Before surgery: what to prepare
Stop aspirin, ibuprofen, naproxen, and blood thinners 10–14 days before. Stop fish oil, vitamin E, ginseng, ginkgo. Smoking and vaping must stop 4 weeks before through 6 weeks after, bone healing depends on blood supply and nicotine compromises it. Dental work completed 2 weeks pre-op. Stock liquid and soft foods. Buy straws and a soft toothbrush. Arrange home help for 1–2 weeks.
The day of surgery
Zygoma reduction is performed under general anaesthesia, runs 2–4 hours, and usually requires one night in hospital. Incisions are inside the mouth and sometimes a tiny additional incision in front of the ear or in a sideburn hairline for access to the zygomatic arch. You wake up with a compression bandage around the upper face and head, drains in the cheeks, and significant swelling.
Days 1–3: peak swelling
Swelling peaks day 3–5 and is dramatic. The upper face and cheek area look much wider than the eventual result. Bruising tracks down into the lower lids and around the eyes, under-eye bruising is universal. Pain is moderate and well-controlled. Liquid diet for the first 2–3 days, soft diet from day 3–7 once swelling stabilizes. Head elevation 45 degrees. Cold compresses on the cheeks outside the bandage.
Week 1: stitches out, bruising fades
Bandage comes off around day 5–7. Swelling is dropping but still pronounced. Bruising shifts from purple to yellow-green. Liquid diet continues. Numbness across the cheek, upper lip, and side of the nose is significant, the infraorbital nerve was in the surgical field.
Weeks 2–4: back to public
Office work from week 3 for most patients. Soft diet starts week 2 and expands. Mouth opening can be restricted because of swelling around the masseter and zygomatic arch even though the jaw itself was not operated on. Numbness improves slowly. No tough food until cleared.
Months 2–3: swelling resolves
Swelling drops between week 4 and month 3. The narrower cheek contour becomes clearly visible. Numbness in the cheek and upper lip continues to improve. Cheek soft-tissue sagging (midface ptosis) becomes visible in 20–35% of patients because the underlying bone support has shifted inward and the soft-tissue ligaments need time to redrape. Some of this settles by month 6; persistent sagging is the most common late issue and can be addressed with fat grafting or a midface lift at month 12 minimum.
Months 6–12: the final result
Final bone position is set by month 6 and bone consolidation completes by 12 months. Numbness in the cheek and upper lip is largely resolved for most patients by month 6; partial residual numbness past 12 months in a minority. The most common late issue is cheek sagging or a slight "sunken" look at the cheek, which is assessed at month 6 and can be addressed with soft-tissue procedures (fat grafting, midface lift) if needed.
Red flags: when to call the clinic
Call the clinic the same day for: fever over 38°C after day 3, sudden firm painful one-sided swelling, pus or foul taste from incisions, sudden inability to open the mouth (possible infection or hardware issue), inability to raise one eyebrow or wrinkle one side of the forehead (possible temporal branch facial-nerve injury from the sideburn or preauricular access), double vision, eye bulging (proptosis), or numbness that gets worse rather than slowly better. Persistent visible asymmetry at month 3 warrants a CT scan to rule out hardware displacement or malunion. Go to an emergency room for: sudden vision loss or severe eye pain with proptosis (rare but possible retrobulbar haematoma), severe airway swelling, or difficulty breathing. Routine cheek numbness, mouth-opening restriction, and asymmetric swelling in the first 4 weeks are not red flags. Hardware removal at 6–12 months is a common patient request in Korea (for palpability or peace of mind) and is straightforward to arrange.