Your Questions
Your Questions
Q: Hello! I’m a young girl who has very puffy and big cheeks. From my cheekbones down to my jawline it is very full. I really love my face otherwise, but it’s too much fat there. I am a very thin girl and no one in my family has these big cheeks. Is there any way to reduce the chubbiness of my face? Do you think liposuction would make it thinner? Or is there something else to make my face thinner? I’m willing to do anything for this, because I’m depressed and desperate. Thanks.
A: Chubby cheeks are part of many person’s facial makeup, particularly when they are young. You did not provide your age other than to say you are young. But if you are under the age of 16, your chubby cheeks may become less so as you mature further. If you are over the age of 18 and at a good body weight then the fullness of your cheeks is built into your genetic code so to speak. Some reduction in the fullness of one’s cheeks can be done by buccal lipectomies and small cannula liposuction of selective facial areas. Potential liposuction areas include the perioral mounds (below the cheeks) and lateral facial areas around and in front of the parotid glands. These facial fat reduction methods will not make a chubby face thin but they will help provide some more shape and contours to an otherwise amorphous round face.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Several years ago I was involved in a cycling accident in which I landed on my face and broke a lot of my facial bones, including my jaw, nose and cheeks. My face was initially reconstructed and looked quite good, almost like it was before the accident. But after 6 months, I began to notice that my cheeks looked a little flat. This appears to have gotten worse and now they look even flatter than a year ago. I don’t like to look at myself in pictures because I look so flat in my face. I know that swelling does take many months to go away but this seems more than just swelling. Why has this happened and what can I do about it? Do you think cheek implants would be a good idea? Wouldn’t they be hard to get due to scar and the metal plates that were used to fix the bones back together?
A: It is not uncommon after extensive facial fracture repair that particularly involves the cheeks, that there is cheek flattening with time. This can happen due to the cheeks not being put back to their original projection or can even happen with the most accurate realignment of the fractured bone segments. This is the result of underlying soft tissue atrophy, particularly the fat which is very sensitive to trauma. As a result fat dies (atrophies) over time. This may make the cheek prominence, which initially looked good, become flatter as the face heals up to a year or so after the injury. Cheek implants can be a good secondary reconstructive procedure. It is important to get the right style and size of cheek implants to get a good result. It would be expected that there would be scar and even some plates and screws in the path of re-entry over the cheeks but this does not prevent the secondary placement of cheek implants.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Is a cheek implant that is placed high (near the orbital rim) and lateral, that extends to the orbital rim and that provides a significant augmentation (5 mm or more), able to lift the portion between the iris and the lateral canthus (not the lateral canthus itself) of the lower eyelid a little bit? I noticed this feature of the lower eyelids in people who have naturally very high and prominent cheek bones.
A: The simple answer is that it is unlikely. While it seems logical that the lower eyelid can be pushed upwards, and it is easy to do with one’s finger, try it by pushing up on the cheek tissue. You will notice the lower eyelid does not really move upward but just creates bunching of tissue right beneath the lid line. This is because the lateral lid line is fixed by the lateral canthal tendon. The only way to change the lateral lid line is by repositioning or tightening the lateral canthus. I suspect that putting in a cheek implant as you have described may seem to work during surgery, only to be disappointed later when no change is seen.
Dr. Barry Eppley
Indianapolis, Indiana
Q: I want to thin out my face and am thinking of having a facelift to initially tighten my skin and then my cheekbones (zygomas) cut and narrowed. The reason I am considering zygomatic reduction and face lift is to first “trim” excess skin for maximum tightening of the jowls, nasolabial region, cheeks and neck. Then narrow my face with zygomatic reduction, perhaps including the arch and the zygomatic body itself. I was hoping to improve skin definition below zygomatic arch and angularity of the jaw first, than schedule second surgery afterwards. Do you think it is a good plan for my case? Thank you kindly.
A: While I don’t have the advantage of looking at your facial pictures, I think your plan is fundamentally fine but it is planned in reverse. You want to do any skeletal or underlying foundational surgery first. The reason being is that such surgery causes a fair amount of external swelling which will stretch any tightened skin, potentially reversing some of the effects of any skin tightening procedure. Maximum tightening of the jowls cheeks and neck (facelift) should, therefore, be done after the bone foundation has been treated.
When considering zygomatic reduction, it is important to know if it will produce much of effect. This can be assessed by locally at plain film x-rays, particularly a submental and/or a water’s view. These simple films give a visual assessment of how significant the curve is on the zygomatic arches. That will have to be ordered through a hospital or any free-standing x-ray facility where the appropriate equipment exists.
Dr. Barry Eppley
Indianapolis, Indiana
Q: I recently had small cheek implants but they don’t seem to have made much of a difference. No one has really noticed. In addition, I have pain on my left side, it is more swollen, and my teeth and upper lip are numb. I think they should just be removed. Do you think implants should be removed sooner rather than later? What sort of time frame would you suggest -one week, two weeks etc? At this point I am taking Oxycodone just to get through work due to the pain. My plastic surgeon does not seem overly helpful at this point. I cannot get in to see him until the end of this month. The pain was so great over the weekend I was thinking of going to the ER but I did not think an ER doc could do a whole lot to help. Also, if the implants are removed will there be any permanent structural change to my cheeks, from the pockets that were created for the implants?
A: I would only suggest getting them removed sooner rather than later given your pain issues. If they weren’t painful, then there would be as much urgency to it. Such pain after cheek implants is uncommon…plus if the implant on the numb side is sitting up against the nerve (don’t know whether it is or isn’t but the numbness on just one side is a concern) the sooner it is removed the better for nerve recovery. With such small implants, there should not be any residual effects from having them in there. The pockets will just shrink down and go away and will leave no residual structural or scar issues.
Dr. Barry Eppley
Indianapolis Indiana
Q: Hi! I have been searching for this kind of procedure for cheekbone surgery or reduction. I am glad to have found this site. I come from a family which we have strong cheekbones, but in my case I have been in a violent incident where I was injured and I think I broke or deformed a bit of my jaw. Now I have some asymmetry in my cheekbone as it seems to have become more prominent after this injury. I would really like to know if it would be possible to reduce them. I used to have a lot of charisma when I was young before my violent incident. Since then it has totally changed me. I would like to know more details in this procedure, time of recovery, possible complications, etc. Thank you.
A: Cheekbone reduction is about narrowing the width of the body of the zygoma and the zygomatic arch. It is a common procedure for those whose face is naturally a little flatter and more wide as exists in certain ethnicities. It can also be used to treat a cheekbone fracture where the body of the zygoma has been pushed back which wides the zygomatic arch, making the cheek area have less prominence and more width.
Your description of your cheekbone problem is a it confusing to me. On the one hand, you state you have naturally strong cheekbones (forward prominence) but, after an injury, they have become more prominent. That would be very unusual given how the cheekbone fractures. For this reason, it would be best to send me some photos of your face for my assessment before I could provide any recommendations, specifically whether cheekbone reduction surgery would be benefical to you.
Dr. Barry Eppley
Indianapolis Indiana
Q: This is in regards to an unusual form of craniofacial surgery which I have been hoping to obtain for many years. I have a slender jawline and forehead, somewhat prominent browline, and both wide and prominent cheekbones. I was wondering if it were possible to have the cheekbones (by which I mean the zygomatic bone itself, the temporal process, and then the zygomatic process of the temporal bone) replaced entirely by synthetic implants so as to make my face more slender and these features, in particular, well-proportioned to the other features of my face.
A: The slimming effect to which you refer is known as cheek or midface reduction. To do so by conventional craniofacial surgery is well known and the techniques well established. It is a more common request in the Asian poopulation due to their facial shape. Complete cheek reduction is done by osteotomizing the front (zygomatic process) and back part (temporal process) of the cheek, removing bone, and allowing the enture zygomatic bone and arch (which creates the facial width) to move inward. The new bone positions are then secured with small plates and screws. This is done through an incision inside the mouth and a small incision in the temporal hairline. One can usually get a bifacial narrwoing of around 1 to 1.5 cms.
While any type of implants can be fabricated off of 3-D C scans and models, it is not practical to replace the entire zygomatic complex and arch to obtain midfacial narrowing. This would require extensive surgery, a large scalp incision, the removal of masticatory muscles which are attached to the bones, and the significnt risk of facial nerve injury. While this is done for extensive traumatic bone injuries and tumor resections, those risks for a cosmetic concern are not reasonable. This is particularly true when you consider that the same if not better result can be obtained by less invasive and ‘simpler’ surgical techniques.
Dr. Barry Eppley
Indianapolis, Indiana
Q: I am a fit 24 year-old guy but I don’t like the look of my cheeks. They are definitely chubby and they don’t fit my face or the rest of my body. I would to get rid of my chubby cheeks, All my family have chubby cheeks and they don’t look good on them either. I have read on the internet about different cheek procedures such as excision of the bichat fat pad, liposuction and smartlipo? Can you please tell me what to do?
A: Chubby cheeks or fullness in the cheeks is caused by excess fat in two different areas not just one. The upper submalar area (right below the prominence of the cheekbone) is where the buccal fat pad (formally known as Bichat’s fat pad) lives. The lower submalar area, unlike the buccal fat pad, is not one large piece of localized fat but is composed of diffuse subcutaneous fat. (fat layer between the skin and the buccinator muscle) A buccal lipectomy which is done from a small incision inside the mouth will help reduce the size of the area right under the cheek. But a buccal lipectomy will not change the fullness below that in the lower submalar area closer to the level of the mouth. These are perioral mounds which can be reduced by very small cannula liposuction done from inside the corners of the mouth. Both locations of fat removal are needed to get the best reduction of chubby cheeks.
Dr. Barry Eppley
Indianapolis, Indiana
Q: What are the options to put volume back to buccal area underneath the cheek bone? I am in my mid 30s.
A: A buccal or submalar indentation or concavity can occur for a variety of reasons including a congenital facial concern (developmental), after a buccal lipectomy (iatrogenic), or medication-induced. (retroviral drugs) This area extends from underneath the prominence of the cheek bone down to the end of the nasolabial fold and out into the lateral face. In many patients the outline of this area resembles a triangle, hence its common referral as the submalar triangle.
The easiest approach for submalar facial augmentation is the injectable route. The most common agents used are the synthetic material Sculptra or your own fat. Sculptra was specifically developed for exactly this facial problem with its initial FDA-approval for facial lipoatrophy in the HIV patient. It is not permanent, however, and it requires a series of three injections a month apart to build up a result that may last up to 2 years. Fat injections are more of a surgical injectable method as they require a fat harvest which is then processed and injected into the submalar area. The fat of fat injections is not always consistent but the submalar does better than many other facially injected areas.
The other submalar augmentation method is the use of implants. A synthetic implant, known as a submalar implant, can be placed on the underside of the cheekbone to provide fullness to the upper submalar area. The other implant option is the use of a dermal-fat graft which can be placed into the buccal space. In a few cases, I have done a combination of a submalar implant with a dermal-fat graft to get a more complete submalar augmentation.
Dr. Barry Eppley
Indianapolis, Indiana