Your Questions
Your Questions
Q: Dr. Eppley, I know I have an asymmetric face. Do you think that I’m going to benefit from a buccal fat removal or my problem is the bone structure? I’m 5’3, 120 pounds and 36 years old. I have these chubby cheeks my whole life. At home, when no one is around, I suck my cheeks in. My definition for a beautiful face is the almost gaunt effect. Thank you.
A: Thank you for sending your pictures. I do think the combination of buccal lipectomies and perioral mound (lower cheek area just opposite the mouth, is not part of the buccal fat pad nor would be reduced by the buccal lipectomies) would be beneficial for slimming your face. I don’t think you can get to a gaunt face, nor would you really want to long-term, but it would make a noticeable difference with your facial structure.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had my buccal fat pads removed over 10 years ago which looked great. Then I lost a considerable amount of weight, over 50 lbs, and now look too sunken in. What is the best filler used to replace where buccal fat pads have been removed?
A: The answer to your question partially depends on how much volume is missing (how sunken in you are) and what method (surgical vs non-surgical) you want to pursue. But using the injectable filler criteria as your question posed, I will answer based on that one variable only. Because of the volume of the buccal fat pads (usually 5 to 10cc per side), the best replacement filler is fat injections. While the injection of fat is unpredictable, it offers an unlimited amount of volume for facial injections and it has the potential for some permanent volume retention. While there are many proponents for the various synthetic injectable fillers that are currently available, one has to recognize the cost of the volume needed per side based on the volume lost and that none are permanent. But if one had to go for a synthetic injectable filler, I would first use one of the longer-lasting hyaluronic acid fillers, like Perlane or Juvederm, to see if you like the effect. While there are longer-lasting fillers, such as Sculptra, Radiesse and Artecoll, they can be associated with higher risks of lumpiness and irregularities than the non-particulate hyaluronic acid-based injectable fillers when it comes to larger volume augmentations.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I would to make my face less fat. It is very round and the fattest area is on the side of my face. It gets a lot better when I suck my cheeks in as this seems to draw in the area where it is the fattest. What is the best procedure to get rid of this facial fat?
A: It is always a little unclear to me when a patient says the ‘ side of their face’, that can mean different things to different people and is of particular significance when one wants a defatting or thinning procedure. Having said that I have a strong suspicion when you mean the equivalent of when you suck your ‘cheeks’ in means the entire side of your face….of which there is no surgical procedure that can accomplish that look completely. There are some areas that make up a portion of the side of the face that can be improved by liposuction. The perioral mound area extends from the corner of the mouth back about halfway between the corner of the mouth and the ear, which is the anterior half of that area. For fullness that goes all the way to the back to the ear, there is no solution.
You would be best off to consider subtotal buccal lipectomies and perioral and lateral facial liposuction. But it will never equate to the contouring or thinning effect of sucking in one’s cheeks.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley,I am interested in liposuction of the perioral mounds. The effect I am going for is what happens when I suck in my cheeks. Would the procedure produce such an effect? However, I have read that it is difficult to do liposuction in this area and that scars and asymmetric results are common. Could you also tell me more about the risks? Thank you!
A: The perioral mounds are small fat collections that lie outside of the corner of the mouth and on the lower end of the cheek area. They are not part of the buccal fat pads, as is commonly thought, but is a less defined area of subcutaneous fat between the skin and the buccinator muscle. A prominent perioral mound can be reduced by small cannula liposuction. The entrance site is just inside the corner of the mouth in the mucosa so there are not resultant scars. Generally 2 to 3 cc of fat can be aspirated from each side. I have not seen that asymmetry or skin irregularities are a problem afterwards. The only real risk of the surgery is that the effect it creates is not significant enough. While I have always seen a reduction of the perioral mounds with liposuction, it will not create the look of sucking in your cheeks. That look results because the soft tissues of the cheek are like a trampoline being suspended between the bony supports of the cheek and jawline. They can easily be pulled inward with suction but no amount of facial fat removal can create that same effect. Perioral mound liposuction is best done as part of buccal fat pad removal to create an overall better facial thinning effect.
Dr. Barry Eppley
Indianapolis, Indiana
Q: I had cheek and jaw angle implants last year. While I think I look better, I still feel my face does not have enough definition and is still a little too round. What do you recommend that will help my facial aesthetics? I have attached some before and after pictures from my previous surgery.
A: Thank you for sending your pictures. I think you have achieved some facial highlights from your previous procedures but implants also add width and volume. In certain faces this can make one’s face look a little ‘fatter’ or fuller and not always provide the definition that one wants. This can be particularly true with jaw angle and cheek implants. To create some further facial refinement, I would recommend buccal lipectomies to slightly narrow the area below the cheek implants, a chin implant with a prejowl extension to smooth out the jawline better (your chin is slightly deficient and there is a notch in the jawline at the prejowl area) and possible a jowl tuck-up to remove some skin along the jawline an give it better highlights and a possible thinning rhinoplasty. The goal now is to create more definition in your face and help better highlight the facial features that you now have.
Dr. Barry Eppley
Indianapolis Indiana
Q: I am interested in correcting some asymmetry in my face and creating more harmony to the lower third of my face. The back of my lower jaw area (masseter muscle) is bigger on my right side. There is also some soft tissue asymmetry with the right side being fuller in my mid cheek area, and my chin is off center. I have been to different cosmetic surgeons but have not come across anyone who has a real solution for this. Orthognatic surgery was recommended, however I believe there is a way to correct this without such invasive surgery. I have had trouble locating a doctor in my town that does jaw implants, that’s why I was happy to find your site because it seems jaw angle implants and dealing with facial asymmetry and the jaw area in general is something you have extensive experience. I have done some research, and the solution I came up with would be jaw angle implants, with the one on the right side being bigger to account for the asymmetry. However, even without the asymmetry I would still be considering jaw implants, just because I feel that my jawline is more narrow/less defined than I would like. For the soft tissue asymmetry I would like to do removal of the buccal fat pad/or facial liposuction to thin out the lower cheek area of my face and make that area more defined. Please let me know what you think. I look forward to hearing from you and getting an idea of what you think is best from the imaging. Thanks!
A: Thank you for your inquiry and sending your photos. As you have astutely pointed out, you have overall lower facial asymmetry marked by a very high left mandibular angle (steep mandibular plane) compared to the right side and chin bone asymmetry. This could be improved by jaw angle implants (3mm lateral style on right and 3mm inferolateral style on left) and chin bony contouring. (right chin tubercle reduction) For the midface, I would look at not only buccal lipectomies but the addition of small cheek implants as well. When you have a long face that is flatter in profile (malar hypoplasia), some anterior projection of the cheeks is helpful. Otherwise, buccal lipectomies alone may just make you look a little more sallow or gaunt and not provide the facial highlighting that you desire.
Dr. Barry Eppley
Indianapolis, Indiana
Q: I am 38 years old and I need some changes to my face. It is a very round face without much definition or highlights. From a side view, I think my profile would be much improved with chin augmentation and fat removed from under my chin.. I do not know if my chin augmentation would benefit more from an implant or osteotomy. From a frontal view, I would like the distance between my upper lip and nose shortened. It is too long and I have a thin upper lip as well. I am attaching some picture for you to image to show me what could be done with plastic surgery.
A: Thank you for sending your photos. I have done some computer imaging based on your desired changes. I think you are correct in predicting that chin augmentation (implant not an osteotomy) with submental liposuction would make a nice change. The combination of the two can completely change the profile of your lower face. From a lip standpoint, your upper lip is very long and a subnasal lip lift would help shorten that distance. I have also added a buccal lipectomy to help slim your cheeks which would provide a good thinning complement to the proposed fat reduction in your neck.
The combination of all four of these changes would help make your face more proportioned and balanced.
Dr. Barry Eppley
Indianapolis, Indiana
Q: I am interested in making my face look thinner. Even though I am not fat (below the neck), my face make me look like I am. I have read about the buccal lipectomy procedure and that seems like it would work for me. I am most interested in getting the lower part of my face thinner. I have attached a front picture for computer imaging to see what the change would look like. Thank you for your help!
A: Thank you for sending your frontal picture. I have imaged the result doing buccal lipectomies (upper submalar triangle) and some perioral mound liposuction. (lower submalar triangle) It is important to realize that these procedures are most effective for the areas below the cheek down to about the mouth level and not for fullness at the jaw angle or in the lower part of the face. Facial defatting procedures work best in areas that are not directly supported by bone where the fullness is more the result of the thickness of the fat and not the bone. In bony-supported facial areas, thickness or projection can only be reduced by bone reduction which is often not only difficult but not that effective. There are no effective lower facial procedures (sides of the face and along the jawline) for defatting or making it look thinner.
Dr. Barry Eppley
Indianapolis Indiana