Malar fat reduction
Malar fat reduction is a cosmetic procedure which in medical terms is known as Reduction Malarplasty. It is one of the most common surgeries which are performed to reduce the malar fat on the face. Reduction Malarplasty is a surgical procedure which alters the appearance of the malar bone by repositioning the malar complex and not by actually “reducing” the malar fat pad. This gives the face a more aesthetic appearance. Therefore, in addition to the reduction, solid fixation and a planned repositioning is also done.
Approach during the surgery
The two main surgical approaches that may be taken to perform malar fat reduction are coronal approach and intraoral approach. Intraoral approach is more popular because the procedure allows for more concealed and shorter incisions. Many patients don’t prefer the coronal approach. But there are certain advantages of coronal approach. This approach provides a better view of the malar complex. Also, with the coronal approach, a more stable fixation can be achieved against the masseter muscle. However, there are certain drawbacks associated with the coronal approach. The procedure for malar reduction with this approach is longer. Also, in coronal approach there is always a possibility of temporal area depression or frontal branch injury. Hence, the coronal approach is a better option for older people or people who are opting for revision surgery. Previously, the intraoral approach was made by sideburn incision, which presented difficulties of the malar complex. To overcome such problems, coronal approach should be used. The damage to the malar fat pad can be avoided in addition to minimizing the temporal depression by making the dissection between temporoparietal fascia and temporalis fascia. The patients are generally informed about the possibility of injury to the frontal branch. However, this injury is generally temporary.
The intraoral approach is the most commonly taken approach because the time involved is less. To reach the malar arch with intraoral approach preauricular or sideburn incisions are also made. If a surgeon makes an intraoral approach, the buccal fat pad can also be removed and the paranasal area can also be augmented. This can give the face a more oval or round shape which is desired.
The reduction of malar fat pad does not actually mean that the size of the bone is reduced. In fact it means that the part of the malar fat pad that protrudes the most is minimized. In other words, instead of reduction, repositioning is the more appropriate term for the procedure. The malar bone is small in size therefore it is not the size of this bone but its position which cause the odd shape of the face. The malar complex can be further understood as being made up of two components namely; malar body and arch. The prominence of the malar relies on its position. The most prominent part of the malar bone is known as the malar highlight. Its protrusion is maximized if it is located externally superiorly and anteriorly. The position of the malar highlight is crucial because if the location of the malar highlight is balanced then only a person’s face can look young and healthy. However if it protrudes too much the face can have masculine and bumpy appearance. Hence in almost all malar reduction cases, the malar highlight area is repositioned either posteriorly or medially. These two methods are employed as tissues can sag if inferior approach to repositioning is taken. In case the medial repositioning is done ostectomy of the medial portion is required. This procedure should focus on the body medialization and not the reduction of the volume. There is no correlation between the reduction of the prominence of the malar body and the amount of ostectomy. If the amount of ostectomy is excessive there could be problems in bone to bone contact after the repositioning. The malar body can be setback to reduce the prominence of the malar. This eliminates the concern of creating gap between the bones which happens in medialization. A surgeon should preferably make soft tissue changes. Sometimes to minimize the possibility of sagging of the tissues, once the ostectomy is done the fixation and the superior and anterior movement of the malar is performed. Fixation is an integral part of the malar fat pad removal. The process requires wires or plates along with screws. With invention of modern substitutes now the plates and screws which are used are absorbable.
The malar fat removal is done to give the face a well defined contour. This procedure ensures that the proportions of the face are not bumpy. Since any changes in a person’s appearance can greatly affect a person’s life, this procedure should be only performed by a reputed surgeon and not any beauty clinic. The postoperative care instructions would be communicated to the patient and should be closely followed by the patient.