title: Revision Surgery for Zygoma Reduction: Causes, Indications, Solutions, and Results from a 5-Year Review of 341 Cases.
abstract: BACKGROUND
  Many patients undergo a revision surgery after malar reduction, which is one of the most popular aesthetic surgeries in Asia. We reviewed the leading causes of revision for malar reduction surgery to establish proper indications for revision, seek adequate surgical strategies, and share the results from revision surgical cases.
  
  
  METHODS
  A retrospective review was conducted involving 341 patients who underwent malar reduction reoperation between March 2010 and June 2015. Surgical strategies were decided based upon specific problems and complaints from the previous surgery. Facial photographs, cephalography, and computed tomography images were analyzed, and a patient satisfaction survey was conducted before and after the surgery.
  
  
  RESULTS
  A total of 341 patients (321 women, 20 men; average age, 26.6 years, range 18-40 years) were included. The main causes of reoperations were subjective dissatisfaction and nonunion-related symptoms. Undercorrection of the zygomatic body and arch (n = 175, 51.3%) was the most frequent reason for dissatisfaction. The patients underwent revision surgeries via different techniques and strategies based on previous problems from primary surgery, and postoperative patient satisfaction was high. Complications occurred in 35 patients (10.3%) after revision.
  
  
  CONCLUSIONS
  Based on the results of this study, patient dissatisfaction with the procedure can be minimized beforehand through accurate goal identification and careful planning. Bone nonunion is usually due to excessive bone resection during zygoma reduction surgery. Careful selection of the reposition site and appropriate fixation based on a thorough understanding of masseter action are essential in ensuring satisfactory outcomes without adverse side effects.
  
  
  METHODS
  This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
authors.affiliation: D.A. Plastic Surgery Clinic, Seoul, Republic of Korea.
authors.forename: Sang Woo
authors.initials: SW
authors.lastname: Lee
authors.affiliation: Slow Plastic Surgery Clinic, Jeju, Republic of Korea.
authors.forename: Yeon Woo
authors.initials: YW
authors.lastname: Jeong
authors.affiliation: Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-Si, Gyeong-gi do, 463-707, Republic of Korea. surgene@snu.ac.kr.
authors.forename: Yujin
authors.initials: Y
authors.lastname: Myung
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D004954:Esthetics; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010027:Osteotomy / Q000009:adverse effects* / Q000379:methods; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods; D012086:Reoperation / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment; D013518:Surgery, Plastic / Q000009:adverse effects* / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult; D015050:Zygoma / Q000601:surgery*
keywords: Patient satisfaction; Revision surgery; Zygoma reduction