Q: Dr. Eppley, Can you please tell me if you perform buccal lipectomy and if so, how many he has performed? Thank you.
A: I have performed well over a 100 cases of buccal lipectomy procedures in the past twenty years. A buccal lipectomy surgery is very straightforward and uncomplicated to perform. There is no real risk to performing the procedure and I have only seen one infection in my 100 plus cases. (1% infection risk) I have not seen any cases of buccal nerve injury.
The key to a successful buccal lipectomy is one of patient selection. Determining who will and who will not benefit from the external facial change that the procedure can create has both short and long-term implications. The concern today with a buccal lipectomy is that it may result in facial gauntness as one ages. Since facial fat is lost as one ages, removal of the buccal fat pads in youth can result in a sunken face look decades later. This is why it should be only considered with caution in younger leaner people. It is ideally best done for patients that have fuller rounder faces who appear to be genetically predisposed to a natural rounder face
Q: Dr. Eppley, I have a very wide face and protruding cheek bones and it’s always been an insecurity of mine. I’ve also always has chubby lower cheeks.when I smile my cheeks tend to protrude a lot which makes my profile look very awkward. I really want to have a slimmer more masculine face/jawline. I’ve also been considering a lip lift to shorten the gap between my upper lip and nose, and a nose job for a slimmer less bulbous nose. What surgeries are right for me? And what combination of surgeries are safe to perform simultaneously?
A: When it comes to fullness of the lower cheeks, which are below the cheekbones and down closer to the side of the mouth, a defatting approach is needed. Given your pictures and the fullness that runs from just below the cheekbone almost down to the jawline, I would recommend the combination of a buccal lipectomy and perioral mound liposuction. These two together are the most you can do for helping change a round face to a more V-shape based on soft tissue changes only. It is also important to remember that the thickness and quantity of skin also plays a role so there are limits as to what facial defatting can do.
When it comes to a rhinoplasty and a subnasal lip lift, I do not recommend that these two procedures be done together. This has to do with ensuring good blood flow into the intervening columellar segment. They will need to be staged or done separately.
Q: Dr. Eppley, a year ago I made a big mistake, I had a buccal fat removal operation (buccal lipectomy) and now I’m really sad about the results. My cheeks are too sunken and this makes me look older. I was reading an article you had written where you said that there two solutions for the buccal lipectomy defect. To add volume where my buccal fat was is it better a dermal-fat graft or fat injections? Will this leave scars on my face?
A: To restore lost volume from an over aggressive buccal lipectomy you can either do fat injections into the buccal space or place an actual dermal-fat graft into the original buccal space. One harvests the fat by liposuction (injection) while the other by an excision. (dermal-fat graft) A dermal-fat graft creates more assured volume but does leave a scar somewhere in your body to harvest it. For this reason many patients may initially opt for the fat injections. Either approach will leave no scars on the face as they are done from inside the mouth….just like your buccal lipectomy was done. In short, restoration of a buccal space defect must replace like with like…or fat lost with fat grafting.
Q: Dr. Eppley, I would like to remove fat from both sides of chin and redefine my jawline and make my face symmetric again. I had a procedure 3 months ago to remove fat from my cheeks (bichat fat) in order to make it look thinner. I did not attain the expected results as my face doesn’t look thinner but is now asymmetric and it looks like I have a lot of fat on both sides of my chin (makes me look older!). Can you please help?
A: Often surgeons think that taking out the buccal fat pads will make a face thinner when the fullness problem is actually much lower. There are two separate fat compartments between the cheek and the jawline, the well encapsulated globular buccal fat pads located just under the cheek bone and the more superficial and less volume perioral mounds located just under the skin besides the corner of the mouth and extending down to the jawline. Since I have no idea what you looked like before their removal, I can not say whether removing the buccal fat pads was truly the main cause of your facial fullness concerns. But the subcutaneous fat around the mouth and chin (perioral mounds) now looks fuller because it remains unchanged as the area above it where the buccal fat pads are is now thinner. It may be that microliposuction of this fat area would complete the ‘project’ and should help. Whether any fat should be replaced due to the asymmetry above caused by the buccal fat pad removal may be a solution to also consider. It is either that or do further removal on the fuller side. That choice is a matter of your aesthetic judgment.
Q: Dr. Eppley, I had perioral mound liposuction and buccal lipectomies a fews days ago to thin out my face. I have some questions about the facial swelling that I now see.
1) I’ve read there can be persistent fluid accumulation that could need to be aspirated…how do I know if I have this problem or just normal swelling?
2) Would wearing a compression garment facilitate faster resolution of swelling?
3) I’ve read massaging the liposuctioned areas can help resolve swelling…would you advise this or is it a better idea to just leave it alone and let it heal on its own?
4) The perioral region is much more swollen, stiff and numb than my cheeks. Is this normal? When I touch the area it feels hard under my skin. What is this? Swelling? Scar tissue? If scar tissue, how long will it take to shrink down?
A: What you are experiencing after facial buccal lipectomies and perioral mound liposuction is normal early after the procedures. But to answer your specific questions:
1) There is no fluid accumulation that will develop under the skin in facial liposuction. That is a phenomenon that is unique to body liposuction where large volumes are fluid are initially instilled (tumescent infiltration) to facilitate the procedure. Facial liposuction does not use this technique.
2) A compression garment will not facilitate the resolution of the swelling nor is it really practical to wear.
3) Digital massage (aka lymphatic therapy) can be beneficial for swelling resolution since it stimulates the lymphatic channels to open up by the pumping effect on the vessels.
4) The perioral region is stiffer and even more swollen than the cheeks because it is in a lower dependent position (gravity) and even the cheek swelling drifts down to that area. That is why the perioral tissues are so stiff.
Q: Dr. Eppley, I am interested in facial reshaping surgery. I can not figure out what my face needs to look better. I’d really appreciate you taking your time for this. I have been given different surgery options from doctors here in Australia. However my opinion is that the best doctors are located in America, especially for facial surgery. It has been recommended to me that I have cheek implants, buccal lipectomy and a chin implant. But I want to know your opinion since you are regarded as one of the best surgeons in the world for facial reshaping surgery.
A: In looking at your pictures, your facial reshaping/restructuring goal would be to shorten your longer face and provide some more central projection. You have a more flat paranasal/midface and thus you have to be careful with how you change things to not look worse. I would recommend the following:
1) Chin augmentation but by sliding genioplasty as your chin needs to come forward but should become vertically shorter not longer. (implants tend to make the chin longer or at least neutral in vertical length)
2) Malar/Submalar implant augmentation with emphasis on providing with anterior projection not so much width
3) Avoid a buccal lipectomy. That would be one of the worst things you can do to a face that already lacks projection and could easily end up looking gaunt.
4) Paranasal augmentation to build out the base of the nose and the maxilla. This complements what the dimensional changes of the cheeks and chin and avoids ‘leaving the area between the two behind’.
Q: Dr. Eppley, After doing some more research, I’ve also wondered about the possibility of facial liposuction or a buccal lipectomy with my vertical chin lengthening procedure.. I know that buccal lipectomy has to be done selectively, because it can cause a gaunt look. Do you think that buccal lipectomy or some cheek liposuction would help me? The fullness of my cheeks bothers me a lot and so I thought the genioplasty would help elongate my face to reduce the roundness or fullness. Basically my question is if some sort of facial liposuction may be a better option, or if it should be done in addition to the genioplasty? (I’ve had one other doctor mention that my chin height isn’t really lacking and that not much vertical height would need to be added). I’m interested in getting your opinion on this.
A: It would not be rare to do further facial derounding by a subtotal buccal lipectomy as a complement to other procedures. A buccal lipectomy produces a subtle effect so it alone would rarely create significant facial slimming. As long as it is not done overaggressively, it will not ultimately produce the gaunt look and will reduce some fullness right under the cheekbones.
By aesthetic measurements, you vertical chin height may be fine. But in the spirit of what you are trying to achieve, vertical chin lengthening is needed. Rather than rely on numbers or what looks right to someone else, use computer imaging to see what facial look is created with and without vertical chin lengthening.
Q: Dr. Eppley, I had buccal fat pad removal (buccal lipectomy) recently and am already seeing positive results. I can see my strong cheekbones a lot more. However, there are parts of my face that still display bits of fullness. Based on your responses to other questions, it appears I still have some perioral mounds. I am considering liposuction in this area. However, my concerns are a return of fat after treatment. I’ve read different online opinions that indicate fat can return after liposuction. As such, my questions are:
1. If I get liposuction on my perioral mounds will the fat go back to my buccal fat pads to compensate for the fat loss in my perioral mounds?
2. If I choose not to get liposuction on my perioral mounds, but either gain some weight, or stay the same weight, will my buccal fat pads eventually return? From what I recall, I had my surgeon take out as much buccal fat as possible, but the temporal part was of course left alone. Can buccal fat regenerate?
3. Lastly, I am also considering some type of laser resurfacing procedure for acne scarring but I am worried the regeneration of new skin cells promoted by these laser procedures will bring my buccal fat pads back. Is this possible?
A: When it comes to liposuction, you have to separate face and body liposuction as the long-term results can be quite different. This is especially true for the unusual buccal lipectomy procedure. To answer your specific questions:
Once the buccal fat pads are removed, they will never come back. A buccal lipectomy is the most unusual of all fat removal procedures in the body as it is a total glandular excision not subtotal fat extraction. Fat only returns in the body by cell hypertrophy not new fat cell growth.
Buccal fat cells, like almost all fat cells in the body, do not regenerate or make new cells. Only the residual or existing cells can get bigger.
A skin laser treatment will have no effect on the deeper underlying fat in terms of ever promoting fat cell hypertrophy or fat cell replication.
Q: Dr. Eppley, I feel like I have a good bone structure but my jawline and lower face shape is hidden by excess fat. Will a buccal lipectomy get rid of the fat above my jawline and chin or would it get rid of the fat below the hollows of my cheek bones? I ask this because I know this procedure can create a hollowed skeletal/meth-head look and having very high cheekbones, I know I may be prone to this effect. I am 20 years old.. Though this procedure is generally for older people, do you think it would benefit me by outlining the contours of my lower face? I would like an estimate and maybe an opinion on the procedure if you can spare one. Thank you for your time 🙂
A: When it comes to a buccal lipectomy, it is important that one distinguish what it can and can not do. It can reduce some fullness right below the cheekbone which you can locate by placing your thumb on the underside of the cheekbone. As you can see by doing this, that will not affect any fullness below it near the mouth or the jawline. This is an area that I commonly treat with small cannula liposuction to reduce the fullness in this area. This procedure has no risk of ‘overskeletonizing’ the face as it is subcutaneous fat removal and not one large lump or ball of fat like that of the buccal fat. (actually if done properly and in a subtotal fashion a buccal lipectomy will not make the face too hollow)
Q: Dr. Eppley, I am interested in facial liposuction. I am slim but hate my chubby cheeks. Whatever I do they don’t go away. I tried buccal fat removal with little luck. Problem is the round bit of fat in malar pads which always goes very high on my apples of my cheeks when I smile. Can the cheek malar pads be removed completely? I want like male models so it looks like no fat at all on cheeks and so When smile it is just skin that raises up instead of the fat malar pad. I dont need malar lift, I just want it to be gotten rid of for good. Can it be completely removed and sucked out even if this may leave some sagginess of the skin. After that maybe I can have midfacelift if needed but I really want this malar pad gone. It is not buccal fat that I want gone, it is malar pad which rests on top of cheekbone. I don’t want a malar lift to redistribute fat on to higher position, just complete removal. Is it possible?
A: I understand perfectly as to what you are referring to and it is no surprise that a buccal lipectomy would have no effect. The buccal fat pad is in a lower anatomic location. The tissues that you are referring to are over the malar region but to describe them as the malar ‘fat pad’ is not anatomically accurate for what you are trying to achieve. The malar ‘fat pad’ is not like the buccal fat pad, it is not an isolated and thus easily extractable type of fat. Rather it is fat mixed in with other tissues giving it a more fibrofatty quality to it. Thus it is not amenable to excision (like the buccal fat pad) and is more resistant to small cannula or microliposuction. This does not mean it can not be treated, it is just a question of how effective it would be and that disrupting these tissues will cause it to sag as the suspensory ligaments would be traumatized. But when it comes to complete removal of the malar fat pad fullness, I do not believe that is surgically possible.