What Is The Cause Of My Heavy Lower Face?

Q: Dr. Eppley, I was hoping you could please help me understand what I can do to resolve the lower heaviness in my face. Despite being 5’11 in height and less than 135lbs, I still (and always have) carried a lot of weight in my face, which becomes particularly pronounced when I smile. I have had masseter reduction with Botox in the past, which has helped but it’s still not getting at the chubbiness at the front and lower sides of my cheeks. Is this buccal fat, masseter or something else? Photos attached. 

A: While I have not seen a truly static picture of your face (all have various forms of smiling which naturally adds to the fullness of your face) your ‘problem’ is undoubtably multifactorial. (meaning the natural thickness of all of your overlying soft tissue…skin, fat muscle, fascia…all make a contribution to the fullness. Thus there is no single one procedure that addresses just one of the tissue components that is going to successfully provide a satisfactory facial thinning effect.

The reality is that the most successful facial thinning procedure I know is the one you would be least motivated to do and one that seems counterintuitive…. a cheek-jowl tuck-up. (a limited form of a lower facelift) This is the most effective approach for facial fullness reduction because it has a known facial sweeping effect, which for an older thinner person may not be a desirable facial change, but in the younger fuller face patient is a positive effect. By tightening the skin, underlying SMAS and removing some buccal fat the face becomes less full.

That being said every other procedure, stand alone buccal lipectomy/perioral liposuction and masseteric muscle/jaw angle reduction provides some modest improvement but never a really significant change.

Dr. Barry Eppley

World Renowned Plastic Surgeon