What Be Done For My Chubby Cheeks and Bulbous Nose?

Q: Dr. Eppley, I’m 27 years old. I need your help to correct my facial cosmetic problem. I had chubby cheeks and broad nose tip, a saddle bulbous appearance. It did not go well with my body as I’m of medium built. I always wanted to have chiseled face and sharp nose. I finally went to a cosmetic surgeon to get this corrected. The doctor performed a face liposuction, rhinoplasty and he also made a cut in my upper eyelids as I had some fat there as well. This procedure was done in January 2009. After this I developed facial asymmetry. The outcome of this surgery is listed below:

Cheek liposuction :

– The right side of the cheek looks more chubbier than the left one.

– The right corner of the mouth does not move as much as the left one.

– The right side cheek pad is sagging in mid cheek region towards the nose.

– Both cheeks lack toning.

– Face still looks chubby & not chiseled.

Rhinoplasty :

– Hardly any difference.

– Nose still looks bulbous.

I went to the same doctor asking for correction but he never agreed to these flaws and in fact tried to ignore. I felt cheated and went to another surgeon.  He extracted the buccal fat from my cheeks. However, still my cheeks look chubby. For my nose he has just placed the L-shaped implant through inside of the upper lip without making any other changes to the nose. I like the upper half of my nose as i needed little augmentation there but not in the later half. This has not solved my bulbous nose or wide tip problem. The shape of my nose has not changed. It just looks ” Over Augmented” specially in the lower part. This was done recently in September 2012. The surgeon says he can remove the implant if I don’t like it and give a stitch in the tip to narrow my tip.

I really wish to get this fixed as soon as possible as my life has stopped I really need to move on. Although I belong from a middle class family, I went out of the way to get this done but just ended up wasting my hard earned money. I am a focused person about what I want to achieve in life. I know things have gone wrong but I have not lost hope as I believe nothing is impossible if you are hopeful.

 I just need right guidance & skilled specialist who can help me correct this. I have read good reviews about you and seen your picture gallery. I really appreciate your contribution in the field of cosmetic surgery. Please help me with whatever best can be done. I have attached my photographs for your kind reference. Please revert to me and let me how we can take it further.

A: Thank you for your inquiry and sharing your unfortunate cosmetic surgery experiences. Your issues break done into two areas; your nose and your chubby face. It looks like you have had some negative effects of liposuction including asymmetric fat removal and weakness of the buccal branch of the facial nerve on one side.  Since you have already had the buccal fat pads removed, ti is not clear how much more improvement, if any, can be gained by further attempts at subcutaneous facial liposuction. I know that you are very unhappy with your fuller cheeks, but I do not think there is any ‘magical surgery’ that can provide the amount of facial slimming that you desire. It may be worth an effort to do some small cannula liposuction to try and get some areas more even but there is no operation that is going to make your face chiseled…it simply does not exist from where you are now.

Conversely, I think your nose does have room for more significant improvement from a further rhinoplasty effort.. What is not clear to me is exactly what has been done. (or even why) It is not clear at all what was done on the first rhinoplasty and the second rhinoplasty appears to merely have been the placement of an L-shaped silicone implant. It does not appear that you have had any real tip work done other than to try and stretch it out with an implant…which may have only pushed the wider tip up higher. I think you would benefit by some tip work for narrowing but the real question is what to do with your L-strut that is in place. There is dorsal augmentation benefit to it being there but it has also now stretched out the tip skin so removing it and not replacing it with something is going to make the tip situation worse. Normally I would opt for a rib cartilage graft replacement but that may further than you want to go.

Dr. Barry Eppley

Indianapolis, Indiana