Your Questions
Your Questions
Q: I am interested in trying to get my face to look less fat. I want to make my face slimmer if possible. I have a small double chin and fatter cheeks and jowls. I have read about Lipodissolve injections and this seems like a good and easy solution for my small areas of facial fat as I know these injections are for small areas and not big ones. Do you think this will work for me?
A: While Lipodissolve injections can provide some minor benefit in fat reduction in the neck and jowl areas, they require three or more injection sessions (spaced 4 to 6 weeks apart) to get the best result. After each injection session, the treated areas will double or triple in size for one week as part of the inflammatory by which it breaks down the fat. . Because of this socially visible recovery, most patients will opt for a more effective set of procedures that actually has less total recovery even though it is surgery. I would recommend a combination of submental, jowl and lateral face liposuction and buccal lipectomies. This reduces all available fat compartments in the face that can easily and safely be treated. This is is the best way to get a slimmer face through fat reduction. It has less recovery than Lipodissolve injections because the swelling is only one time and is largely over after a few weeks.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in getting my fatter face and neck thinned out if possible. I am sending pictures for your review (frontal and profile) so you can see what I mean. I am interested in a buccal lipectomy procedure and submental lipectomy. I have always thought my face has made me look, in pictures, 30-40 lbs heavier than I actually am. I have also looked at people that are obese or considerably heavier than I am in pictures, comparatively, and noticed that my face make me looks extremely heavy which I am not. I would like to have the procedures done if the changes are significant. I would also like to know if the procedures can be done under local anesthesia. Please advise.
A: Thank you for sending the pictures. I can see your concerns with the fuller tissues around the jawline and into the neck. Certainly fat reduction by neck liposuction and buccal lipectomy is all that is appropriate or should be done. The good question is how much improvement will be seen. That is a tough one to answer as the final result is determined by how well the skin adapts and shrinks down. The limiting factor in your result, and in other male patients who look just like you, would be controlled by the subplatysmal fat at the cervicomental angle (it is not all just above the platysma in the neck angle area) and the subcutaneous fat layer around the jaw angle and over the parotid. Subplatysmal neck fat can be removed by direct excision but the jaw angle fullness is more limited because it can not be treated neither by liposuction or direct excision because of the marginal mandibular branch of the facial nerve. While changes will clearly be seen, I would use the term moderate improvement rather than a dramatic change. Because of the variabiity of the result, you should only undergo the procedure if you can accept modest to moderate improvement. If it turns out to be significant or dramatic in your view then that would be a bonus.
To get the best result possible, doing the liposuction and lipectomy procedure under local anesthesia would not be my approach. That limits how much can be done as patient comfort then takes precedence over the extent of the result.
Dr. Barry Eppley
Indianapolis Indiana
Q: I am impressed with the results I saw of yours on a patient that I ran accross on the internet while doing plastic surgery research. The patient had cheek implants and I think removal of buccal pads. I am 57 years old and have a lean face. I think this procedure is what I would need to achieve the results I am looking for. My buccal pads are more prominent with age and above the buccal pad area my cheeks are flat. I am not interested in filler because the buccal pad area, I believe, still needs to be addressed. Did you remove the buccal pads in this patient and insert cheek implants? I am thin so I do not think liposuction would be in order. I once asked a plastic surgeon about removing the buccal pads and he told me that would make me look dreadful. Please advise. Thank you for your time.
A: Cheek or midface augmentation can include several procedures depending upon the make-up of the anatomic problem. Implants for cheek and submalar augmentation, submalar or buccal fat removal OR augmentation, and cheek or midface lifts for sagging skin are all potential options. These procedures can be done alone or some combination thereof may be more ideal. But it all depends on an appreciation of the cheek bone anatomy and the soft tissue make-up around the cheek bones. Only through a pictorial analysis could I provide you with what may be beneficial for you.
That being said, a thin face almost never aesthetically benefits from a buccal lipectomy. I have a suspicion that what you may be seeing as buccal fat may be cheek tissue ptosis or sag. Rather than a buccal lipectomy, you may need a midface lift which resuspends the sagging cheek tissues which have fallen into the buccal triangle up back onto the bone. A midface lift may or may not be complemented by small cheek implants.
Dr. Barry Eppley
Indianapolis Indiana
Q: I am bothered by my puffy cheek look. I feel that the area under my cheekbones is full and, as a result, does not give good definition to my cheek area. I had cheek implants placed but they didn’t give me that more sculpted look that I was looking for. I think the problem isin the full area below the cheek. I have read this is called the submalar area. Is it possible to have a tightening of the submalar soft tissues area. Is there such a procedure? I have simulated this concept in front of the mirror many times without knowing it was possible outside of a full facelift and really liked the improvement it makes in highlighting the cheekbone. How would such a procedure be done? Is there any external scarring or is it done completely intraorally? I would like to pursue this procedure seriously so any information you can provide would be much appreciated. Thanks again.
A: The submalar area of the face is a non-bone supported area beneath the cheek bone (malar eminence) that is influenced exclusively by the volume of soft tissue that it contains. Thinning, or creating an indentation, in the submalar area is commonly done by buccal fat removal. While this simple procedure can be helpful in the right patient, it does not work well for every fuller face. And can even create too much of an indentation later in life when one gets older as natural fat atrophy occurs in most people.
An alternative procedure is submalar tightening. It is not nearly as well known but can also create a narrowing of the submalar triangle. Using the same intraoral incision and approach as one does for a buccal lipectomy, the underlying soft tissues are cinched down with a suture anchor placed into the underside of the zygoma. This can be done in conjunction with buccal fat removal for a combined submalar indentation effect.
Dr. Barry Eppley
Indianapolis, Indiana
Q: I recently had a buccal fat extraction procedure 6 weeks ago. I had minimal discomfort and recovered quickly. I am concerned now, however, about the symmetry in the final result. I initially thought that the swelling on one side may go down more quickly than the other and I wanted to give it time to see if it was indeed the swelling or not. I did have slightly more removed out of one side than than the other because when I smiled it seemed to be bigger. I didn’t consider that it may it could end up being more sculpted on that side at rest (not smiling) than the other. At this point the one side is definitely “chubbier” than the other. So, I am wondering if think that it may even out a bit more if I wait longer?
A: A buccal lipectomy, or buccal fat extraction, is a simple procedure. But despite its ease of doing it, the final result does take some time to see. Because swelling goes away fairly quickly, within a few weeks, most patients understandably think that will be the final result. But the second phase of healing from this procedure is the contracture or scarring down of the space where the buccal fat was removed. This takes much longer, at least 3 to 4 months, before one can appreciate the fine details of the ultimate result. Whether your submalar areas will eventually even out and stay asymmetric can not be predicted. But I can say that it is too early to make a final judgment. Time is your friend at this point.
Indianapolis Indiana
Q: I have a very square jaw with a lot of fullness towards the front which has always bothered me and made me self conscious. I try to keep myself thin because any weight gain will make it even fuller. I am currently 43 and it seems to be feeling fuller, where I always felt when I got older the baby fat would decrease. My mother and father both had full faces with fairly square jaw lines as well. I am hoping the buccal fat procedure and would help my profile and thin my face from the front and side…like when I bring in my cheeks by sucking them in…it seems to show the angles more rather than looking chubby.
A: A square facial architecture is strongly influenced by the shape of the lower jaw and the cheek bones. To make a square face less full, the only area that can be changed is an inward movement of the submalar triangle facial zone. That is the area beneath the cheek bone done past the corner of the mouth in an inverted triangle shape. This is an area that is not supported by bone or muscle which is why you can suck it inward. Fat removal of this area is the only way to create some tapering in of this zone. The buccal fat pad occupies the upper region of the submalar triangle but not the area down by the mouth, known as the lower submalar triangle area. So a buccal lipectomy will help but needs another method of fat removal of the lower area also known as the perioral mounds. Microliposuction should be done from inside of the mouth to help this area in conjunction with the buccal lipectomies. The combination of both has the best chance to help achieve the look you are after.
Indianapolis Indiana
Q: Hello, I am 27 years old and thin but have always had these little fat pouches that are positioned below the corners of my mouth. It’s hard to explain but it makes my cheeks look like they’re sagging (but they aren’t). If I put one finger in the inside of my mouth, and one on the outside and pinch that area, I can feel the distinct fat pocket. I have two questions. What is this fat called? I can’t find any similar cases online, and I’ve done lots of searches. And secondly, what can I do to remove this?? Thank you in advance.
A: It sounds like you may have a unique facial condition known as pseudoherniation of the buccal fat pad. This is where the normal buccal fat pockets, which lie right under the cheek bone, fall or prolapse through their containing fascia and create a low fullness opposite the corners of the mouth or even lower. While rare, this problem has been described in the plastic surgery literature before. Undoubtably the ‘ball of fat’ that you feel is a part of the buccal fat pad.
Q: Hello Dr. Eppley. I’m a 25 yr old male who is dissatisfied with my cheeks. They are very round and full, and give me a infantile or boyish look, rather than a more angular, defined, masculine one. I’m pretty thin so weight loss is not an option. I’m wondering what my surgical options are. Apparently plastic surgeons don’t think buccal fat reductions are a good idea. Would creating a cheek dimple help? What do you think?
A: Full cheeks do contribute to a more round facial shape although they are just one factor in creating that appearance. Depending upon how one defines the cheek area, a full cheek can be due to a prominent cheek bone, a large buccal fat pad, a thicker subcutaneous fat layer across the cheeks and face, or some combination of all three. It is obviously important to know what in the cheek area is creating that look when one tries to figure out how to change it.
From a practical standpoint, the only reliable method of ‘cheek’ fullness reduction is partial or complete buccal fat pad removal. While this is a very simple procedure, one has to appreciate what type of facial slimming effect that it will create. Buccal fat removal will create a soft tissue indentation below the cheek bone prominence. If you put your finger under the prominence of the cheek bone, this submalar or under the cheek location will be the area effect. The slimming effect will not go down or past the corner of the mouth.
For most patients, buccal lipectomies will create a mild reduction in cheek fullness in the submalar area, but never dramatic. It is a good procedure, in my opinion, in the properly selected patient. It has gotten a bad reputation because of poor patient selection and over aggressive fat removal. In patients with thin or lean body types, the short-term facial sculpting effect may not be worth the potential for a long-term facial atrophy look with aging.
In trying to create a more sculpted face, it is also important to look at other potentially useful procedures such as chin augmentation, neck liposuction, and maybe even mild cheek augmentation. When put together with buccal lipectomies in the right face, a signficant more defined facial look can be obtained.
Dr. Barry Eppley
Indianapolis, Indiana
