Q: Dr. Eppley, I had both buccal fat pad removal (10+ years ago) and cheek implants (6 mos ago). I'm now considering fat transfer to go over my cheek implants since that didn't seem to add enough volume. I was also considering perioral mound lipo, but I have a concern that I hope you can advise me on. Ever since my buccal fat pad removal (10+ years ago) I've felt a constant throbbing in my cheeks, the Dr. that did my cheek implants said it was likely due to nerve damage. Do I face a higher risk (than the typical person) of further nerve damage because of this? If further nerve damage did occur, what would be the extent of it? i.e., do I run the risk of paralyzing all the nerves in my face, or having thick scar tissue, or…?? Also, do you think with the fat transfer that I could look like I did before? My goal is to not only look like before, but also go back into modeling and acting. I very much like your website and it seems you have a lot of experience.
A: Knowing your prior facial surgery history explains your younger appearance with the indentation in the submalar/buccal fat pad space from an earlier picture. Since you had cheek implants just six months ago, that explains several current findings. First, the throbbing that you feel in your face is not likely nerve damage. The nerve that runs around the buccal fat pad is a branch of the facial nerve which is partially responsible for upper lip and nostril movement. If that nerve was damaged you would have some observable facial weakness not a throbbing sensation. The most likely reason you feel a throbbing sensation is the loss of the buccal fat pad which helps buffer the pulsations from a large branch of the facial artery that crosses around it. You always have to remember that the buccal fat pad was there serving some purpose. Thus your face is not at any higher risk of further nerve damage no matter what additional procedures that you may undergo. Second, if the cheek implants didn't give enough volumetric addition that would indicate that the style or size of your current cheek implants is inadequate. When considering additional cheek augmentation, your options would be an exchange to cheek implants that have more projection (much easier the second time around because of the existing pockets) or fat injections. Each of these has their own advantages and disadvantages. While you can certainly put fat injections above cheek implants (not actually on the implants) there is always the unpredictability of how much fat will survive. But certainly fat injections are easier with next to no recovery other than the temporary acceptance that they will be a little too big, compensating for some injected fat absorption in the first 6 weeks after the procedure. That combined with perioral mound liposuction creates a complementary cheek effect.
In terms of can you get back to exactly to how you were when you were younger, I would say no not exactly. At best I would anticipate you would get closer but never exactly that exact look again as you are now older.
Dr. Barry Eppley
Q: I am thinking about getting numerous facial procedures and I have a few questions. I am wondering if getting a chin implant will stop hair growth on my chin? Whatever I have done I want a natural look, will too much facial surgery ruin this or make me look unnatural? Last question,what are some alternatives to cheek implants?
A: A chin implant will not stop beard growth on the chin. It is put in through an incision under the chin so it is very far away from the hair follicles of the chin skin.
Getting a natural result in facial surgery is based on doing whatever procedures are done in balance with the rest of the face and not overdoing any one procedure. Facial surgery, whether it is a rhinoplasty, chin implant or forehead recontouring, is making the structural change to look ike it belongs to the rest of the face.
The only alternative to cheek implants is fat injections. While I think cheek implants and their numerous styles and sizes offer more versatility for cheek changes, fat injections can definitely add volume to the cheek and submalar (below the cheek) areas. With today’s more concentrated methods of fat preparation, fat injections to the face also work better in terms of maintaining volume to the injected facial area.
Dr. Barry Eppley