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Page 8 of 13 Bradley et al. Plast Aesthet Res 2019;6:11 I http://dx.doi.org/10.20517/2347-9264.2019.06

A B

Figure 9. Graphs illustrating the type of incision used to access the frontozygomatic (FZ) suture (upper blepharoplasty, lateral eyebrow
and previous scar (A); and the infraorbital margin (IOM) (transconjunctival, subciliary and subtarsal) (B)

Figure 10. Graphs showing the association between number of fixation point versus: associated injuries, high impact injuries, and injury
to operation time

Overall, 95% (n = 37) of cases involved a ZM buttress fixation, all accessed through an intra-oral buccal-
sulcus incision. Furthermore, 41% (n = 16) of cases involved an FZ fixation: one case for a one-point fixation,
7 cases for a two-point fixation, and 8 cases for a three-point fixation. Upper blepharoplasty incision was
used in 56% (n = 9) of FZ fixations, with 31% (n = 5) via a lateral eyebrow incision, and 13% (n = 2) via a
previous scar [Figure 9]. Lastly, 31% (n = 12) of cases involved an IOM fixation: one case for a one-point
fixation, 3 cases for a two-point fixation, and 8 cases for a three-point fixation. Of the IOM fixations (n = 12),
75% (n = 9) were via a transconjunctival incision, 17% (n = 2) via a subciliary incision and 8% (n = 1) via a
subtarsal incision [Figure 9].

Number of fixation versus associated injuries, impact of injury, and injury to operation duration
Of the two-point fixation cases (n = 10), 50% (n = 5) had other associated maxilla-facial injuries, of the
three-point fixation cases (n = 8), 42% (n = 3) had other associated maxillofacial injuries. In the one-point
fixation cases (n = 21), only 24% (n = 4) had other associated facial injuries [Figure 10]. However, there was
statistically significant correlation shown between the number of fixation points and presence of associated
injuries (P = 0.52).

High impact injuries accounted for 19% (n = 4) of one-point fixation cases, 20% (n = 2) of two-point fixation
cases and 14% (n = 1) of three-point fixation cases [Figure 10]. RTCs, assaults from hard objects, or falls
from a significant height (greater than 2 m), were considered high impact injuries. There was no significant
correlation found between the number of fixation points and the impact of injury.