Is This The Location Of The Widening Created By The Zygomatic Arch Implants?

Q: Dr. Eppley, A picture is worth a 1000 words 

I found this picture with the red circle drawing  where I think the actual cheek augmentation would be. Is this correct and does this show the length of the widening? It seems that this would make higher cheekbones laterally plus significantly increase the width in that area. Is this correct or is only part of the length Of the circle that is widened? 

If I recall correctly you had mentioned that there can be some quite significant widening achieved, and the amount of widening is something that can be chosen by the size of the implant.

Would the temporal implants plus the chin reduction alone give a noticeable facial widening if we can get at least 7 mm, or would it likely just help some.

 Also during the last botched surgery, the surgeon ended up pushing the lobes of my ears forward. Is it possible to just excise the lobes? I would want to make my ears look smaller anyway.

Finally, in this article there is something called ZSO, and I don’t know what this is but they’re saying that this procedure will produce a widening that is more round and typically suited for women’s faces, but I think I already have a lot of angles (correct me if I’m wrong) and a more around widening maybe what I’m looking for. maybe I’m wrong, and I certainly need your opinion, but it seems like my face already has a lot of angulation.

A: In answer to your facial questions:

1) You have illustrated what the lateral cheek/zygomatic arch implants are generally located. They not be quite that far back as the shown example has prominent bone anatomy in which the zygomatic process of the temporal skull bone is naturally enlarged. But you can get implants quite that far back unless one does a direct sideburn incision to do so. (which is not a bad thing as it avoids an intraoral approach)

2) Temporal implants sit above the zygomatic arch and their intent is to decrease tenurial hollowing, not create facial widening. Facial widening as to be done down at the cheek/arch level.

3) You are referring to an inferior helical rim earlobe reduction which is commonly done tor reduce the size of the earlobes and the overall vertical ear height.

4) The ZSO is the zygomatic sandwich osteotomy which means the anterior cheekbone (right to the side of the eye is cut vertically and the cheekbone is pushed out and a graft placed to hold it out. (hence the term ‘sandwich’) While it is a facial widening procedure it is way forward from the posterior facial widening effect seen in the picture. For anterior cheek widening the ZSO is the autologous option over an onlay cheek implant But fir what you are looking for…and you have found a visual example of the widening effect you are seeking….that can only be done by an inlay implant over that portion of the arch.

Dr. Barry Eppley

Indianapolis, Indiana