Q: Dr. Eppley, I am a 32-year old woman and I have been searching for a solution to my protruding mouth (or perioral mounds)…I have had this all my life, and recently got some filler in my chin to balance out my bottom lip protrusion and also have Invisalign to correct my teeth. However, none of these treatments will get rid of the fat around the corners of my mouth and under my bottom lip. I saw a great case study on your web site and I’m wondering if I might be a candidate for the corner of the mouth lift and perioral mound liposuction. My big concern is that surgery could affect the muscles, leaving irreversible damage. Also, I wanted to comment on the results in the case study were very appealing to me because it appeared that the mouth lift and liposuction actually gave the patient an illusion of dimples, which I think is very attractive.
A: Small cannula liposuction can be done very successfully on the sides of the mouth, known as the perioral mounds. But it can not or should not be done below the lower lip as, not only will not be effective, but may cause injury to the depressor muscles of the lower lip. (as you have correctly surmised)
Tweaking up the corners of the mouth with perioral mound liposuction can certainly create the appearance of dimples as the mound area goes from convex to concave with enough fat removal.
Dr. Barry Eppley
Q: Dr. Eppley, I am a 25 old year guy and I am really not satisfied with my looks. I am looking to improve upon my face for a more youthful look .I know it’s not wise to compare yourself to others as everyone’s face is unique but I think the most distracting feature of my face is a very big and wide lower face (mandible) that makes my face chubby and more old looking. The last time I inquired you about an outer cortex osteotomy for as such the same problem and you requested my pictures so I did attach them. Now I would be really grateful if you clarify me my following doubts:
1. Is it possible to reduce my lower jaw width and angle to make my face more slimmer and proportionate?
2. If yes, how much is it possible to reduce the bigonial distance and achieve a more ovoid looking face (Front view) in my case?
3. Would chin augmentation be helpful to achieve the same?
4. I also want to have a tip rhinoplasty that would give my nose tip more definition and sharpness. Again, how much is it possible to achieve a nose like the one in the model pictures I have attached?
5. Please suggest any additional improvements in case you notice that would be required for a more youthful appeareance such as brows,cheeks or any other.
A: In answer to your questions:
1) There is not a really good procedure to make your entire lower face more narrow. Even if one could do a lateral corticotomy (remove the outer layer of the lower jaw bone) that would just not make enough of a difference in your face.
2) Certainly the jaw angles can be removed but whether that would make a very visible difference is uncertain. Some of your facial width is soft tissue and can not be reduced. The best way to answer whether this procedyure would be worth it is frontal cephalometric x-ray or facial film to look at how much flare the angles have. If it is significant then it may be worthwhile.
3) Vertical chin lengthening is, by far, a more practical approach to facial lengthening (and narrowing) for you given the more square facial shape that you have.
4) A tip rhinoplasty will definitely help narrow your nose but trying to achieve the very slim noses in the pictures you have sent is unrealistic. You will likely end up halfway between where you are now and those type of results.
5) Some soft tissue (fat reduction) would also be helpful, removing part of the buccal fart pad and thinning out the fat outside of the corners of the mouth.
I would think that a vertical lengthening chin osteotomy, tip rhinoplasty and buccal lipectomy with perioral liposuction would be the three procedures that I would recommend that could make the greatest difference in your facial shape/appearance.
Dr. Barry Eppley
Can My Upper Lip Be Made Smaller, My Face Look More Masculine and My Acne Scars Be Treated All In One Surgery?
Q: Dr. Eppley, I am looking to improve the appearance of my lips, acne scars, and face contouring. I have very large lips and the upper lip is very full and bigger than the lower one, it gives me a duck lip appearance. The upper lip rests above the lower lip instead if the other way around. What would be the best thing to do about that? I have also attempted to loose weight to slim the face yet there is much fat around the lip area and the cheek bone area which does not go well with the full cheeks. I am attempting to achieve a slim-defined male model type of face as well as diminish the appearance of my acne marks. Somehow my facial features don’t mix well with one another. I believe my face is feminine in a way, is there a way to give it a more masculine look?
A: While many people want to achieve an upper lip size that matches the lower one, you have an opposite concern. The upper lip can be reduced by an internal vermilion reduction to reduce its size and roll back the pout of the upper lip. That leaves any scar on the inside of the upper lip.
From a face standpoint, I don’t see large buccal fat pads to remove but I could see some benefit by perioral liposuction to reduce the perioral mounds out to the side of the lips. While you did not provide a side profile view, chin augmentation with more width and horizontal projection may be more masculinizing for you. But I would need to see some additional photos to be sure that is of benefit.
Acne scars can be improved by fractional laser resurfacing but it is important first to have the acne eruptions under control. With laser resurfacing the ointments needed afterwards as it heals can cause a lot of pore obstruction and an onset of new eruptions.
Dr. Barry Eppley
Q: Dr. Eppley, I am interested in having liposuction of my perioral mounds done. I just hate those blobs of fat to the side of my mouth. My only concern about the procedure is that I have read that there are a number of facial nerves near the perioral area. My question is could they possibly be damaged by perioral liposuction. Is this a real concern in your opinion and, if so, what are the risks and side effects of this type of complication?
A: The perioral area is located between the buccal and the marginal mandibular nerve branches of the facial nerve as it comes forward from the ear. Therefore, liposuction is in a safe zone from a facial nerve injury standpoint. So this is not a concern I have as I have yet to see any nerve problems with liposuction in this area.
Dr. Barry Eppley
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