Reduction malarplasty through the intraoral or the combined approach using intraoral and preauricular incisions is widely performed as an aesthetic surgical procedure in northeast Asia. The authors recently examined a patient who underwent this type of surgery and presented with discoloration of both upper canine teeth that was diagnosed as pulp necrosis. This case suggests the possibility that pulp necrosis occurs as a result of vibration and heat energy transmitted from a rotating bur to the anterior superior alveolar nerve branch located in the more lateral and superficial portion than in the normal position. Although pulp necrosis is extremely rare, it is hoped that this case will heighten the awareness of surgeons to this potential complication.