Can The Malar Fullness (Fat Pad) Be Reduced?

Q: Dr. Eppley, I stumbled across a question someone asked that is the exact issue I’m having and have been trying to research a solution for. Someone asked “Can my Malar Fat Pads be removed by liposuction” as it was prominent on the persons cheekbones once they smiled, and not exactly a buccal fat issue. I’ve attached a screenshot of the Question/Answer for reference. This is exactly the question/issue I have so I appreciate your response. My follow up question is now what CAN be done as alternative solutions or have you performed any type of treatment to address this, as he acknowledged complete removal is likely not possible/effective but not to say that it couldn’t be addressed. I’ve been struggling with this for years and looked into Cheek Reduction surgeries performed in South Korea, but even this doesn’t appear to be what I’m looking for either as that seems to move volume in cheekbones from the high sides to the front of the face for a youthful appearance, which is the exact opposite of what I’m looking for despite the fact that a “cheekbone reduction” by the name alone sounds like what I want. I look much younger than I am due to this (not really why I dislike it, it’s more so that it becomes extremely exaggerated in photos to the point where I don’t look like myself in photos, almost looks like a ventriloquist doll). I’m looking for the fat only to be lessened and not the cheekbone itself to be moved, as suggested in the Korean surgeries. Also, I find that my smile gets stunted (and that part I’m not sure if that is a buccle fat issue. My dentist acknowledged that I have a small mouth which I feel is because of potential full cheeks. I find it similar to smile/full cheeks of Khloe Kardashian or Scarlett Johanson when they smile as opposed to the wide smile of say Cameron Diaz, if that makes sense). Look forward to hearing from you!

A: As stated in your posted answer of mine from an identical inquiry on the same topic, such malar fullness/fat ‘pad’ is not treatable by a surgical procedure. It is not a discrete fat pad like the buccal fat pad that can be excised and it is composed of fibrofatty tissue that is largely resistant to liposuction not to mention the buccal branches of the facial nerve which course through this area and thus risk injury.

The only alternative to try is non-surgical and that is energy-based reduction. One of the well known unintended and adverse effects of skin tightening devices is underlying soft tissue atrophy due to the consequences of heat on fat. While not intended this concept can be used for problematic facial fatty areas that are not amenable to surgery. We use it for such problems and in particular to help reduce undesired fat injection results. It usually takes multiple treatments to see its full effects but it is at least associated with no risks….it either works a little bit or it works a lot.

Dr. Barry Eppley

Indianapolis, Indiana