On Prominent Cheekbone Procedures

[IckyOoey]

Prominence is the defining characteristic of an aesthetically appealing set of cheekbones; vertical projection makes little difference unless the lack of it is accompanied by recession. High cheekbones are always prominent to a degree, but only low cheekbones can be either prominent or recessed. Angelina Jolie, Johnny Depp, and many other aesthetically appealing celebrities have low-prominent cheekbones for example.

That being said, there are no modern procedures that can fix recessed cheekbones, except in certain cases. Conventional cosmetic surgeries that address the zygomas such as implants and filler are hindered by their inability to change the shape of the infraorbital rim and move the origins of the skeletal muscles, which the implants or filler instead surround or avoid altogether.

The osteotomies are capable of moving the origins of the skeletal muscles, but none of them are universal solutions: Lefort III can only be applied to patients with class III malocclusions, Zygomatic Sandwich osteotomies can only increase lateral projection, and Lateral Swing osteotomies can only increase forward projection.

If a procedure existed that could fix recessed cheekbones, it would have to be capable of changing the shape of the zygomaxillary complex and the section of the maxilla lateral to the nasal cavity so that there is adequate forward and lateral projection. It would also need to provide new origins for the skeletal muscles. There are two ways I can image this being done, and both options are highly dangerous, and likely impossible considering the medical limitations we currently have:

• Replacing the zygomaxillary complex entirely with 3D printed bone scaffold. But how are you to preserve the infraorbital nerve and transfer the origins of the skeletal muscles onto the scaffold?
• A combination of the Zygomatic Sandwich osteotomy and the Lateral Swing osteotomy. But what would happen to the infraorbital nerve?

Any thoughts, criticisms or contributions? Are there any new procedures that I should know about? There’s a lot of knowledgeable people on this board, and I’d love to be educated further on the subject .

[IckyOoey]

I think maybe I should treat this thread as a compilation of information regarding prominent cheekbone procedures- to be used as a source for myself and others. Here are some comparisons:

• Low vs. High Cheekbones
• Shallow vs. Prominent Cheekbones

[varbrah]

Prominence is the defining characteristic of an aesthetically appealing set of cheekbones; vertical projection makes little difference unless the lack of it is accompanied by recession. High cheekbones are always prominent to a degree, but only low cheekbones can be either prominent or recessed. Angelina Jolie, Johnny Depp, and many other aesthetically appealing celebrities have low-prominent cheekbones for example.

High cheekbones are less likely to appear prominent since they necessarily have less bone mass, all else held equal. Due to the volumetric factor, high-set + recessed will look aesthetically inferior to low-set + recessed; however, high-set and forward grown will look aesthetically superior to low-set + forward grown due to the superior contour produced, as well as the larger amount negative space beneath the zygoma for the soft tissue to drape and fall into. Low-set cheekbones are simply more 'forgiving' given less than ideal development.

That being said, there are no modern procedures that can fix recessed cheekbones, except in certain cases. Conventional cosmetic surgeries that address the zygomas such as implants and filler are hindered by their inability to change the shape of the infraorbital rim and move the origins of the skeletal muscles, which the implants or filler instead surround or avoid altogether.

The osteotomies are capable of moving the origins of the skeletal muscles, but none of them are universal solutions: Lefort III can only be applied to patients with class III malocclusions, Zygomatic Sandwich osteotomies can only increase lateral projection, and Lateral Swing osteotomies can only increase forward projection.

Pure orbital-zygomaticomaxillary osteotomies (a.k.a "modified Lefort III") exist. Had this with Sinn in 2020. looks fine and addresses the forward dimension very well, and the transverse dimension reasonably well. Can do MSE beforehand (which I also did, lol) for widening the complex.

[celest218]

All about proportion. I've seen people with nice cheekbone/jaw in photos but in person can make the face look too harsh or "big".  Or malenificent like. truly believe aesthetic/beauty  is subjective. Some people even reduce their cheekbone and jawline  to achieve a smaller face.

[IckyOoey]

Pure orbital-zygomaticomaxillary osteotomies (a.k.a "modified Lefort III") exist. Had this with Sinn in 2020. looks fine and addresses the forward dimension very well, and the transverse dimension reasonably well. Can do MSE beforehand (which I also did, lol) for widening the complex.

This surgery is a good solution for patients with class III malocclusions, but not for patients with other types of bites. It's not a universal solution if I'm correct. Hopefully I'm wrong and there's a way to work around this.

[varbrah]

This surgery is a good solution for patients with class III malocclusions, but not for patients with other types of bites. It's not a universal solution if I'm correct. Hopefully I'm wrong and there's a way to work around this.

It has nothing to do with occlusion. I’m a mild class II

[GJ]

The problem with moving the cheekbones is you're going to be left with a step that has to be filled somehow, and there's really no good method to do that right now. Also you're going to risk blindness having someone cut up that high. The one person I know who had this done has complained of the step off, and to my knowledge never found a solution.

I personally find prominent cheekbones creepy (as someone mentioned "harsh" look), but I get it, society in general still finds it an admirable trait. Mine are pretty defined for a male who was class 2, so it's not sour grapes or anything. I just like a softer look.

[December]

I have high cheekbones, but poorly defined, which makes me look much younger. Plus a poor orbital/malar area which I believe could be the reason I'm always perceived as depressed or otherwise unhappy. Interestingly, I don't see this anywhere else in my immediate family.

Pure orbital-zygomaticomaxillary osteotomies (a.k.a "modified Lefort III") exist. Had this with Sinn in 2020. looks fine and addresses the forward dimension very well, and the transverse dimension reasonably well. Can do MSE beforehand (which I also did, lol) for widening the complex.

Very interesting. I've read a few people got it done with Dr. Sinn. What a decision though.



 

[celest218]

Prominent cheekbones does not equal beauty. I think you've been brainwashed. I've seen plenty of people with prom cheeks or wide cheekbones and they either hate it or went to korea to have them reduced for a softer look. Some even cover their cheekbones with their long hair.

It really depends on the scale of the face, proportion and symmetry. It's not about having big or prom cheekbones its about having the right cheekbones for your face and features.

[mindwitch]

I disagree with the commenters cheekbones are definitely beautiful ij my opinion. However beauty is in the eye of the beholder.

[IckyOoey]

It has nothing to do with occlusion. I’m a mild class II

If you had a Class II bite with a vertical maxillary deficiency, wouldn't advancing the lower half of the maxilla sagittally exaggerate the overbite? Or is there a way to keep the lower maxilla in the same sagittal position? I wonder if the Modified Oblique Lefort III can be paired with vertical maxillary advancement and BSSO for cases like that. Sorry for the late reply too.
 

[TheGerman]

Are my cheekbones high or low?

https://imgur.com/a/un94GGc

[IckyOoey]

Are my cheekbones high or low?

https://imgur.com/a/un94GGc

You have high cheekbones I think.

[Lazlo]

I would just wait for custom bones implants once these procedures go a bit more mainstream.

This is an updated article from 2022 and I'd just use filler for now and once they're available in Europe have them done by someone whoo is just very good with implants.

It does concern me that a few cases ended in infection at operation site, but it sounds like the best material to essentially simulate and act like real bone and hopefully feel and look ultimately more natural. I wonder if nerve cells and such will also grow into the porosoity of the material. Kavan is the expert on such things:

https://3dprint.com/220737/3d-printed-ct-bone-grafts/

[IckyOoey]

I would just wait for custom bones implants once these procedures go a bit more mainstream.

This is an updated article from 2022 and I'd just use filler for now and once they're available in Europe have them done by someone whoo is just very good with implants.

It does concern me that a few cases ended in infection at operation site, but it sounds like the best material to essentially simulate and act like real bone and hopefully feel and look ultimately more natural. I wonder if nerve cells and such will also grow into the porosoity of the material. Kavan is the expert on such things:

https://3dprint.com/220737/3d-printed-ct-bone-grafts/

Good point. I wonder how it'll interact with the soft tissue of the face and the muscle origins.