Your Questions
Your Questions
Q: Dr. Eppley, I am interested in Perioral mound liposuction. I received Perlane to the corners of of my mouth and they have never been the same. I know the product is gone, but nonetheless the bulges remain. I do not know if they are fat, scar tissue or simply excess soft tissue, but I have these convex mounds on either side of my mouth which are less than attractive. I hate them and want them gone. They age me more than any other facial area.
A: Thank you for sending your pictures. Despite your lean face you do have very discrete convex mounds at the sides of your mouth. I could not tell you what composes them or how effectively they can be eradicated. But I do know that the only procedure that has any chance of reducing them would be small cannula perioral mound liposuction. This can be performed under local anesthesia or IV sedation. This is a small procedure that has a short recovery. Because of swelling and the small size of the perioral mounds, perioral mound liposuction can take several months to see the final result. I will have my assistant followup with you tomorrow to pass along the cost of the procedure.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have a very wide face and protruding cheek bones and it’s always been an insecurity of mine. I’ve also always has chubby lower cheeks.when I smile my cheeks tend to protrude a lot which makes my profile look very awkward. I really want to have a slimmer more masculine face/jawline. I’ve also been considering a lip lift to shorten the gap between my upper lip and nose, and a nose job for a slimmer less bulbous nose. What surgeries are right for me? And what combination of surgeries are safe to perform simultaneously?
A: When it comes to fullness of the lower cheeks, which are below the cheekbones and down closer to the side of the mouth, a defatting approach is needed. Given your pictures and the fullness that runs from just below the cheekbone almost down to the jawline, I would recommend the combination of a buccal lipectomy and perioral mound liposuction. These two together are the most you can do for helping change a round face to a more V-shape based on soft tissue changes only. It is also important to remember that the thickness and quantity of skin also plays a role so there are limits as to what facial defatting can do.
When it comes to a rhinoplasty and a subnasal lip lift, I do not recommend that these two procedures be done together. This has to do with ensuring good blood flow into the intervening columellar segment. They will need to be staged or done separately.
Dr. Barry Eppley
Indianapolis, Indiana
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
Indianapolis, Indiana
Q: Dr. Eppley, What type of procedure may work to reduce lower cheek fat. I have gotten filler in my cheeks, but it made no difference. I would prefer non surgical. I provided two photos for you to view, one at rest and one smiling. As you can see the smiling photo shows the problem I would like addressed.
A: In my experience the only effective method for reducing lower cheek fullness is microliposuction of the perioral mounds and down into the jowl area. I know of no non-surgical treatment that would have a thinning effect in this facial area. Nor am I surprised that filling up the cheeks would help this concern. It would not be improved by such a diversionary maneuver. Whether enough reduction can be obtained by the procedure can not be predicted beforehand, particularly in the thinner face where the fat layer is not excessive. But in my experience I have seen more successful perioral mound liposuction results than not even in thinner patients with no overly round faces.
Patients often confuse the location of the buccal fat pad which causes upper cheek fullness fullness with the perioral mound area that sits lower in the more superficial lower cheek area.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had perioral mound liposuction and buccal lipectomies a fews days ago to thin out my face. I have some questions about the facial swelling that I now see.
1) I’ve read there can be persistent fluid accumulation that could need to be aspirated…how do I know if I have this problem or just normal swelling?
2) Would wearing a compression garment facilitate faster resolution of swelling?
3) I’ve read massaging the liposuctioned areas can help resolve swelling…would you advise this or is it a better idea to just leave it alone and let it heal on its own?
4) The perioral region is much more swollen, stiff and numb than my cheeks. Is this normal? When I touch the area it feels hard under my skin. What is this? Swelling? Scar tissue? If scar tissue, how long will it take to shrink down?
A: What you are experiencing after facial buccal lipectomies and perioral mound liposuction is normal early after the procedures. But to answer your specific questions:
1) There is no fluid accumulation that will develop under the skin in facial liposuction. That is a phenomenon that is unique to body liposuction where large volumes are fluid are initially instilled (tumescent infiltration) to facilitate the procedure. Facial liposuction does not use this technique.
2) A compression garment will not facilitate the resolution of the swelling nor is it really practical to wear.
3) Digital massage (aka lymphatic therapy) can be beneficial for swelling resolution since it stimulates the lymphatic channels to open up by the pumping effect on the vessels.
4) The perioral region is stiffer and even more swollen than the cheeks because it is in a lower dependent position (gravity) and even the cheek swelling drifts down to that area. That is why the perioral tissues are so stiff.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am a 40 year old male who had my buccal fat pads removed about 10 years ago. My issue went unresolved however as the puffiness was closer to my mouth. There was no information online at the time and I have just lived with it. Recently, I came across the term ‘periorial mounds’. I went to see a local plastic surgeon about it and he admitted that he had never heard of such a procedure, that it would be much too risky and that there is no fat there regardless. I came across your name when further researching it. You seem to be alone in addressing the needs of people with this issue. I have attached photos of my condition and would love to get your feedback. I should mention, it is not only the visual aspect I am hoping to change, but also the constant weight I feel around my mouth. My questions are:
1. do I qualify for perioral mound reduction?
2. do I risk damaging nerves?
3. will the amount you are able to reduce have a noticeable effect physically?
4. will a reduction aid in reducing the fat on my jawline?
Thank you so much in advance for any further knowledge you can bring me, I really appreciate it.
A: The perioral mounds are a well known collection of subcutaneous fat that exists at the level of the corner of the mouth that is distinctly different than that of the buccal fat pads. It can be reduced by very small cannula liposuction and even a 1cc to 2cc fat reduction can make a noticeable difference. Although some plastic surgeons make not be familiar with its treatment, that does not mean it does not exist nor is it risky to do. In answer to your questions:
- You do have a fullness in the perioral mound area with an overlying skin fold which presumably is due to aging. (descent of the midfacial tissues) It is impossible to know beforehand how much the skin excess or subcutaneous fat is contributing to that appearance. But in my experience removing the subcutaneous fat through perioral mound liposuction can make that skin fold ‘lay down’ so to speak.
- This is a very safe facial area to do liposuction in. The buccal facial nerves run above it and the marginal mandibular nerve lies below it. This is a safe facial triangle for subcutaneous fat removal.
- There is no way to absolutely predict the change but I have yet to see a patient who did not get some improvement in their perioral fullness.
- The liposuction can and should be carried down to the jawline to maximize the procedure’s effectiveness.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Do I need a facelift to correct my chin sagging after being burred? I had a procedure done three months ago where the surgeon burred under and shortened the chin. It was done intra orally and the lower chin and my face is slack and looks like there is a protrusion. In other words it still looks like I have a double chin despite everything. I am not sure which procedure I need but I did include pictures. Also could a slight buccal fat removal be done in conjunction with this?
A: Intraoral chin reduction is almost always associated by loose chin skin afterwards and often fails to make a big improvement in the amount of chin projection. A submental approach to your chin reduction would be more effective. Whether this is addressed only by a submental tuck (submentoplasty) or would be rolled into a lower facelift would depend on where you see the area of improvements needed and whether you want the whole jawline tightened. It is not crystal clear in the pictures and the real test would be what happens when you bend your head down and where the skin rolls appear.
When referring to the buccal area, there is the area right below the cheekbone (the true buccal fad pad area) and the area that lies much lower near the mouth and jowl area known as the perioral mounds. (which is often confused with being the buccal area) I believe you may be referring to the perioral mound area by description and in the pictures. Perioral mound liposuction can be done in conjunction with any submental chin tuckup or facelift procedure
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I really need an opinion on what I should do to correct facial sagging or ‘bulging’ around my perioral area. I had upper jaw surgery six months ago which was a maxillary impaction. Since then, the left side of my face looks normal but the right side looks ‘pouchy’ and droopy to me. I’m glad I did the jaw surgery for my bite, but the way the right side of my mouth looks makes me feel old and ugly. I had a tiny bit of Juvederm injected in my cheeks and near the corner if my right lip a few weeks ago, but it hasn’t made any difference whatsoever to the problem. What do you recommend?
A: When you think about the mechanics of this type of facial skeletal surgery, it is perhaps no surprise that some facial sagging can occur in a few patients. When the maxilla is vertically shortened and the lower jaw rotates more upward in a new bite relationship, the overlying soft tissues have not changed. Thus there may be a relative ‘excess’ of soft tissue to bone. (bone is removed but the soft tissue is the same amount) While this is theoretically true, it rarely poses an aesthetic problem. But this can be a source of the tissue sagging…a relative soft tissue excess compared to the vertical length of the facial bones.
The options for improvement could be simple perioral mound liposuction on the fuller/sagging side or attempt to lift the sagging tissues by a variety of cheek augmentation methods. Which one may be best for you I can not say based on just this one picture and how you feel about the rest of your midface.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have a question about perioral mound liposuction. Do these mounds include the triangle from the corner of the mouth down to the jaw line? I was wandering if the jaw can be reached through the same procedure (I read on realself that you liposuction through the inside of the corners of the mouth.) I live on the east coast and cannot find any professional willing to do this. I am thinking of flying in for the procedure and would like to know the cost and recovery time.
A: You are describing exactly the location of the perioral mound, the subcutaneous fat that runs from the corner of the mouth radiating outward towards the cheek and down to the jawline including the jowls if so desired. Perioral mound liposuction is a very simple ‘micro’ liposuction procedure which, although only removing a few ccs of fat from each side, can make very visible difference in my experience. Although than some mild swelling there really is no recovery per se.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I feel like I have a good bone structure but my jawline and lower face shape is hidden by excess fat. Will a buccal lipectomy get rid of the fat above my jawline and chin or would it get rid of the fat below the hollows of my cheek bones? I ask this because I know this procedure can create a hollowed skeletal/meth-head look and having very high cheekbones, I know I may be prone to this effect. I am 20 years old.. Though this procedure is generally for older people, do you think it would benefit me by outlining the contours of my lower face? I would like an estimate and maybe an opinion on the procedure if you can spare one. Thank you for your time 🙂
A: When it comes to a buccal lipectomy, it is important that one distinguish what it can and can not do. It can reduce some fullness right below the cheekbone which you can locate by placing your thumb on the underside of the cheekbone. As you can see by doing this, that will not affect any fullness below it near the mouth or the jawline. This is an area that I commonly treat with small cannula liposuction to reduce the fullness in this area. This procedure has no risk of ‘overskeletonizing’ the face as it is subcutaneous fat removal and not one large lump or ball of fat like that of the buccal fat. (actually if done properly and in a subtotal fashion a buccal lipectomy will not make the face too hollow)
Dr. Barry Eppley
Indianapolis, Indiana
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
Indianapolis, Indiana
Q: Dr. Eppley, I am looking into buccal fat pad removal (buccal lipectomy) and possibly perioral mound liposuction. My face holds a lot of weight compared to my low body fat percentage. I workout consistently and follow a very precise diet but no matter how hard I try I can never seem to lose the fat on my face. I am self conscious and try not to smile in public as smiling makes the fat on my face more apparent. My father and my grandfather both have the same issue. I would like to know your opinion on what could be done to improve my appearance. I would really like to have a thinner face, similar to that of a male model.
A: I think your face would benefit by a buccal lipectomy and perioral mound liposuction to provide some improved contouring. Whether that would be enough of a change to give your face the ‘male model’ look is a more indeterminate question. It would definitely be beneficial in that regard, and you have the right face for these procedures that will best show their effects, but the male model look per se may be asking more than is possible. That, of course, depends on how one expects that type of face to look.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am a 19 year old considering a buccal lipectomy and wondering if I am a good candidate for it. I feel that there is some roundness to my cheeks that make the lower half of my face disproportionate to the upper half. I was wondering if the procedure would benefit me or if it wouldn’t make much of a difference. And if it does, whether I might not look too gaunt. I’ve seen a lot of regrets online but I wonder if it’s just a vocal minority. Thanks for the opportunity to gain some nice insight! Truly appreciated.
A: In looking at your your pictures and your young age, you would not be a good candidate for a buccal lipectomy procedure. While the initial result would meet your objectives, the long-term of it in your case would leave you looking gaunt and end up along with those that you have read that has regrets online. It is not that a buccal lipectomy is a bad procedure, as it can be very effective and successful in the right patient, but your face is not one of them. You do not have a ‘fat face’ or even a round face. Your level of fat lipodystrophy is very modest and the buccal lipectomy is too aggressive for your facial fat concerns.
In addition, where your facial fat concerns are is actually below of where the buccal fat pad actually is. It is situated just under the cheekbone and not down by the side of the mouth.
If you were to consider any facial thinning procedure, perioral mound liposuction is a better choice as it helps reduce the fat thickness at the lower end of the cheek and is a procedure that cannot really be overdone and has no long-term ‘gaunt face’ consequences.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in perioral mound liposuction. I have a problem with fat pockets around the corners of the mouth. I’ve had buccal fat pad removal before, but it did not help at the right area. I also have some fat along my jaw line that I do not like. Do you think it is possible to perform microliposuction at those areas? And how drastic will the result be? Are there any complications with this surgery? Have you done this surgery many times?
A: I am not surprised that a buccal lumpectomy do not affect your area of concern as the large buccal fat pad or any of its arms does not extend downward toward the corner of the mouth and jawline. This area, as you have correctly pointed out, is known as the perioral mound area which is a subcutaneous layer of fat. (not like a well defined fat capsule like the buccal fat pad) I have done perioral mound liposuction numerous times. It is done with a very small cannula from a small incision inside the corners of the mouth. As there are no facial nerve branches in this area, one can aggressively liposuction it. It never produces a large amount of fat and often only a few ccd is obtained, but in the right patient, that can make for a noticeable thinning effect.
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 makes 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. Thank you for your help!
A: To treat the soft tissue facial triangle area (lines drawn between the cheek, chin and jaw angles), the procedures of buccal lipectomies and perioral mound liposuction may be useful for ‘facial derounding’. 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. A buccal lipectomy removes a very distinct large ball of fat that sits right below the cheek bone. It is done from a small incision inside the mouth. It is important to not totally remove it so one does not get a gaunt look later in life. But for someone with a really round ‘fat’ face this potential issue may be irrelevant. The perioral liposuction procedure removes fat from below the buccal fat pad that sits right under the skin opposite the mouth. It is done from a small incision inside the mouth. Done together these two distinctly different facial fat removal procedures can help create a facial thinning effect.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I was interested in having liposuction in order to remove the perioral mounds in my face. I am 20 years old. I have some questions related to this operation. First of all what are the dangers of it and how much time does it require for the face to be full recovered? Will it damage my face muscles? Does this liposuction last? Will the fat mounds come back again? I was also curious to know if this operation is going to remove the marionette lines from my face.
A: In answer to your questions about perioral mound liposuction:
1) There are no dangers to the procedure, nothing adverse can happen to your face. It is just a question of how much reduction can be achieved.
2) It will take a full 3 month to see the final results of the soft tissue reduction although about 85% to 90% is evident by 6 weeks after surgery.
3) It will not damage the facial muscles.
4) Unless one gains a lot of weight, the results should be permanent. The perioral mounds are not a fat depot area. They are usually there due to congenital development not as excess fat deposits due to too many injected calories.
5) Perioral mound liposuction will NOT remove your marionette lines. They are not there because of the fat in this area.
Dr. Barry Eppley
Indianapolis, Indiana
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
Indianapolis, Indiana
Q: Dr. Eppley, I want to look younger and more attractive. I used to get comments that I looked so much like Angelina Jolie. I don't get those compliments anymore. One of the attached photos is me when I was younger. The other one is me now. I need some cheek sculpting to bring my now fat cheeks in more.
A: Thank you for sending your pictures. The difference between you now and when you were younger appears to be wide or 'fatter' cheeks with loss of a high cheek definition look. This could be caused by aging (falling cheek tissue) or increased fat collections in the lower cheeks with age and some potential weight gain. Careful analysis of your pictures shows that the main difference is inversion of the soft tissue cheek triangle. When younger the cheek was an upside triangle with most of the fullness up top and the apex of the triangle down below inverted inward. With time the triangle has inverted with the base of the triangle now at the bottom of the cheek (most fullness) and the top of the triangle up high over the cheek bone. (Ileast fullness) To attempt to rearrange this soft tissue triangle the following needs to be done…buccal fat pad extraction and relocation to the cheek bone (like placing an implant) or cheek fat injections and perioral (lower cheek) liposuction. In essence, add fullness over the cheek bones and remove fat below the cheek bones. Since fat changes are the crux of the facial problem it makes most sense to undergo a fat redistrbution surgery.
Dr. Barry Eppley
Indianapolis,Indiana
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 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 want a slimmer less round lower face, so a slight ogee curve is visible. How is that best done? Or can it even be done?
A: When it comes to contouring the area between the cheek and the jawline, it is important to remember that this is an area not supported by bone. So any fullness is due to the thickness of the soft tissues. (skin, fat and muscle) To get any change in this area (a midfacial slimming effect), a combined buccal lipectomy with perioral liposuction (affects lower cheek area, buccal lipectomy does not) is needed to achieve the best facial contouring. The question for this procedure combination is how much of a change can it make. In my experience, most patients will experience a visible contouring effect but it may take up to six weeks after surgery to see the full result.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had a chin implant and buccal fat removal several years ago to make my face less round. While that has provided some significant improvement, I still feel my cheeks are too fat. The fullness that bothers me is the fat pad below the buccal fat area. I have had several consultations with differing opinions. One surgeon suggested liposuction with a mini face lift while another recommended a deep plane facelift with removal of fat under the cheek muscle. I am confused.
A: The specific cheek area to which you refer is below the buccal fat pad and is known as the perioral mounds. This is a fat layer that is separate from the buccal fat pads and will not be affected by their reduction/removal. It is a common misconception that buccal fat removal will thin out this area as well. Perioral mounds can be reduced by small cannula liposuction done through a small incision inside the corners of the mouth. I have found that ‘chubby cheek reduction’ usually needs a combination of buccal fat pad reduction and perioral mound liposuction to get the best reduction possible. In some cases, small cannula liposuction also needs to be done above the level of the nasolabial fold at the subcutaneous level. While a mini-facelift may help with tightening loose jowl and neck skin, it will not make a significant effect on the thinning of your cheeks. Skin tightening will not make a dent in the thinning of full cheeks.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have previously sent you photos of me for consideration of a rhinoplasty and a chin augmentation. You sent back some imaging results and, after reviewing them, I have a few questions:
1) Rhinoplasty – I like the overall effect! I just wanted to ask if there was anyway you could make the bridge a little more concave, and if it would also be narrower from the frontal view, and if the tip might be narrowed as well? I know you said that you usually provide an image of the minimum effect that could be achieved, and if this is it, that’s great – I’d still be happy with the improvement.
2) Chin – I think I like the implant a little more than I like the osteotomy, though of course it doesn’t fix the underlying skeletal problem. I might still consider the implant but I haven’t decided.
3) Cheeks – One more question regarding my “chipmunk cheeks”. While my friends and family call them “endearing”, I”ve always wondered if I couldn’t have a little less of a balloony cheek especially right below the corner of the mouth. Is there any way of filling in the tissue right at that spot, or (I guess) of removing fat from the cheek (though I do like my dimples!
Thank you for taking the time to answer my questions and being patient with me!
A: In answer to your questions:
1) Ideally I would like the front view rhinoplasty result to be more narrow, and it may be possible, but your thicker skin may preclude that from happening. For this reason, I have imaged it so that the amount of narrowing will reflect what I believe will happen… but I am pulling for more.
2) I would agree that the implamt effect, while not providing as much horizontal advancement as an osteotomy, seems to be more ‘natural’ looking. It is always best in chin augmentation in a female to be less rather than more. That still preserves a feminine look.
3) You are referring to what is known as the perioral mounds. a cheek fat area that is below the buccal fat pad. That can be effectively treated by small cannula liposuction done from inside the mouth.
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 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
