Q: Dr. Eppley, I would like to remove fat from both sides of chin and redefine my jawline and make my face symmetric again. I had a procedure 3 months ago to remove fat from my cheeks (bichat fat) in order to make it look thinner. I did not attain the expected results as my face doesn’t look thinner but is now asymmetric and it looks like I have a lot of fat on both sides of my chin (makes me look older!). Can you please help?
A: Often surgeons think that taking out the buccal fat pads will make a face thinner when the fullness problem is actually much lower. There are two separate fat compartments between the cheek and the jawline, the well encapsulated globular buccal fat pads located just under the cheek bone and the more superficial and less volume perioral mounds located just under the skin besides the corner of the mouth and extending down to the jawline. Since I have no idea what you looked like before their removal, I can not say whether removing the buccal fat pads was truly the main cause of your facial fullness concerns. But the subcutaneous fat around the mouth and chin (perioral mounds) now looks fuller because it remains unchanged as the area above it where the buccal fat pads are is now thinner. It may be that microliposuction of this fat area would complete the ‘project’ and should help. Whether any fat should be replaced due to the asymmetry above caused by the buccal fat pad removal may be a solution to also consider. It is either that or do further removal on the fuller side. That choice is a matter of your aesthetic judgment.
Dr. Barry Eppley
Q: Dr. Eppley, I am interested in facial liposuction. I am slim but hate my chubby cheeks. Whatever I do they don’t go away. I tried buccal fat removal with little luck. Problem is the round bit of fat in malar pads which always goes very high on my apples of my cheeks when I smile. Can the cheek malar pads be removed completely? I want like male models so it looks like no fat at all on cheeks and so When smile it is just skin that raises up instead of the fat malar pad. I dont need malar lift, I just want it to be gotten rid of for good. Can it be completely removed and sucked out even if this may leave some sagginess of the skin. After that maybe I can have midfacelift if needed but I really want this malar pad gone. It is not buccal fat that I want gone, it is malar pad which rests on top of cheekbone. I don’t want a malar lift to redistribute fat on to higher position, just complete removal. Is it possible?
A: I understand perfectly as to what you are referring to and it is no surprise that a buccal lipectomy would have no effect. The buccal fat pad is in a lower anatomic location. The tissues that you are referring to are over the malar region but to describe them as the malar ‘fat pad’ is not anatomically accurate for what you are trying to achieve. The malar ‘fat pad’ is not like the buccal fat pad, it is not an isolated and thus easily extractable type of fat. Rather it is fat mixed in with other tissues giving it a more fibrofatty quality to it. Thus it is not amenable to excision (like the buccal fat pad) and is more resistant to small cannula or microliposuction. This does not mean it can not be treated, it is just a question of how effective it would be and that disrupting these tissues will cause it to sag as the suspensory ligaments would be traumatized. But when it comes to complete removal of the malar fat pad fullness, I do not believe that is surgically possible.
Dr. Barry Eppley
Q: Dr. Eppley, I am interested in facial reshaping/liposuction for my son. For several years my 16 year old son has expressed concerns with excess fat in the cheek/chin/neck area. He has a genetic double chin that upon weight loss did not help and did not go away. In tears, my son asked if he could do what I did (lower face lift/liposuction) While I do not feel it would be necessary for him to go as extreme, I told him I would research his options. In my own experience, I know it’s not something that diet and exercise alone can help with. As a parent though I am conflicted regarding the risks/ psychology etc. of a surgery for cosmetic purposes at his age. Thank you in advance for your help and information!
A: When it comes to facial reshaping via fat removal, there are several specific areas in the face where fat extraction can be very helpful. This includes the neck (liposuction), buccal fat pad (buccal lipectomy) and the perioral mounds. (liposuction) All three areas would be of benefit to your son based on his pictures. That may not necessarily completely deround is face or give him a thin face but would make a substantative improvement.
When it comes to plastic surgery in teens, the major consideration is their level of expectations. Being less mature and often being guided by information that they find on the internet, their sense of realistic expectations and the necessary recovery process until they truly see the final results is often not accurate. But from a physical standpoint, there is no greater risk of these facial procedures in a teen ager than in an older adult.
Dr. Barry Eppley
Q: Dr. Eppley, I’m 27 years old. I need your help to correct my facial cosmetic problem. I had chubby cheeks and broad nose tip, a saddle bulbous appearance. It did not go well with my body as I’m of medium built. I always wanted to have chiseled face and sharp nose. I finally went to a cosmetic surgeon to get this corrected. The doctor performed a face liposuction, rhinoplasty and he also made a cut in my upper eyelids as I had some fat there as well. This procedure was done in January 2009. After this I developed facial asymmetry. The outcome of this surgery is listed below:
Cheek liposuction :
– The right side of the cheek looks more chubbier than the left one.
– The right corner of the mouth does not move as much as the left one.
– The right side cheek pad is sagging in mid cheek region towards the nose.
– Both cheeks lack toning.
– Face still looks chubby & not chiseled.
– Hardly any difference.
– Nose still looks bulbous.
I went to the same doctor asking for correction but he never agreed to these flaws and in fact tried to ignore. I felt cheated and went to another surgeon. He extracted the buccal fat from my cheeks. However, still my cheeks look chubby. For my nose he has just placed the L-shaped implant through inside of the upper lip without making any other changes to the nose. I like the upper half of my nose as i needed little augmentation there but not in the later half. This has not solved my bulbous nose or wide tip problem. The shape of my nose has not changed. It just looks ” Over Augmented” specially in the lower part. This was done recently in September 2012. The surgeon says he can remove the implant if I don’t like it and give a stitch in the tip to narrow my tip.
I really wish to get this fixed as soon as possible as my life has stopped I really need to move on. Although I belong from a middle class family, I went out of the way to get this done but just ended up wasting my hard earned money. I am a focused person about what I want to achieve in life. I know things have gone wrong but I have not lost hope as I believe nothing is impossible if you are hopeful.
I just need right guidance & skilled specialist who can help me correct this. I have read good reviews about you and seen your picture gallery. I really appreciate your contribution in the field of cosmetic surgery. Please help me with whatever best can be done. I have attached my photographs for your kind reference. Please revert to me and let me how we can take it further.
A: Thank you for your inquiry and sharing your unfortunate cosmetic surgery experiences. Your issues break done into two areas; your nose and your chubby face. It looks like you have had some negative effects of liposuction including asymmetric fat removal and weakness of the buccal branch of the facial nerve on one side. Since you have already had the buccal fat pads removed, ti is not clear how much more improvement, if any, can be gained by further attempts at subcutaneous facial liposuction. I know that you are very unhappy with your fuller cheeks, but I do not think there is any ‘magical surgery’ that can provide the amount of facial slimming that you desire. It may be worth an effort to do some small cannula liposuction to try and get some areas more even but there is no operation that is going to make your face chiseled…it simply does not exist from where you are now.
Conversely, I think your nose does have room for more significant improvement from a further rhinoplasty effort.. What is not clear to me is exactly what has been done. (or even why) It is not clear at all what was done on the first rhinoplasty and the second rhinoplasty appears to merely have been the placement of an L-shaped silicone implant. It does not appear that you have had any real tip work done other than to try and stretch it out with an implant…which may have only pushed the wider tip up higher. I think you would benefit by some tip work for narrowing but the real question is what to do with your L-strut that is in place. There is dorsal augmentation benefit to it being there but it has also now stretched out the tip skin so removing it and not replacing it with something is going to make the tip situation worse. Normally I would opt for a rib cartilage graft replacement but that may further than you want to go.
Dr. Barry Eppley
Q: Dr. Eppley, I am interested in a more structured feminized face. I am 40 years old and have wanted to balance my face my entire life. The fat never dissipated with age so I now find it agonizing. I also think chin augmentation would help but I am not sure about that.
A: In looking at your face, I believe your fat concerns go beyond the buccal fat pad area. Most people have a misconception about where the buccal fat pad lies. Even though it is a fairly large fat collection, it only occupies a small area immediately below the cheek bone. It does not extend down near the mouth area which is a different area of fat in the subcutaneous layer know as the perioral mounds. When looking for facial thinning in the cheek area, it is usually necessary to combine partial buccal fat pad reduction with perioral mound liposuction.
I can not tell about the potential benefits of chin augmentation based on just a frontal picture only. I would need to see a side picture. Chin augmentation is usually only beneficial to facial thinning if it helps elongate the face and helps makes the chin more narrow in the frontal view.
Dr. Barry Eppley
Q: Dr. Eppley, I had buccal fat removal a few months ago. That helped a little but I want an overall smaller face so I would like to get liposuction around my neck area, neckline my lower cheeks, areas surrrounding my jowl and chin area. I want all the fat that I have from my mid face down, ear to ear, to be all 100 percent removed.I just don’t like the fact that I have fat on my lower face instead of in my upper cheeks. When I smile I feel like the muscles or perhaps the fat pulls my nostrils out making them look wide. I thought that may be fixed with liposuction or it might just be fixed with rhinoplasty.
A: When it comes to facial liposuction, the reality is what you are asking for can’t be done with the result that you want. There is no such thing as ‘removing all of the fat’ no matter where on the body liposuction is performed. Facial liposuction is particularly unique because the fat is in very select and limited compartments, thus limiting how much facial slimming can be achieved. There are several discrete compartments of the face in which face can be reduced and includes the buccal space, perioral mounds, submental, lateral neck, lateral face and jaw angle area. Liposuction can help provide some refinement and mild sculpting to the face but it is best not to overestimate its facial slimming potential. Facial contour improvement is possible but removing all the fat is the face is impossible.
Dr. Barry Eppley
Q: Dr. Eppley, I’m emailing to consult on your ability to improve some concerns that has not been ameliorated through exercise and diet. I am 5’10 and weight 172 pounds. Specifically, my upper cheeks and face carry a significant amount of fat which appears to be genetic and gives my face a chubby look. I have attached pictures and circled the areas of my concern. In addition, I’m curious what you can do for the fat in my chest and underarm area. A number of military guys I have spoken with have mentioned a procedure known as “pectoral etching”. What it sounds like is liposuction in this area with some contouring to create a more defined/chiseled pectoral look.
A: What you are demonstrating in your pictures is a zone of cheek and perioral subcutaneous fat, a layer that lies just under the skin. It should not be confused with deeper fat layers, such as the buccal fat pad, which it is not. These are very difficult areas to successfully reduce although its treatment is straightforward. Small cannula liposuction is used from a small incision inside the mouth and the bottom end of the nasolabial fold. In my experience I have seen good and mediocre results with this procedure. The hardest area to improve is that closest to the eye. The other issue with facial liposuction in this area is some prolonged swelling. While this is very typical of liposuction anywhere, it is very visibly noticeable when it is in the middle of your face.
From a chest standpoint, you are correct about pectoral etching. There is nothing magical about this technique. It is the artistic use of liposuction to create a better pectoral definition, largely using reduction of the lateral pectoral triangle for its effect. I have used it frequently with overall chest liposuction in male gynecomastia liposuction surgery.
Dr. Barry Eppley
Q: I am a former patient of Dr. Eppley. I had buccal fat removal and love my results… however, I am still interested in having facial liposuction to sculpt my cheeks out a bit. I am wondering if he can do this and this is possible.
A: The removal of the buccal fat pads is the largest fat depot that can be surgically removed on the face aside from the neck. Its removal creates a slimming change in but one region of the face, the submalar region or the area right below the cheek bones. There are no other distinct or encapsulated fat areas to remove on the face. The rest and majority of facial fat is located in the subcutaneous level or right under the skin. This is much more difficult to remove and can only be addressed by small cannula liposuction. Many such facial fat areas are not even treatable by liposuction.
When patients seek a slimming effect of the face, they often are referring to the side of the face from the cheeks down to the jaw line. This leaves a lot of facial areas beyond the submalar or buccal fat region. Most of these areas can be treated by liposuction if done carefully and not done too deep. The buccal branches of the facial nerve lie on top of the muscle layer just underneath and injury to them should obviously be avodied. The question is not whether it can be done, but whether any significant change can be achieved. In general you can not make a wholesale facial slimming change by facial liposuction but small discrete areas may be able to be improved.
Dr. Barry Eppley
Q: I am Korean and I would like to have more of an oval face shape. My face seems too wide and I would like a narrower lower half of my face that looks less puffy and flabby. I am thinking that maybe jaw angle reduction nd facial liposuction would be what I need. Here are some pictures for you to see what my face looks like.
A: Thank you for sending your pictures. It appears that your desire is to narrow the lower third of your face, which is most affected by the shape of your jaw located at the angle area. The consideration of a jaw angle reduction is reasonable, it is a question of how much reduction can it achieve. That question is best answered by knowing how much the bony jaw angle is actually contributing to the fullness in that area. While it clearly makes some contribution, particularly with your ethnicity, the question is whether it is enough to make it worthy of reducing it. That question can be answered by a simple dental films, a panorex and a lateral cephalometric x-ray. They will show the exact amount of flare at the angle as well as the thickness of the bone. That information is crucial in determining whether jaw angle reduction can be justified.
Facial liposuction will make but a very minor contribution to any facial narrowing effect. I can see in your pictures the value of submental/neck and lateral facial liposuction as a possible complement to jaw angle narrowing.
From a loose flabby skin standpoint, only some type of skin tightening procedure (e.g., jowl tuck-up) would be of benefit and you seem too young for that effort at this time.
Dr. Barry Eppley