Technical Refinements in Reduction Malarplasty: A CT-Based Evaluation With Clinical Follow-Up

BACKGROUND: Reduction malarplasty increasingly emphasizes structural preservation and precise facial contouring. This study evaluates CT-based and clinical outcomes following a modified L-shaped osteotomy with standardized technical refinements. METHODS: Forty-four consecutive patients underwent reduction malarplasty using a modified L-shaped osteotomy with standardized 6 mm bone strip resection. CT scans were obtained preoperatively and at 6 months postoperatively. Quantitative measurements included malar eminence width (MEW), zygomatic medial displacement (ZMD), zygomatic posterior displacement (ZPD), arch setback at the coronoid level (ASC), malar symmetry index (MSI), and soft-tissue projection (STP). Patient satisfaction was assessed using a 5-point Likert scale. Measurement reliability was evaluated using intraclass correlation coefficients (ICC). RESULTS: MEW decreased significantly from 102.1±3.6 mm to 95.0±3.4 mm, with a mean reduction of 7.1 mm (P<0.001). Mean ZMD and ZPD were 3.3±0.6 mm and 3.2±0.7 mm, respectively, and ASC ranged from 3 to 4 mm. MSI improved significantly, indicating enhanced facial symmetry. STP was preserved or slightly decreased postoperatively. Greater MEW reduction correlated moderately with higher patient satisfaction (ρ=0.46, P=0.004). Transient hypoesthesia occurred in 2 (4.5%) patients and resolved within 3 months. ICC values demonstrated excellent intraobserver (0.91-0.97) and interobserver (0.87-0.94) reliability. CONCLUSIONS: Modified L-shaped reduction malarplasty with standardized 6 mm bone strip resection achieves predictable skeletal narrowing, improved symmetry, and preservation of soft-tissue contour with a low complication rate. CT-based morphometric analysis provides objective validation of surgical outcomes at 6-month follow-up.