Posts Tagged ‘buccal lipectomy’
Monday, January 9th, 2012
Q: Dr. Eppley, I have a very weak jawline and some fullness to my cheeks and face. My face is sort of round and not very distinct. I went to one plastic surgeon and he said that a chin implant would change my facial shape. But I have read that many chin implants also have liposuction under the chin as well. This seems to make sense to me but I still don’t see how that will improve my chubby cheeks. What would be your recommendations? I have attached some pictures of me from the side.
A: I think there is no question that you have a short chin and a rounder fuller face. A chin implant will definitely over good improvement of your profile. But to really ‘deround’ a fuller face it is going to take other adjustments. These would include some fat removal as well. Liposuction under the chin would also be a definite plus and, with the chin implant, can dramatically change the jawline. But the cheek area needs thinning by a partial buccal lipectomy with perioral liposuction. Buccal fat removal only affects the upper cheek area below the cheek bone. Perioral liposuction is needed to remove fat from the lower cheek area at the level of the corners of the mouth. The combination of chin augmentation and fat removal from the neck and cheeks can very effectively make a round face have a much more defined shape.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: buccal lipectomy, chin augmentation, dr barry eppley, indianapolis, neck liposuction
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Tuesday, September 13th, 2011
Q: Dr. Eppley, I am interested in buccal fat removal to make my cheek area less full but I have a few questions. If complete removal of the buccal fat pads is what is decided to be the best result after seeing my photos, is there a high risk for nerve damage? I’ve read that partial, more superficial removal is fairly safe but complete removal poses a risk of possible facial paralysis and/or nerve damage. From what I’ve heard and read it seems as if plastic surgeons are either for or against buccal fat pad extraction, in regards to the risks and how the patient will look when aging. I don’t seem to find any middle ground.
A: Having done many buccal fat manipulations over the years, I have no concern with facial nerve damage with buccal fat removal. It is not something that I have ever seen. Whether it is subtotal or closer to a more complete buccal fat removal, that problem is completely avoidable if you know how to do the procedure properly. How aggressive one should be with buccal fat removal is based on what type of face they have and how much the buccal fat pads are contributing to the submalar fullness. The amount removed varies depending upon the patient, their immediate thinning needs, and in consideration of what the future may be as they age with their kind of face shape.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: buccal fat pad removal, buccal lipectomy, dr barry eppley, indianapolis
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Sunday, July 24th, 2011
Q: I am a former patient of Dr. Eppley. I had buccal fat removal and love my results… however, I am still interested in having facial liposuction to sculpt my cheeks out a bit. I am wondering if he can do this and this is possible.
A: The removal of the buccal fat pads is the largest fat depot that can be surgically removed on the face aside from the neck. Its removal creates a slimming change in but one region of the face, the submalar region or the area right below the cheek bones. There are no other distinct or encapsulated fat areas to remove on the face. The rest and majority of facial fat is located in the subcutaneous level or right under the skin. This is much more difficult to remove and can only be addressed by small cannula liposuction. Many such facial fat areas are not even treatable by liposuction.
When patients seek a slimming effect of the face, they often are referring to the side of the face from the cheeks down to the jaw line. This leaves a lot of facial areas beyond the submalar or buccal fat region. Most of these areas can be treated by liposuction if done carefully and not done too deep. The buccal branches of the facial nerve lie on top of the muscle layer just underneath and injury to them should obviously be avodied. The question is not whether it can be done, but whether any significant change can be achieved. In general you can not make a wholesale facial slimming change by facial liposuction but small discrete areas may be able to be improved.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: buccal lipectomy, dr barry eppley, facial liposuction, facial slimming, indianapolis
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Wednesday, May 25th, 2011
Q: I have been researching how to make my cheek area look better as it seems to be kind of flat and has no cheek highlights, plus my face is a little round. It seems I have two choices, cheek implants, buccal fat removal or some combination. In my research I have reading that cheek augmentation would be better than the buccal fat removal as far as years down the road as I may not like it and it may look like I am older than I really am. Just doing some research on this subject. What is your opinion? Thanks for your help.
A: Both cheek implants and biccal lipectomies do impact on the appearance of the midface. While they are in close proximity, they create different midface effects. Buccal fat removal decreases the fullness below the cheekbone area. If the complete buccal fat pad is removed then a gaunt look may eventually appear is some patients. The key is subtotal reduction, particularly in someone who does not have a ‘fat’ or round face. Cheek implants create a different effect as it brings out the prominence of the bone above the buccal fat area. These can be not so subtle differences and you have to look and play with your own face to see whether more cheek or less fullness below it is better. They are not necessarily interchangeable procedures. Whether one is better than the other, or whether a combination of both is best, is determined by one’s facial shape and must be decided on an individual basis
Dr. Barry Eppley
Indianapolis Indiana
Tags: buccal lipectomy, cheek implants, dr barry eppley, indianapolis
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Monday, April 25th, 2011
Q: I`m considering having some plastic surgery and that`s the reason I`m writing to you. I am 28 years old and I`ve got a very rounded face with lot of babyfat and I want to make it more sharp/angled and more masculine looking. I have had a rhinoplasty done on my nose when I was 18 and it looks great from the profile, the only thing is that from up front one of the sides is indented and I was thinking that either an injectable filler to build up that side up or a silicone implant to make that side more fuller and match the other side. I don`t need a major or new nose job, just to fill up one side of my nose. I`ve got a double chin and even when I was thinner I still didn`t have a 90 degree angel between my neck and chin. So I want a liposuction and tightening of the neck muscles. I think this will also help to make my jawline stand up a bit more. I have a very round and big chin. It`s not too big but it`s very round so I was thinking that the liposuction of the double chin and platysmaplasty will also help to give my chin more angles but I`d also like to have a small dimple there. This will give me that masculine clefted chin look. I`d also like to have liposuction of my lower face (removal of buccal fat) to give it more angles and make it less rounded and more masculine. I think some cheek implants will give my face more bone structure. I want to remove the bags under my eyes. I`d like the procedure where the incision is from the inside of my eyelid. My upper lip is a bit uneven. One side is more rounded than the other, so I`d like to correct and get more symmetry to my lips. It`ll be nice to get them a bit bigger too. I have attached some photographs for you to review and await your comments/recommendations.
A: In reviewing your photographs and your concerns, I can make the following suggestions/recommendations:
1) Nose. Your nose is asymmetric because you have left upper cartilage/middle vault collapse. That is why it appears deviated due to the inward turning of the dorsal line. This is the result of your prior rhinoplasty. That is best corrected not by an implant or an injectable filler, but by cartilage grafting. The use of a left spreader graft and a crushed cartilage onlay graft over the indented area is the treatment of choice.
2) Lips. Fat injection grafting would be best. Although a vermilion advancement would perfectly correct the left upper lip asymmetry (lack of vertical height), that fine line scar in a male would be unacceptable.
3) Lower Eyelids. The lower eyelid bags could be removed by a transconjunctival lower blepharoplasty with fat removal only.
4) Cheeks. Cheek implants would be a good choice for your malar-infraorbital hypoplasia. I would also add fat injections above the cheek implants along the infraorbital rims.
5) Cheeks. Buccal lipectomies are needed to get rid of the fullness below the cheek bones which are going to be highlighted with the implants.
6) Chin. A square-shaped chin implant is needed with the placement of a central dimple or cleft, whichever is your preference. The chin implant would have minimal forward projection but is more to create fullness on each side.
7) Neck. it could be improved by some liposuction and a corset muscle plication (platysmaplasty ) to maximize the cervicofacial angle.
Lastly the Jaw Angle. A would do some liposuction around the jaw angle area to try and make it a little more distinct although the result would be fairly subtle.
Most of these procedures you had already surmised but here is what can be realistically done in an effort to achieve more of a sculpted masculine facial appearance.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: buccal lipectomy, cartilage graft to nose, cheek implants, dr barry eppley, indianapolis, platysmaplasty, rhinoplasty, square chin implants
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Monday, January 31st, 2011
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
Tags: buccal lipectomy, dr barry eppley, indianapolis, lipodissolve, liposuction of the face and neck, submental liposuction
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Tuesday, January 18th, 2011
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
Tags: buccal lipectomy, dr barry eppley, indianapolis, neck liposuction, plastic surgery
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Wednesday, January 5th, 2011
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
Tags: buccal lipectomy, cheek implants, dr barry eppley, indianapolis, midface lift, plastic surgery
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Sunday, November 28th, 2010
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
Tags: buccal lipectomy, dr barry eppley, indianapolis, plastic surgery, submalar tightening
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Friday, November 19th, 2010
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.
Dr. Barry Eppley
Indianapolis Indiana
Tags: buccal fat extraction, buccal lipectomy, dr barry eppley, indianapolis, plastic surgery
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