Can The Area Of My Cheek That Bunches Up When I Smile Be Reduced?

Q: Dr. Eppley, Thank you again for you prompt response, and please find the previously mentioned photos attached below.

*Please note I’ve included the frontal photo me smiling that is when I feel my area of concern is most pronounced

The green on Area of Concern photo indicates bone that I would like brought ‘in’ to reduce width of face. This is on the sides of my face starting parallel to the corner of my eye and goes down for 4cm.

The purple/pink indicates the area starting under my eye sockets and going down 3cm to the bottom of my nose where I would like to reduce the extent to which the bone comes forward from my face.

A:Thank you for sending all of your pictures and a good description of your concerns and objectives to which I can say the following:

1) The cheek area you have highlighted in green can be reduced in width and is done so by anterior and posterior cheekbone osteotomies…which moves the zygomatic arch width inward which is the primary source of facial width increase in that area.

2) The area you have highlighted in purple, however, is not going to be reduced by any form of bone reduction. This anterior cheek area thickness is comprised of soft tissue which becomes exacerbated (bunches up ) when you smile. (This is a very common facial concern in smiling) The underlying bone is actually concave in contour (not convex like the zygomatic arches) and this is not a bony protrusion that can be reduced. Any further bone reduction in this area, besides not having the eternal desired effect, will expose the maxillary sinus which lies immediately beneath it.

3) The purple cheek area is a facial region for which no effective soft tissue reduction is possible. Cutting out the soft tissue is not an option as permanent injury to branches of the facial nerve will occur. Liposuction of this fibrofatty tissue in this area is ineffective. I have tried its many times and it never produces any improvement.

Dr. Barry Eppley

Indianapolis, Indiana