Why Does My Face Look Fat After Cheek and Jaw Implants?

Q: Dr. Eppley, I got jaw and cheek implants (and a genioplasty) and they made me look like I gained weight by pushing my masseter muscle or cheek fat out. It is especially prominent when I smile. Can this be fixed without replacing the implants? I’ve had one surgeon suggest buccal fat removal and another suggest a masseter shave. I also believe I have masseter dehiscence on one side which may be exacerbating the issue.

A: Thank you for your inquiry and sending your pictures to which I say the following:

1) Since surgical procedures are done in the static mode (non-smiling)  there is no way to predict before surgery as to what the aesthetic outcome may be.

2) That being said you were less than an ideal candidate for jaw angle implants but the design that was chosen was bound to create the exact effect you now have. (round and heavy) That is not a jaw angle implant design I would ever use as its round and high shape has its greatest effect on pushing out the central muscle mass. Such implant designs are great examples of the material chosen for the implant (metal) is design limited. A big round jaw angle implant in your facial shape has done what could be predicted.

3) While I could tell much from a single front view smiling picture, the placement of rigid metal implants in the jaw angle area has increased risks of postoperative masseteric muscle dehiscence.

3) While you had a vertically short chin and a more flat mandibular plane angle choosing to vertically elongate the chin by a lengthening bony genioplasty was an appropriate treatment selection. But in the face of jaw asymmetry (left side longer than the right) it is not clear why your external result is what it is. I would need to see static before and after pictures to provide a more definitive answer, as well as a postop 3D CT scan, to provide a more definitive answer to that question.

4) In regards to your cheek implants that is a classic example of choosing an implant design that is not best for your face and, quite frankly, is not best for most male faces.  In fuller face in particular a high cheekbone implant design is best to avoid increasing sub cheekbone fullness.

Dr. Barry Eppley

World-Renowned Plastic Surgeon