Malar Hypoplasia: the Underprojected Midface
Quick facts
- Definition
- Reduced projection of the malar region, generally from less development of the zygomatic bone and the maxilla.
- How it shows
- A flatter midface, a gaze that looks more tired and a hollow infraorbital region.
- Difference from volume loss
- In hypoplasia it is a baseline feature; in volume loss, it is a change acquired with age or weight loss.
- Assessment
- Frontal and profile views, palpation and a history of skeletal changes.
Malar hypoplasia is reduced projection of the upper cheek region, due to less development of the zygomatic bone and the maxilla. The face looks flatter in the midface, and the contour of the gaze can look less supported. The term comes from skeletal assessment, not from aesthetics alone.
How do you recognize it?
In profile, the line between the orbital margin and the malar region sits farther back relative to the eyeball. From the front, the cheekbone has less light and the face looks less defined. The assessment includes the facial profile and relations such as the facial convexity angle. It can come with other features, such as a recessed chin.
Hypoplasia or volume loss?
| Feature | Hypoplasia | Volume loss |
|---|---|---|
| Origin | Skeletal, baseline | Acquired (age, weight loss) |
| When it is noticed | From a young age | Appears over time |
| Useful question | Has it always been this way? | When did it change? |
The difference changes the conversation with the patient. In one case, the expectation is to adjust projection; in the other, to acknowledge what was lost. More in facial volume loss after weight loss.
Frequently asked questions
What is malar hypoplasia?
It is less development of the skeleton of the malar region, which leaves the midface underprojected. It is generally a trait present from birth, not just an effect of age.