Q: Dr. Eppley, I had my buccal fat pad extracted a few years back when I was younger. I liked the look initially, but it has now made me look a little too gaunt.
Anyway, I’m looking to add more volume back to the buccal region. I’m not sure how to describe it, but imagine pressing a couple of fingers diagonally up below the cheek bones.
The question is, I’m not sure what route to go for volume restoration to the region. Personally, it seems the more logical choice would be to replace like with like and to use fat injections to the region. However, I’ve read some doctors advocate the use of submalar implants.
In your opinion, which would present with the better result?
A: By far and away, the best approach is the submalar implant combined with a little fat injection around it. The submalar implant covers the upper half of the buccal space but not the lower half. So depending upon the extent of the buccal deficiency, fat injections may or may not be needed.
Dr. Barry Eppley
Q: Dr. Eppley, I am concerned about the way my face has started to look. I am only 45 years old but I look much older. I don’t think there is anything in my medical history that could explain this change in my appearance. I’m otherwise quite healthy; I eat well, exercise regularly, and have not had any recent weight loss or gain. I had a hormone panel done and they are all normal. The only other possibility I can come up with–although I highly doubt medical data could back-up my hypothesis–is that over the past few years I lost both of my parents. I feel that perhaps stress and anxiety have taken their toll on my face. I have attached pictures so you can see what I mean. I also have an indentation below my left cheek that has appeared without any explanation. I wonder if a submalar implant would work to build out that area. Otherwise, I would welcome any other suggestions you would have for my aging face.
A: Thank you for your inquiry and sending your pictures. Based on a review of your pictures, I can make the following comments.
1) The area of left facial indentation/depression is not over a bony prominence or the submalar area. It is actually over the concave portion of the underlying maxilla and is in the area of the infraorbital nerve exit/distribution into the tissues. I do not know why it has selectively become that way.
2) You also have more generalized facial lipoatrophy which is apparent when looking at your younger facial photographs. While you have no sagging skin that would require something like a facelift, your face has undergone more deflation or loss of volume.
3) A submalar or any other type of synthetic or bone-based implant is not what will work for the soft tissue indentation.
4) I think that concentrated fat injections, not only into the left maxillary indentation, but through your cheeks, orbital and lateral facial areas would be a good treatment for you. You need restoration of facial volume through injectable fat grafting.
Dr. Barry Eppley