The need to reduce or narrow wide cheeks is a far less frequent request than making them bigger. Most commonly, cheek reduction surgery is requested by Asian cultures, notably Eastern Asians. East Asian cultures value a small face, and wide cheekbones appear to make the face bigger. In rare cases, a patient may have developed a wide cheek(s) due to a facial bone fracture from an injury or may simply have a more flat face appearance which makes the face look wide.
Cheek reduction can be done by two methods, Through an incision from inside the mouth, the prominence of the cheek bone can be burred down or a piece of cheek bone can be removed allowing it to become narrower. Burring down the cheek bone is rarely a good idea. It takes a lot of bone reduction to make a visible external difference and the soft tissues of the cheek may sag after if they do not heal back down to the bone. Taking a vertical wedge of cheek bone out where it attaches to the main bone of the upper jaw, allows the entire cheek bone complex to fall in, narrowing the width of the face. I usually place a very small plate and screws to make sure the outer part of the cheek bone stays in the newly narrowed position permanently. The back end of the cheek bone, where it attaches to the skull (temple) , can also be cut as well as the front end. When both are done together, the face is further narrowed.
While cutting and removing a piece of cheek bone sounds like a complex procedure, it is really quite simple and quick to perform. It is similar to a chin osteotomy but it is easier on the patient as this part of the upper jaw is not responsible for jaw movement even though there are some muscles attached to it. It is far more effective than burring of the cheek prominence and poses no risk of the soft tissues of the cheek sagging after surgery.
Dr. Barry Eppley