Your Questions

Q: Dr. Eppley, I am interested in facial thinning. I have a soft tissue region around the jaw area (just below the TMJ), it is a narrow strip that runs along the back border of my jaw as it goes from the angle to the TMJ. This region flares out and gives the appearance of an overly wide face. I have been to some parotid specialists and they have confirmed that I have no parotid swelling and that it is other tissue – SMAS/fatty tissue. I am about 10% body fat, so it is not because I am overweight. I was wondering if you could reduce this region of the face by removing this tissue?

A: The area on the face to which you refer is composed of the parotid gland and the SMAS layer. Undoubtably the greater fullness in this area is whatever size the parotid gland is. The SMAS layer is not that thick particularly at only 10% body fat. Can the SMAS layer be thinned out/removed in this area? Yes although there are branches of the buccal facial nerve that are at some risk of injury and removing the SMAS over the parotid gland creates the risk of a parotid sialocoele or salivary leak. All of these risks associated with lateral side of the facial thinning are done without knowing whether it would make much of a difference. The best way to answer that question is to get an axial MRI of the face where that question can be answered.

Dr. Barry Eppley

Indianapolis, Indiana

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

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