How Can I Achieve A More Defined Lower Third Of My Face?

Q: Dr. Eppley, I am writing to inquire about your expertise in facial contouring, specifically regarding procedures to achieve a more defined lower third.

I have been researching the various defatting techniques you offer, and I am particularly interested in a combination approach including Buccinator Mucosal Myectomy, buccal lipectomy and perioral liposuction. My primary goal is to address a persistent “baby face” appearance. Despite being very lean overall, I feel I carry a significant amount of fullness in my lower cheeks and jawline that is resistant to diet and exercise.

My main question concerns the extent of buccal fat pad removal. I would like to understand the anatomical limits of the procedure. To put it in concrete terms, if I had, for example, 10cc of buccal fat on each side, what is the maximum percentage or volume that can be safely excised? My aesthetic goal is to achieve the most dramatic reduction possible, as I am not concerned with the traditional risks of looking “gaunt” as I age. My philosophy is that if future volume loss were to become an issue, that could be addressed later with fat grafting.

I am very interested in your perspective on this approach.

Thank you for your time and expertise.

A:When it comes to defatting the face the procedures you have outlined are the appropriate ones including potentially submental liposuction. When it comes to buccal lipectomy in particular you take out as much of the central fat pad as can be safely extracted without injuring the closely attached buccal branches of the facial nerve. In most patients that is somewhere between three and 6 mL per side. I’ve never seen anybody in 40 years and hundreds of buccal lipectomies that had 10 mL on the single side.

That being said, while that is the most fat you can remove in the face, will that achieve your desired effect? No one can say precisely before hand but it’s probably fair to say that it probably won’t achieve as much as you would like simply because you don’t have a fat face. What you do have, is a vertically short chin with a deep labiomental fold, which works against optimal facial contouring. Ideally you need to have the chin vertically lengthened which always makes a major contribution to thinning out the lower face (see attached imaging)

To put that in perspective I would argue the vertical lengthening of the chin makes a more major contribution to thinning out the lower face then the defatting procedures will. Ideally you do both together to achieve a maximum change and that is the best approach.

Dr. Barry Eppley

Plastic Surgeon