approach in Group GL offers two key advantages:
- Reduced Fat Graft Requirements: By lowering the zygomatic arch’s prominence, the height disparity requiring correction diminishes, reducing graft volume. This minimizes overcorrection risks and maintains a natural facial contour.
- Harmonized Facial Proportions: Simultaneous reduction of zygomatic protrusion and temporal augmentation creates a smoother transition between facial regions, ideal for patients desiring a slimmer profile.
Safety and Precision
No major complications (e.g., infection, cysts, edema) occurred. Superficial liposuction with low-pressure syringes and blunt cannulas prevented nerve injury or contour irregularities. Fat injections into the temporal region targeted the subcutaneous layer to avoid vascular compromise and ensure graft viability.
Discussion
The study demonstrates that zygomatic arch liposuction enhances the efficiency of temporal depression correction by addressing both sides of the height disparity. While fat grafting alone effectively augments volume, combining it with liposuction reduces the reliance on graft survival, a critical factor given variable fat retention rates.
Mechanistic Insights
The zygomatic arch’s lateral projection contributes to the perceived depth of the temporal depression. Reducing this projection through targeted liposuction decreases the relative concavity, allowing modest fat grafting to achieve equilibrium. This approach aligns with anatomical studies emphasizing the interplay between facial prominences and depressions in aesthetic perception.
Limitations and Future Directions
The study’s single-center design and homogeneous patient cohort (Asian females) limit generalizability. Long-term follow-up beyond 12 months is needed to assess fat graft retention and zygomatic arch stability post-liposuction. Comparative studies with alternative techniques, such as synthetic fillers or implants, could further validate this method’s efficacy.
Conclusion
Combining zygomatic arch liposuction with temporal fat grafting provides a safe, efficient solution for temporal depression correction. The technique reduces graft volume requirements while achieving balanced facial contours, making it particularly suitable for patients seeking subtle, natural-looking results. Future research should explore its applicability across diverse populations and refine technical protocols for optimized outcomes.
doi.org/10.1097/CM9.0000000000000944
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