Cheekbone Reduction

Who it’s for

People whose face is widest at the cheekbones, with the arch visibly flaring out in front of the ear in a straight-on photograph. Often it becomes the widest point only after something else has changed. Narrow a square jaw and the cheekbones above it can suddenly carry the width, which is why this is sometimes planned as a later addition to jaw and chin contouring.

The first thing to establish is what the width is made of. Bone, fat and muscle all read as width. Full cheeks from fat are what oestrogen tends to add, and many trans women want that. Bulky masseters sit lower but can look like a wide face overall. A scan settles it, and a surgeon should show you where the bone actually is before you agree to move it.

Look elsewhere if your midface is flat rather than wide. Taking bone away from a flat cheek makes it flatter, and cheek augmentation is the operation you want. If your skin is already loose or you are older, talk through how the cheek will be supported in detail, because the sag risk rises with both.

Hormones are not required. Nicotine has to stop for weeks either side, since this operation depends on cut bone healing, and a stable weight helps, because losing a lot afterwards can reveal a width you had not noticed.

Before you decide

Take a straight-on photo with your hair pulled back and look at where your face is widest. If it is the cheekbones, this page applies. If it is lower, at the jaw or the cheek pads, your answer is probably somewhere else.

How it’s done

It starts with a CT scan and a plan of where the cuts will go. The surgeon measures the width across both cheekbones and the thickness of the bone, and decides how far the body and the arch need to move to get there.

The front cut is made through the mouth, through an incision high in the gum above the upper molars. The surgeon lifts the tissue off the cheekbone and makes an L-shaped cut through the body of the zygoma. Sometimes a narrow strip of bone is taken out so the body can sit further in.

The back cut is on the arch, near the ear. It goes through a short incision in front of the ear or in the sideburn, or it is reached from inside without a separate cut. With the arch freed, the whole segment is pressed inwards and backwards. The body is then fixed with small titanium plates and screws, so it cannot drift while the bone heals. Some surgeons plate the arch as well.

Where the only problem is a bump at the front of the cheekbone, a surgeon may simply burr it down. That is a smaller operation, and it does nothing for arch width.

The step that matters for the result comes last. Before closing, a careful surgeon resuspends the cheek tissue, stitching it back up onto the bone so it does not settle lower than it started. Ask whether they do this and how.

At the consultation

Ask the surgeon to show you on your scan how much of the width is bone, and what they will do to hold your cheek up once it has moved. Both answers should be specific to your face, not a general reassurance.

Cheekbone reduction recovery

The first fortnight looks worse than it feels. Swelling across the midface is heavy and wide for a while, which is expected even in an operation meant to make you narrower. Many surgeons put you in a compression band around the face for the first week or two, day and night, to control it and support the cheek while it reattaches.

Eating is the long part. The masseter, the main chewing muscle, attaches to the underside of the arch, and every bite pulls on bone that is still healing. Expect liquids and soft food for several weeks and nothing hard to chew for longer. The incision inside your mouth also needs rinses after every meal.

Some people find their mouth will not open fully for a few weeks. It loosens with time and gentle stretching. The shape emerges slowly, and the face you see at a month is still carrying swelling you will not keep.

In the first six weeks

Keep hard and chewy food off your plate even once you feel ready for it. The arch is still knitting and the chewing muscle pulls on it with every bite, so patience here protects the result.

Cheekbone reduction scars

The main incision is inside the mouth, high in the gum, and heals out of sight. You feel it with your tongue for a few weeks, and then you stop noticing it.

The arch cut is where the external scar comes from, if there is one. A short line in front of the ear, or tucked into the sideburn, usually fades well because the skin there is forgiving. Some surgeons reach the arch without it. Ask which route they use.

If you are having forehead work through a hairline or coronal incision, the surgeon can often reach the arch from above through that same cut. No extra scar, which is a real advantage of combining them.

Sensation after cheekbone reduction

The infraorbital nerve comes out through a small hole just below the eye socket, close to where the front cut is made. It supplies the cheek, the side of the nose and the upper lip. Lifting tissue off the bone around it stretches it, so numbness in that area is normal for weeks and often for a few months.

Feeling returns for the large majority, often with a phase of tingling or itching first. A small number of people keep a dull patch.

The other nerve near this operation is the branch of the facial nerve that lifts the eyebrow. It crosses above the arch, near the ear. Injury is rare, and it is the reason experienced surgeons are careful where they work on the arch, but it is worth asking about.

Risks and complications

Early on, the risks are those of any facial bone operation. Bleeding, infection around the plates, and a gum incision that is slow to close. All uncommon. Infected hardware generally has to come out, though often not until the bone has healed.

Then the healing problems. Bone that has been cut must knit where it has been put, and occasionally it does not. A segment that heals out of position, or fails to heal at all, can leave the arch loose, painful when chewing, or clicking. Surgery is usually the fix. This is why plating the body firmly and keeping hard food out of your mouth for weeks matters.

The risk specific to this operation is cheek sag. Stripping tissue off the cheekbone and moving the bone inwards leaves the soft tissue with less to hang from, and it can drop. That shows as fuller jowls, a deeper fold from nose to mouth, and a face that looks older rather than softer. It is more likely with more reduction, looser skin and no resuspension. Asymmetry and a small palpable step where the bone was cut are the other things people notice.

Cheekbone reduction results

At a year, a good result narrows the face from the front without changing how it looks in profile. The widest point moves lower and further in, and the outline tapers more gently from cheek to chin. People around you are more likely to say you look well than to say you had something done.

It works on bone width. Fat over the cheek stays, and masseter below it stays, which is why confirming on a scan that your width is bone is the key to a great result.

The other thing to plan for is the temple. A narrower arch can make a hollow above it look deeper, which is why some surgeons plan fat grafting to the temple alongside.

Alternatives to cheekbone reduction

Adding volume in the right place is sometimes the better answer. A face can look wide because it is flat from the side, and forward projection high on the cheek, with fat or an implant, makes it read less wide without touching the arch. That sounds backwards, and it is still worth ruling out before bone work. Hollow temples do the same trick in reverse, making the arch look more prominent than it is, and filling them is a far smaller job.

If the width is lower down, the tools are different. Buccal fat removal thins the lower cheek. Jaw and chin contouring narrows the face below the cheekbones. Muscle-relaxing injections thin a bulky masseter over a few months. Every one of these is smaller than cutting and moving the zygoma, which is why it makes sense to rule them out on a scan first; when the width really is the cheekbones, this is the operation that addresses it.

Combining cheekbone reduction with other surgery

Usually one item on a longer list. With forehead and brow reconstruction done through the hairline, the arch can be reached from above through the same incision. With jaw and chin contouring, the whole face is narrowed at once, and the result is judged as one outline rather than two.

Temple fat grafting is often added in the same session. Some surgeons also add a midface lift to deal with the sag risk directly, particularly in older patients. It adds time and cost. Ask whether they think you need it, so it is part of the plan from the start.

Cheekbone reduction cost

Ask what the quote includes. A reduction of the body alone is cheaper than body and arch, and the arch is where most of the narrowing comes from. The CT scan, the plates, the hospital night and the compression garment can all sit outside a surgeon's fee.

Ask too who pays for a second operation if the bone heals badly or a plate has to come out. That is the commonest reason for going back, and policies differ.

Plan on self-pay. Even plans that cover some facial feminisation rarely stretch to the midface.

Choosing a cheekbone reduction surgeon

This is one of the few FFS procedures where the most experienced surgeons are often not gender surgeons. East Asian cosmetic surgery does zygoma reduction in large numbers. A surgeon who does it weekly for cis patients and understands what feminising a face involves is a strong combination.

The two numbers I would ask for are how many zygoma reductions they do a year and how many have needed a second operation, for any reason. Then ask how they prevent cheek sag. A surgeon who does this often will talk about resuspension and how much they are willing to move the bone, and that is the answer to listen for.

In photographs, look at straight-on views at a year for the narrowing. Then look at three-quarter views for the jowl and the fold beside the nose, because that is where sag shows first. Asking for the three-quarter view is one of the most useful things you can do here.

When you look at photographs

Ask for three-quarter views at a year or later, not only straight-on ones. The front view shows the narrowing, and the angle shows whether the cheek stayed up.

Frequently asked questions

Is a wide face a masculine trait?

Not usually. Male-pattern midfaces tend to be flatter rather than wider, so most feminising work adds to the cheek. This is for a face that really is widest at the cheekbones. See who it's for.

Will my cheeks sag afterwards?

It is the main risk to plan for, more likely with loose skin or a large reduction, and resuspending the tissue at the end of surgery reduces it. See risks.

How long until I can chew normally?

Soft food for several weeks and nothing hard for longer, because the chewing muscle pulls on the healing arch. See recovery.

Why do so many zygoma surgeons work in Korea and Thailand?

Because a narrower midface is a common cosmetic request there, so surgeons in those countries do this operation far more often than most Western FFS surgeons.