How Can I Achieve A Greater Indentation Between The Zygomatic Arch and the Jaw Angles?

Q: Dr. Eppley, Thank you for reading my message. I am curious what solution, if any could achieve a specific type of width reduction in the lateral temporal cheek area with a concave curvature below the cheekbones and above the jaw angle to create a more heart shaped face. Basically I want use a cheekbone implant combined with some sort of soft tissue manipulation to pull back/up the skin to highlight the skeletal structure and reduce the fullness in this area. 

I have attached three reference images to illustrate my goals. 

One image shows me squinting to accentuate the cheekbones while applying a small amount of pressure with my finger in the temple/masseter region to very gently “push in” or pull back the skin and simulate a roughly .25 inch/6mm reduction in width with a concave curvature to highlight the skeletal structure to create the heart shaped look. 

The second image shows me squinting but without applying pressure with my finger, which shows the normal state without the width reduction or concave curvature. 

The third image shows a patient who has undergone masseter reduction with Botox which achieves this exact width reduction/concave curvature below the cheekbones that I’m looking for. 

The problem is that I don’t have particularly large masseter muscles. I am assuming mine are “average” and are roughly ~12 mm thick, so if they are average in size they would need to be reduced in thickness by roughly 50% in order to achieve the 6mm reduction I’m seeking. I’m not sure how anatomically viable this is. 

I also understand that the ramus portion of the jawbone sitting underneath the masseter muscle is extremely thin and I’m assuming it would not be feasible to shave this area of bone very much or at all without compromising the nerve running through it. 

In summary I’m trying to figure out how to create this .25 inch/6 mm width reduction with a concave curvature below the cheekbones given my skeletal/soft tissue profile? Would cheekbone implants be be sufficient to pull the skin to simulate what I’m doing in the over by pressing my finger? Masseter muscle reduction? Liposuction of the lateral cheekbone area? Could a mini-facelift pull the skin back slightly to highlight the skeletal profile? 

Is this achievable at all? 

Thank you again for reading.

A: The facial reshaping effect you seek is not going to come from a masseter muscle reduction as that is not the area in which you are indicating. That is the parotid gland/SMAS area above the level of the bulk of the masseter muscle…and you are obviously not going to do a superfical parotidectomy to achieve that effect. An aggressive buccal lipectomy that gets the pterygoid extension and a SMAS excision in front of the parotid gland…..with cheek-arch implants will likely achieve that effect.

Dr. Barry Eppley

Indianapolis, Indiana