Zygoma Reduction: Patient Guide
A wide midface has several possible causes and only one of them is the cheekbone. This site is about what follows once that has been settled: the body of the cheekbone and the arch behind it are two structures that do different things, the change to either is permanent, and the support that holds the cheek up is part of what the operation takes away.
Reviewed by Tongchun Mao, MD, head of aesthetic surgery at Chongqing West District Hospital. Bone that is cut away cannot be restored as it was, the result is hidden by swelling for months, and no outcome is guaranteed.
Width is a diagnosis before it is an operation
Four different things produce the same impression of a wide midface and only one of them is the cheekbone. The width may be muscle, fat or proportion: a heavy masseter, the fat over the cheek, a narrow forehead or a hollow temple each make the cheekbone read wider than it is, and reducing bone in that face narrows nothing that was the complaint. The cheekbone is two structures, a body beside the nose and an arch running back towards the ear, and a plan that changes one does not change the other. Width is judged from the front, which is why a profile photograph cannot show it and why the assessment is done in the views the patient actually uses. The change is irreversible: bone that has been cut away is not restored by cutting more, and rebuilding it later is a harder operation than the first. Narrowing and support are the same structure, so the operation that removes width also removes part of what holds the cheek up, and hollowing or descent is the other face of that coin. And the swelling takes months to clear, so the width that frightens a patient at two weeks is not the width she will keep.
What cheekbone reduction changes, and what it leaves exactly as it was
Each card is one thing that changes when the target is the cheekbone. Read them as a boundary rather than as a list of benefits, because most of the disappointment in this area comes from expecting the operation to reach something it does not touch.
The width of the midface from the front
The cheekbone is the widest point of the face at the level of the eyes, and reducing it narrows that measurement. It does not narrow the lower face, which is a different bone and a different operation, and it does not change the profile, which the cheekbone barely contributes to.
The body of the cheekbone
The body sits beside the nose and forms the front of the cheek, including the prominence under the eye. Moving it changes how the front of the midface reads and how the eye area sits above it. A plan that reduces the body and expects the side of the face to narrow has addressed the wrong half.
The arch behind it
The arch runs backwards from the body towards the ear and forms the outer wall of the midface. It is the structure that reads as width in a photograph taken slightly off centre, and reducing it changes the outline of the face rather than its front. The two are separate measurements and are planned separately.
The support the cheek sits on
The cheekbone is a buttress. The soft tissue of the midface rests on it, and removing part of it removes part of what holds that tissue up. This is not a complication of the operation but a property of it, and it is the reason a lift is sometimes discussed in the same breath as the reduction.
The plane the nerve runs in
The zygomatic branch of the facial nerve crosses the field on its way to the muscles around the eye and the upper cheek. The approach and the plane of dissection are chosen so that the nerve stays outside the operative field rather than being met inside it, which is a decision made before the operation and not during it.
The hollow that appears afterwards
Once the swelling has gone, a face that has lost cheekbone volume reads differently in the temple and in the cheek. In some faces this is the intended change and in others it is the change the patient did not ask for, which is why the plan anticipates it rather than discovering it at six months.
Asymmetry that was already there
The two sides of a face are rarely identical, and a plan that reduces both by the same amount can make a difference that was always present more visible rather than less. Imaging measures each side separately, and the frontal view is what judges the result.
Everything the operation does not reach
It does not narrow the jaw, change the bite, lift the soft tissue, alter the skin or make a round face oval. Where the complaint is one of those, the answer lies elsewhere, and a plan that implies otherwise is a plan that will not deliver what the patient asked for.
Who is a candidate, and who is not
The physical requirements are specific. There has to be enough bone along the planned line for what remains to be structurally sound, and the position of the arch and the thickness of the body have to be known before the plan is made rather than estimated during it, which means imaging rather than an examination alone. Any previous injury to the cheekbone has to be identified, because a fracture that healed in a different position changes both the anatomy and the plan. The nerve's course has to be established so the approach can be built around it. Smoking has to have stopped, blood pressure has to be controlled, and there must be no condition that impairs the blood supply to bone. Beyond the physical requirements there are considerations of age and of motive. Age matters because the bone has to be mature and because the soft tissue has to be able to settle over the new contour rather than descend across it. Motive matters more. A patient reducing a cheekbone because a photograph of somebody else was the goal, or because a stranger told her her face was wide, is asking an operation to do something it cannot, and the assessment is where that should be said. Where the width comes from muscle, from fat or from the proportions of the face around it, the honest answer is often not this operation at all.
Which half of the cheekbone is producing the width
This is the decision that matters most in this area of surgery, and it is a diagnostic one. The body and the arch are different structures with different effects, they are reached through different approaches, and the commonest planning error is to treat the two as one measurement.
Establishing which structure is responsible
From the front, the body of the cheekbone sets the width at the level of the eyes. From an oblique view, the arch sets the outline behind it. The same face can be wide in one and not the other, which is why the assessment uses several views and why the answer decides the operation rather than following from it.
Reducing the body
Where the prominence beside the nose and under the eye is the finding, the body is the target. It changes how the front of the midface reads and how the eye area sits above it. It does not narrow the outline of the face from an oblique view, because that is the arch.
Reducing the arch
Where the outline behind the cheek is the finding, the arch is the target. Reaching it involves a different approach, and the amount that can be moved is limited by the structures beneath it and by the nerve's course. It changes the outline rather than the front.
Both, in one plan
Where both structures contribute, both are addressed. This is a longer operation with a longer recovery and a larger change to the support the cheek rests on. It is planned as one operation rather than as two, and the decision to include the second structure is made from measurements rather than from a wish for a narrower face.
The approach and the plane
How the bone is reached decides what the nerve is exposed to. Different approaches place the dissection in different planes, and the choice follows from which structure is being moved and where the nerve runs in that patient. This is a technical decision the patient does not make, but it is the one that governs the risk.
Leaving the bone alone
Where the width comes from muscle, from fat or from the proportions of the face around the cheekbone, the honest plan does not involve the bone at all. This is a common outcome of an assessment for cheekbone reduction and is worth saying plainly rather than treating as a disappointment.
The months of swelling, and the wait for the final shape
The first day is the operation itself, with dressings and drains if they are used and a bulky wrap, and swelling that is significant from the first hours; eating is uncomfortable and the face feels heavy. Swelling and bruising build over the cheeks and around the eyes and peak in the first week, when a soft diet, sleeping with the head raised and cold compresses are what help most. By the second and third weeks the dressings and sutures are out and the swelling begins to fall, and at this stage the face looks uneven from side to side in many patients, which is expected and is not the result. Between four and six weeks most of the bruising has gone and normal activity returns, and numbness in the cheek and the upper lip is common and usually improves slowly over months. From two to three months the width begins to read as the swelling drops, and hollowing or a change in the midface becomes visible rather than hidden by it. Most of the result is visible by four to six months, when the soft tissue has settled over the new bone contour and asymmetry can be judged for the first time honestly. The final contour and any residual numbness are clear somewhere between six and twelve months, and that is where a revision question belongs. Your own team's instructions take precedence over any general timeline.
The nerve, the support, and the hollow the operation can leave
The general risks of any operation under anaesthesia apply, including bleeding, infection and the small risk of a clot in the leg or the lung. The risks specific to this operation are three. The first is the zygomatic branch of the facial nerve, which supplies the muscles around the eye and the upper cheek and crosses the region the arch is reached through. A weakness after surgery is usually temporary and usually resolves over weeks to months, and a lasting weakness is uncommon but possible, which is why the approach and the plane of dissection are chosen to keep the nerve outside the field rather than met inside it. The second is the soft tissue, and it is the risk patients are least prepared for: the cheekbone is a support, removing part of it removes part of what holds the midface up, and the same operation that narrows the face can leave it looking flatter, more hollow or lower in the cheek. This is anticipated in the plan rather than discovered afterwards, and where it is judged likely the plan is changed or another procedure is discussed at the same time. The third is the bone itself: removing too much cannot be undone, bone that has been cut away is not restored by cutting more, and rebuilding a contour later is a harder operation than the first. Numbness of the cheek and the upper lip is expected rather than a complication and is watched over months. Swelling that increases rather than settles, or that is much greater on one side, is assessed rather than waited out.
What else could answer the same complaint
If the width comes from the masseter muscle, a treatment that relaxes the muscle addresses the lower face without an operation, and its effect is temporary, which makes it both a treatment and a test of the diagnosis. If the complaint is fat over the cheek, removing fat changes what sits over the bone and does not narrow the skeleton, so it treats a different finding. If the face reads wide because the temple above it is hollow or the forehead is narrow, the width is a matter of proportion rather than of bone, and adding volume to the upper face changes the same impression without touching the cheekbone. If the complaint is that the midface looks flat rather than wide, adding volume is the direction that answers it and reducing bone is the direction that makes it worse. If the complaint is that the cheek has descended, the answer lies in the soft tissue rather than in the bone. And where a patient wants to rehearse a narrower face before committing, it is worth understanding that adding filler shows a fuller shape and does not preview the result of removing bone, which makes it a poor test of this particular operation. Where several of these apply at once, or where none of them does, the honest plan may be no operation at all.
The surgeon responsible for these guides
This site is medically reviewed by Tongchun Mao, MD, Deputy Director of the Plastic Surgery & Aesthetics Medical Center and head of its aesthetic surgery service at Chongqing West District Hospital. He operates inside a tertiary general hospital, with imaging, anaesthesia, laboratory workup and intensive care in the same building as the operating theatre, which is what this operation needs: the imaging that establishes bone thickness, the position of the arch and any previous fracture before the plan is made, and the hospital-level care for the complications that are uncommon but consequential. His assessment begins by asking whether the cheekbone is producing the width at all, and it frequently ends without an operation on the bone. He is supported by Dr. Shaoliang Wang on complex and previously operated cases, by Dr. Ke He on the assessment of what a non-surgical route could change, and by Dr. Yongbo Jia on the skin and soft tissue that have to settle over the new contour. Read the full team profiles.
Where this decision sits in the cluster
If you have not settled whether to have a contouring operation at all, start with the guide to contouring the width of the lower face, which answers that question for the jaw and is not repeated here. If what bothers you is the cheek rather than the bone, the account of the cheek as an aesthetic region sets out the whole area, and if you are weighing an injectable against an operation, the explanation of what filler can and cannot do in the cheek is the place to start. If the impression of width comes from hollowing above the cheekbone, the guide to hollow temples describes a proportion problem that is often mistaken for a width problem. If the two sides of your face differ, the guide to facial asymmetry covers a finding this operation can reveal as well as correct, and the hub on facial aesthetic surgery places all of it inside the wider subject.
Recovery After Cheekbone Reduction, and the Wait for the Final Shape
What happens, and roughly when, from the day of operation to the point at which the result of cheekbone reduction can honestly be judged. Two features dominate: swelling, which hides the width for months and resolves unevenly on the two sides, and the settling of the soft tissue over the new bone contour. Your own team's instructions take precedence over any general timeline.
The decision, in twelve parts
Each guide takes one question that only arises when the target is the cheekbone: which half is producing the width, which view shows it, where the nerve runs, what happens to the cheek when its support changes, and when the honest answer is not to reduce it. Read the two or three that match where you are.
Body and Arch: The Two Halves of the Cheekbone
The cheekbone is two structures with two different effects. Why a plan that changes the body leaves the arch alone, and what each one does to a face.
Read the guide →Width From the Front, Not the Side
A profile photograph hides the measurement patients care about most. Why cheekbone width is judged in the frontal and oblique views, and what that changes.
Read the guide →The Zygomatic Branch of the Facial Nerve
The nerve nearest the operative field, what it controls, how the approach keeps it out of harm, and what a weakness would look like afterwards.
Read the guide →Cutting the Body, the Arch or Both: Three Plans for Width
Three surgical families compared by what each moves, what each leaves untouched, and which facial pattern each one suits. Categories only, no products.
Read the guide →The Hollow That Follows Reduction
Removing cheekbone support changes the surface above it. Why hollowing happens, who is most at risk, and how a plan anticipates it rather than finding it later.
Read the guide →Midface Soft Tissue After the Bone Moves
What happens to the cheek when the bone beneath it changes, why a lift is sometimes discussed in the same appointment, and how that decision is made.
Read the guide →Start by finding out whether the cheekbone is the cause
Arrange an assessment. We will establish whether the midface width comes from the cheekbone, the masseter, the fat over the cheek or the proportions around it, which structure of the cheekbone is involved, and how much support the midface can give up.
Frequently asked questions
How can I tell whether the width is the cheekbone rather than the muscle or fat?
It is established by examination rather than by looking in a mirror. A heavy masseter stands out when the teeth are clenched and softens when they are not. Fat over the cheek moves with the skin rather than with the bone. What remains when both have been allowed for is the cheekbone, and imaging establishes the rest. The three are treated differently, so this comes before any decision about what to reduce.
Which part of the cheekbone would be reduced in my case?
That is the diagnostic question this operation turns on. The body beside the nose sets the width at the level of the eyes; the arch behind it sets the outline seen from an oblique view. A face can be wide in one and not the other, and the two are reached through different approaches, so the answer decides the operation rather than following from it.
Can the cheekbone be built up again if too much has been removed?
It can be attempted and it is harder than the first operation. Bone that has been cut away cannot be put back as it was, and material used to rebuild a contour does not behave like the bone that was removed. Adding volume back is the commoner revision direction, and it is the reason the amount removed is decided conservatively from imaging and treated as fixed once it has been set.
Will my face look hollow after the cheekbone is reduced?
It may, because the cheekbone is a support and the soft tissue of the midface rests on it. Removing part of it removes part of what holds the cheek up, so hollowing in the temple or the cheek is a property of the operation rather than an accident. In some faces that is the intended change and in others it is the change the patient did not ask for, which is why the plan anticipates it.
Is the nerve that moves the face at risk?
The zygomatic branch of the facial nerve supplies the muscles around the eye and the upper cheek, and it crosses the region through which the arch is reached. The approach and the plane of dissection are chosen so that the nerve stays outside the operative field. A weakness after surgery is usually temporary and usually resolves over weeks to months, and a lasting weakness is uncommon but possible.
How long before the width can honestly be judged?
At two or three weeks the swelling is still falling and the face looks uneven from side to side. The width begins to read at two to three months, most of the result is visible by four to six months once the soft tissue has settled over the new contour, and the final shape is clear somewhere between six and twelve months. Judging it earlier is the commonest source of unnecessary worry.
Part of Cheeks and Midface — 5 sites on this topic