Traditional three-point reduction may not restore proper projection of the malar prominence following a fracture dislocation of the zygoma if two of the three anterior points of realignment are comminuted. In such cases, reconstruction of the fourth or posterior projection, the zygomatic arch, increases the accuracy of the multidimensional reconstruction. Although the extended access approach required to repair the arch increases operative time and possibly length of hospitalization, its use is justified by the improved results in selected patients with severe injuries of the zygoma.