Posts Tagged ‘buccal lipectomy’
Monday, April 22nd, 2013
Q: I am interested in making my face look thinner. Even though I am not fat (below the neck), my face makes me look like I am. I have read about the buccal lipectomy procedure and that seems like it would work for me. I am most interested in getting the lower part of my face thinner. Thank you for your help!
A: To treat the soft tissue facial triangle area (lines drawn between the cheek, chin and jaw angles), the procedures of buccal lipectomies and perioral mound liposuction may be useful for ‘facial derounding’. It is important to realize that these procedures are most effective for the areas below the cheek down to about the mouth level and not for fullness at the jaw angle or in the lower part of the face. Facial defatting procedures work best in areas that are not directly supported by bone where the fullness is more the result of the thickness of the fat and not the bone. A buccal lipectomy removes a very distinct large ball of fat that sits right below the cheek bone. It is done from a small incision inside the mouth. It is important
to not totally remove it so one does not get a gaunt look later in life. But for someone with a really round ‘fat’ face this potential issue may be irrelevant. The perioral liposuction procedure removes fat from below the buccal fat pad that sits right under the skin opposite the mouth. It is done from a small incision inside the mouth. Done together these two distinctly different facial fat removal procedures can help create a facial thinning effect.
Dr. Barry Eppley
Friday, April 19th, 2013
Q: Dr. Eppley, I am interested in cheek augmentation and an African-American rhinoplasty. I have fat cheeks and I want them smaller. I also want a more refined and less fat nose. I have attached a picture of me so you can see what needs to be done.
A: Thank you for sending your picture. This one view is not the best picture to judge the result but it is helpful. I believe you are looking for a buccal lipectomy to reduce buy cialis online without a prescription the fullness under your relatively flat cheek bones. Or you could leave the buccal fat alone and augment the cheekbones which I think is a better alternative. (maybe just a little buccal fat removal. Your nose shows many of the typical ethnic features and that could be improved by an open rhinoplasty in which the nasal bridge is built up with an implant, the tip lengthened and narrowed and the nostril flaring/width reduced. I have just imaged the buccal lipectomy and the rhinoplasty.
Dr. Barry Eppley
Saturday, April 6th, 2013
Q: Dr. Eppley, My face is slightly asymmetrical; the right side of my face is less wide than the left side. Consequently, my jaw line is more square and substantial on the left, and less so (its a little more rounded) on the right. There is also a greater fat buildup in my right cheek, since it has less area to distribute itself over than the left. Finally, my nose has a fatty round tip (I am not sure of the proper medical term for it, but I can feel that the problem isn’t the cartilage, so it must be a fat buildup), and it obscures the definition of my nostrils.
So, the surgeries I would like to have done are 1) rhinoplasty (reducing and defining the tip of my nose; the cartilage and bone are fine), 2) buccal fat removal from my right cheek, and 3) a jaw implant on my right jaw to balance with the left side. Each of these features affects the others, so I assume that it is best done by the same doctor, and at the same time under general anesthesia. The reason I am writing to you about this is because of all the plastic surgeons I have researched, you are one of the only ones who explicitly does jaw implants, not just chin implants or facial injections. I understand my face will not be totally symmetrical after this procedure (my whole left skeleton is slightly wider than the right side), but I do want to balance out the corner of my jaw, the fat in my cheek, and the nose with the rest of the face.
I have attached an informal frontal shot of my face, so you have some sort of visual to accompany my description.
A: Thank you for your inquiry. I believe your description of your facial asymmetry and your approach to improve it is spot on. I would just make a few modifications/clarifications on your proposed procedures. First, the round tip of the nose is not primarily caused by the subcutaneous fat under the skin. It is a component to it
and minimally modifiable due the risk of skin necrosis of the overlying skin. The major component to making one’s nasal tip less ‘fat’ is to modify the underlying lower alar cartilages, particularly that of the dome area. Thus a tip rhinoplasty changes the size and width of these cartilages to make the tip more refined. Second, a buccal lipectomy affects the fullness right under the cheekbone and not further out on the face. Lastly, the type of jaw angle implanted needed would be a lateral augmentation style that only adds width and not length to the jaw angle area.
Dr. Barry Eppley
Sunday, December 16th, 2012
Q: Dr. Eppley, I want to look younger and more attractive. I used to get comments that I looked so much like Angelina Jolie. I don't get those compliments anymore. One of the attached photos is me when I was younger. The other one is me now. I need some cheek sculpting to bring my now fat cheeks in more.
A: Thank you for sending your pictures. The difference between you now and when you were younger appears to be wide or 'fatter' cheeks with loss of a high cheek definition look. This could be caused by aging (falling cheek tissue) or increased fat collections in the lower cheeks with age and some potential weight gain. Careful analysis of your pictures shows that the main difference is inversion of the soft tissue cheek triangle. When younger the cheek was an upside triangle with most of the fullness up top and the apex of the triangle down below inverted inward. With time the triangle has inverted with the base of the triangle now at the bottom of the cheek (most fullness) and the top of the triangle up high over the cheek bone. (Ileast fullness) To attempt to rearrange this soft tissue triangle the following needs to be done…buccal fat pad extraction and relocation to the cheek bone (like placing an implant) or cheek fat injections and perioral (lower cheek) liposuction. In essence, add fullness over the cheek bones and remove fat below the cheek bones. Since fat changes are the crux of the facial problem it makes most sense to undergo a fat redistrbution surgery.
Dr. Barry Eppley
Saturday, November 3rd, 2012
Q: Dr. Eppley, I am interested in a more structured feminized face. I am 40 years old and have wanted to balance my face my entire life. The fat never dissipated with age so I now find it agonizing. I also think chin augmentation would help but I am not sure about that.
A: In looking at your face, I believe your fat concerns go beyond the buccal fat pad area. Most people have a misconception about where the buccal fat pad lies. Even though it is a fairly large fat collection, it only occupies a small area immediately below the cheek bone. It does not extend down near the mouth area which is a different area of fat in the subcutaneous layer know as the perioral mounds. When looking for facial thinning in the cheek area, it is usually necessary to combine partial buccal fat pad reduction with perioral mound liposuction.
I can not tell about the potential benefits of chin augmentation based on just a frontal picture only. I would need to see a side picture. Chin augmentation is usually only beneficial to facial thinning if it helps elongate the face and helps makes the chin more narrow in the frontal view.
Dr. Barry Eppley
Wednesday, September 26th, 2012
Q: Dr. Eppley, I had buccal fat removal upon the misleading instruction of a doctor . Now my cheeks look sunken and dented. After reading your article “Contemporary Cheek Enhancement – Malar and Submalar Zone Considerations”, I have the following questions which are consistently suffering me.:
1. Will the removal of buccal fat pad lead to great fat loss (lipoatrophy)? e.g. due to loss of the supporting fat. I just found myself look like dying.
2. I guess the doctor just removed the whole fat pad, which was not told to me. May I know if there are any suggestions for repair with the least potential risks? I consider fat grafting, but it seems so unpredictable. Do fillers like Juvederm or Artefill work in my case?
I will move US next year and I think surgeons of US are better. Wish you can save me out of this. Thanks a million for your great help!
A: Buccal fat removal can be beneficial for facial reshaping in the properly selected patient, such as someone with a very thick and round face with full tissues. But in the wrong type of patient or if too aggressively done it can result in a gaunt overresected look. I suspect by your description you fit into the latter category. In answer to your questions:
1) I do not know how far out from surgery you are. But if you are six months or more after surgery, the result you see is likely stable. The degree of surgically-induced ‘lipoatrophy’ that you see could be worsened with additional weight loss or further facial fat loss with progressive aging. Whether this occurs or not depends on your facial type.
2) Synthetic injectable fillers is certainly a simple albeit a short-term fix. I would not rule out injectable fat grafting. Its volume retention results may be unpredictable but the cheek is one of the best areas on the face for fat transplant survival. Other options include submalar implants placed intraorally and even dermal-fat grafts placed through a limited facelift incision.
Dr. Barry Eppley
Saturday, September 15th, 2012
Q: Dr. Eppley, I am a 25 old year guy and I am really not satisfied with my looks. I am looking to improve upon my face for a more youthful look .I know it’s not wise to compare yourself to others as everyone’s face is unique but I think the most distracting feature of my face is a very big and wide lower face (mandible) that makes my face chubby and more old looking. The last time I inquired you about an outer cortex osteotomy for as such the same problem and you requested my pictures so I did attach them. Now I would be really grateful if you clarify me my following doubts:
1. Is it possible to reduce my lower jaw width and angle to make my face more slimmer and proportionate?
2. If yes, how much is it possible to reduce the bigonial distance and achieve a more ovoid looking face (Front view) in my case?
3. Would chin augmentation be helpful to achieve the same?
4. I also want to have a tip rhinoplasty that would give my nose tip more definition and sharpness. Again, how much is it possible to achieve a nose like the one in the model pictures I have attached?
5. Please suggest any additional improvements in case you notice that would be required for a more youthful appeareance such as brows,cheeks or any other.
A: In answer to your questions:
1) There is not a really good procedure to make your entire lower face more narrow. Even if one could do a lateral corticotomy (remove the outer layer of the lower jaw bone) that would just not make enough of a difference in your face.
2) Certainly the jaw angles can be removed but whether that would make a very visible difference is uncertain. Some of your facial width is soft tissue and can not be reduced. The best way to answer whether this procedyure would be worth it is frontal cephalometric x-ray or facial film to look at how much flare the angles have. If it is significant then it may be worthwhile.
3) Vertical chin lengthening is, by far, a more practical approach to facial lengthening (and narrowing) for you given the more square facial shape that you have.
4) A tip rhinoplasty will definitely help narrow your nose but trying to achieve the very slim noses in the pictures you have sent is unrealistic. You will likely end up halfway between where you are now and those type of results.
5) Some soft tissue (fat reduction) would also be helpful, removing part of the buccal fart pad and thinning out the fat outside of the corners of the mouth.
I would think that a vertical lengthening chin osteotomy, tip rhinoplasty and buccal lipectomy with perioral liposuction would be the three procedures that I would recommend that could make the greatest difference in your facial shape/appearance.
Dr. Barry Eppley
Monday, September 10th, 2012
Q: Dr. Eppley, I want a slimmer less round lower face, so a slight ogee curve is visible. How is that best done? Or can it even be done?
A: When it comes to contouring the area between the cheek and the jawline, it is important to remember that this is an area not supported by bone. So any fullness is due to the thickness of the soft tissues. (skin, fat and muscle) To get any change in this area (a midfacial slimming effect), a combined buccal lipectomy with perioral liposuction (affects lower cheek area, buccal lipectomy does not) is needed to achieve the best facial contouring. The question for this procedure combination is how much of a change can it make. In my experience, most patients will experience a visible contouring effect but it may take up to six weeks after surgery to see the full result.
Dr. Barry Eppley
Wednesday, August 8th, 2012
Q: Dr. Eppley, I would be very grateful if you could answer some questions about the removal of the buccal fat pad. What is the level of risks of sustaining damage to the buccal nerve branch of the facial nerve? Approximately how long does it take to recovery and when to expect the end result?
A: The buccal fat pad is an encapsulated fat mass in the cheek which is located between the buccinator muscle and the masseter and zygomatic muscles and largely lies underneath the zygomatic arch. It is deep to the malar fat pad which lies directly under the skin and the jowl fat pad which is situated much lower near the jawline and should not be confused with these two regionally close fat collections. The buccal fat has one large body and usually four processes like fingers which extend outward from it. The part that is removed in a cosmetic buccal lipectomy is part of the main body. The biggest risk in buccal lipectomy is transection of its blood supply, the buccal artery or vein during its removal. This can result in bleeding and a hematoma afterwards. The key to avoiding this complication is gentle dissection of the main body outward and cauterizing attached blood vessels under direct vision. The buccal branches of the facial nerve are in close proximity to the main body but usually cross over top of it. Staying inside the buccal fat pad capsule and not being too aggressive with removal are the keys to avoiding a traction nerve injury. It is not a complication that I have ever seen. Trying to pull too much fat out runs the risks of pulling the nerve branches into the field of removal/cautery.
Buccal lipectomies will cause some swelling but most of that is gone after about three weeks from the procedure. The final result can be judged six weeks from surgery although some continuing fat atrophy may be ongoing based on how the fat pad was removed.
Dr. Barry Eppley
Tuesday, June 5th, 2012
Q: Dr. Eppley, I wanted to have a well defined face shape, so I am thinking of doing buccal fat removal but at the same time I want high cheek bones. Is it possible for me to do buccal fat removal and at the same time still put Juvederm fillers in right under my eyes? Does that make sense?
A: That does make sense with the exception of it is unclear how that will give you high cheek bones. Buccal fat reduction provides some submalar ccontouring which helps in some small amount of facial thinning in that area but will not, by itself, give you high cheek bones. The Juvederm filler will help with tear trough filling but also will give not give you any cheek bone augmentation effect. Those two procedures make sense for what they are intended to improve but neither one will create the illusion of high cheek bones. For that result, you should consider a small cheek implant which can be placed through the same incision as tha of buccal fat removal. That combination will create a more shapely cheek look.
Dr. Barry Eppley