Should I Do Buccal Lipectomies Before Getting Cheek Implants?
Q: Dr. Eppley, I consulted with you in the past about possible chin augmentation, and after that having visited many plastic surgeons for various reasons you are the only one I trust when it comes to facial sculpting/implants. I have moved on from the chin for now because I realized a much more pressing issue is my cheeks. Another plastic surgeon told me I was a good candidate for buccal fat removal, but after reading some of your Q+A on realself I am unsure if that is the exact area where my cheek fullness even comes from so am worried it would not even make a noticeable difference! It seems like no other doctor understands (or at least is transparent) that there are other reasons for chubby cheeks that are NOT the buccal fat and therefore removing it would not fix the problem in those cases!
I also know I have extremely weak cheekbones in the mid-face beneath my eyes and am just trying to decide if I need an infraorbital rim implant with malar extension or just the malar cheek implant (or if I am better off just with filler.) I am thinking any cheek implant or filler would be a bad idea without getting rid of the soft tissue fullness beneath the cheek bone FIRST, as it would just add to the fullness. I am just unsure what the best procedure would be for me to address that. While losing 25-30 lbs would effectively get rid of all that fullness in my face, I am already a bit underweight so I know that’s not the answer.
A: Based on your pictures I would say the following:
1) I would view buccal lipectomies and perioral liposuction as a complementary or adjunctive procedure to cheek implants for your midfacial enhancement. Facial defatting alone is not going to create more defined cheeks. One can certainly do the defatting first and see what it looks like.
2) I don’t think you are a good candidate for a cheek implant that has a substantial infraorbital extension as that would require a lower eyelid approach to place. (true custom infraorbital-malar implant) Your infraorbital rim deficiency is mild.
Dr. Barry Eppley