Cheekbone Reduction

Most facial surgery adds. Cheekbone reduction subtracts. It is the procedure for a midface that is too wide or too high at the bone — a prominent zygomatic complex that makes the face read as broad or angular from the front and the three-quarter view. The goal is not to flatten the cheek but to narrow it, so the widest point of the face moves inward and the midface looks more tapered.

The zygomatic complex has two parts that govern width: the body of the cheekbone, which sits below and to the side of the eye, and the arch, the bridge of bone running back toward the ear. A face can be wide because the body projects, because the arch bows outward, or both. Reducing one without the other leaves an uneven result, which is why the modern operation addresses the body and the arch together.

The workhorse technique is an L-shaped osteotomy with infracture. The surgeon cuts the cheekbone body in an L pattern, makes a second cut at the arch, then moves the freed bone inward toward the midline — the infracture — and fixes it in its new, narrower position. The L shape is favored because it controls both how much the bone is reduced and the final contour, and it gives a stable surface to fix as reported in the peer-reviewed surgical literature.

This page is the deliberate counterpart to our cheek implant page. An implant adds projection to a flat midface; this procedure removes projection from a prominent one. They solve opposite problems and are never used together on the same cheekbone. The consultation establishes which direction your anatomy actually calls for.

Cheekbone reduction is performed under general anesthesia and typically takes 2–3 hours. Surgery takes place in our AAAASF-accredited facility, and is planned in advance from CT or facial imaging that maps the exact width and height of the zygoma.

The L-shaped body osteotomy. Through an intraoral incision in the upper gum, the surgeon exposes the cheekbone body and makes an L-shaped cut. The L pattern, rather than a single straight line, allows the bone to be reduced in more than one dimension and provides a clean surface for fixation. The highest point of the bony prominence is identified beforehand and addressed directly.

The arch cut and infracture. The posterior part of the cheekbone — the arch — is cut through a small pre-auricular or temporal incision so the whole complex can move as a unit. The freed bone is then pushed inward toward the midline, the infracture, narrowing the face. Because the body and arch are released together, the transition along the bone stays smooth rather than stepped.

Fixation. The repositioned bone is held with miniplates and screws so it heals in the narrowed position. Secure fixation is what prevents the two most-discussed problems of this operation — nonunion of the cut bone and sagging of the soft tissue that the bone supports. You will know your plan, including incision pattern and fixation, before surgery.

Good candidates for cheekbone reduction typically meet the following criteria:

• A genuinely wide or high bony cheekbone. The indication is skeletal prominence of the zygomatic body or arch — not fullness from fat or soft tissue, which is a different problem with different treatment. Imaging confirms the source of the width before surgery.
• Good skin elasticity. Because reducing the bony support can let the overlying tissue droop, patients with firm, elastic skin tolerate the operation best. This is one reason it is more straightforward in younger patients.
• Healthy gums and teeth. The main incision is intraoral, so active dental or gum infection near the upper gum is treated first to protect healing.
• Non-smoker. Nicotine impairs bone union and soft-tissue healing and raises the risk of nonunion and wound problems. Full cessation before and after surgery is required.
• No uncontrolled medical conditions. Bleeding disorders and conditions that impair bone healing are reviewed in detail at consultation.
• Realistic expectations about scope. This operation narrows the bony midface. It does not lift the cheek, remove a double chin, or change a midface that is flat rather than wide — that opposite concern is addressed by a cheek implant or fat transfer. Older patients with laxity may need a soft-tissue support planned alongside the reduction.

Candidacy is assessed in full at your consultation, with imaging. Your bone shape, skin quality, age, and goals determine the plan — not a general checklist.

Cheekbone-reduction recovery is dominated by midface swelling and the soft-diet period while the intraoral incision heals. A compression garment around the midface is worn early to control swelling and support the soft tissue over the narrowed bone.

The timeline above is a general reference. Your written post-operative instructions, provided at discharge, are the authoritative guide. Every milestone is confirmed at follow-up appointments, not assumed.

All surgery carries risk. Cheekbone reduction has a particular profile because bone is cut and moved beneath the soft tissue of the midface, and because the dissection passes near sensory nerves. Understanding these risks in detail is part of informed consent.

Soft-tissue sagging. The risk that most distinguishes this operation. Reducing the bony platform under the cheek can leave the overlying soft tissue with less support, allowing it to droop. Secure fixation, careful soft-tissue handling, and good patient selection — favoring firm, elastic skin — reduce it; in patients with laxity a soft-tissue support or lift may be planned alongside the reduction.

Asymmetry. The two cheekbones must be reduced to match, and the face is rarely perfectly symmetric to begin with. Some difference between the sides can persist and is the most common reason a revision is considered. Pre-operative imaging and intra-operative measurement keep the two sides as even as possible.

Nonunion or shifting of the bone. The cut bone must heal in its new position. If fixation is inadequate or the patient smokes, the segment can fail to unite or can move, producing a palpable step or asymmetry. Plate-and-screw fixation and smoking cessation are the main defenses.

Cheek numbness. The infraorbital nerve, which supplies sensation to the cheek, upper lip, and side of the nose, runs near the operative field. Temporary numbness is common and usually resolves over weeks to months; lasting altered sensation is uncommon but possible.

Infection and bleeding. Intraoral incisions are exposed to mouth bacteria, so antiseptic rinses, a soft diet, and peri-operative antibiotics are used. As with any bone surgery, bleeding and swelling are managed with elevation, compression, and post-operative monitoring.

Risks are discussed in full at your consultation. No minimizing, no alarmism.

The techniques and figures described here are consistent with the following independent medical and academic sources. They are references, not endorsements.

• NIH / PubMed — A New Infracture Technique for Reduction Malarplasty with an L-Shaped Osteotomy Line
• NIH / NCBI PMC — Reduction Malarplasty: L-shaped osteotomy and arch infracture (full text)
• American Society of Plastic Surgeons — Facial Implants (context for malar augmentation vs. reduction)
• American Academy of Facial Plastic & Reconstructive Surgery (facial skeletal surgery resource)

Want to dig deeper? For independent, non-commercial medical information on cosmetic and plastic surgery, see MedlinePlus, published by the U.S. National Library of Medicine, and the patient education resources of the American Society of Plastic Surgeons.

At Colores you may also want to read about Chin Surgery and Eyelid Surgery (Blepharoplasty), meet our board-certified surgeons, or request an itemized written quote.