In short. A prominent cheekbone is a bone question with its own risks, and it points in the opposite direction from the flat midface.
Key points
- Filling a flat midface and reducing a wide one are not two ends of one scale.
- One adds material to a face that lacks projection; the other cuts the skeleton that gives it.
- A face that is prominent at the cheekbone and hollow beneath it is a difficult planning problem.
A wide midface is a different complaint from every other one on this site, and it points the other way. The flat cheek wants more projection; the wide cheek has too much in the wrong place, and the structure holding it there is bone. No injectable changes the width of a skeleton.
Why the bone is usually the answer
Width across the midface is set by the zygomatic body and the arch that runs back towards the ear. Where those are prominent, the face reads as wide from the front and the cheekbone reads as high in a three-quarter view, and both impressions stay the same whatever happens to the soft tissue. Fat can also make a face look wide, and a heavy lower cheek can make the midface look broader than it is, so the assessment establishes where the widest point actually sits.
What the operation changes
Reducing the zygoma means cutting the bone, repositioning it inwards and fixing it there. The change is to the width of the face from the front and to the prominence of the cheekbone in profile, both judged at months rather than weeks because the swelling takes time to settle. The approach is usually through the mouth with small external incisions, and it is an operation on the skeleton: a general anaesthetic, restricted chewing for a period, and a recovery measured in weeks.
The risks that belong to this operation
The zygomatic and buccal branches of the facial nerve cross the cheek on their way to the muscles around the mouth and nose, and the infraorbital nerve runs beneath the eye and supplies sensation to the cheek and upper lip. Both are structures this operation works near. The specific problems are numbness in the cheek or upper lip that may take months to settle, weakness of the muscles that move the mouth, asymmetry between the two sides, and a change in how the soft tissue sits over the reduced bone.
Opposite directions, and no middle ground
Filling a flat midface and reducing a wide one are not two ends of one scale. One adds material to a face that lacks projection; the other cuts the skeleton that gives it. A face that is prominent at the cheekbone and hollow beneath it is a difficult planning problem.
Who is usually advised against it
A face that is wide because of the jaw rather than the cheekbone, one whose width comes from the muscles of the jaw, and one whose width is mostly soft tissue are better served by a conversation about the structure actually responsible. So is a person whose midface is already thin, since reducing the bone removes support the soft tissue relies on.
After an operation on the facial bones
- Numbness that is spreading, or weakness of one side of the face.
- Pain, swelling or fever that is increasing rather than settling.
- A change in the bite, or an inability to open the mouth normally.
Frequently asked questions
How do I know whether my face is wide because of bone or because of fat?
The useful test is what happens to the widest point of the face when you look at an older photograph and at yourself in a three-quarter view. Fat can be pinched and moves when you smile; bone does not change with expression and stays where it is whatever your weight does. A face that stays wide at its lowest weight, and wide in the same place from every angle, is usually wide because of the skeleton.
Is the operation reversible if I do not like the result?
Not in any straightforward way. The cheekbone is cut and repositioned and the change is to the skeleton, so there is nothing to dissolve and nothing to remove. Revision is possible but it is a further operation on bone that has already been cut and fixed, and it is a more difficult proposition than the first. That is the strongest argument for a decision made slowly and for a very clear picture of the intended result beforehand.
Will reducing the cheekbone make the midface look flat later?
That is the consideration people most often raise afterwards rather than before. Reducing the projection of the cheekbone changes the support that the soft tissue above it rests on, and a face that was already thin in the midface has less to spare than one that was full. It is one of the reasons the assessment looks at the whole face rather than at the width of the cheekbone alone.
Risks & Limitations
- Volume does not correct descent, and no result can be guaranteed.
- Swelling and bruising are usual after cheek treatment and settle over one to two weeks, often unevenly.
- Materials that are not hyaluronic acid cannot be dissolved, and an operation on the cheekbone cannot be reversed.
- A result is judged at months rather than weeks, and a second session is common after fat grafting.
When to Seek Care
- Severe pain during or shortly after an injection, blanching, or a dusky patch of skin.
- Any change in vision, or pain behind the eye.
- New weakness on one side of the face, or difficulty closing one eye.
- Fever with spreading redness, warmth or discharge around a treated area.
References & Further Reading
- American Society of Plastic Surgeons (ASPS) — procedure and safety guidance
- National Institute for Health and Care Excellence (NICE, UK) — relevant guidance
- Cochrane Library — systematic reviews
- Chinese Medical Association Plastic Surgery Branch — clinical guidance
This page is patient education, not medical advice, and it does not cite individual studies. Discuss your own case with a qualified clinician. To arrange an assessment at Chongqing West District Hospital, see Contact & Consultation.