Kurren Gill, MD

I would recommend consulting specifically with a facial plastic surgeon for this procedure. We are all board certified Ear, Nose & Throat surgeons and have extensive expertise in nasal surgery, both functional for breathing purposes (straightening out a deviated septum) and cosmetic (for improving the outside appearance of the nose). You will communicate to your surgeon exactly what you are hoping to change on the outside of your nose, and together, with the use of photography and morphing software, he/she will show you what can realistically be accomplished, and you will be on the same page before agreeing to proceed with surgery.

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You don't have a drastically enlarged buccal fat pad to the point where I would say you definitely should undergo a buccal fat surgery. However, as you alluded to, most surgeons only reduce the fat pad and don't fully remove it, and this could certainly give some definition to the area.

Instead, I would actually recommend masseter/jawline slimming with botox first to see if your lower face slims to the degree that you are pleased with. You may find that provides enough of a slimming effect to avoid buccal fat surgery.

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You may want to look into a non-surgical treatment that can be tailored to specific problem areas, such as jowls/submentum called AGNES RF. It's a radiofrequency device we carry that is operated by a physician that melts fat in targeted areas and the radiofrequency energy promotes collagen and elastin production for long lasting results. It's a same day procedure with minimal downtime.

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Based on the photos provided, I would recommend a sliding genioplasty. That can be paired with submental liposuction for more neck contouring. I would recommend against a chin implant given the degree your chin is recessed. Based on your occlusion (how your teeth come together), a jaw advancement (which is a bigger surgery) may even be indicated. It is best to consult with a surgeon who specializes in these procedures, and at our practice we employ state of the art virtual surgical planning as part of the design and planning process for our genioplasties to achieve noticeable yet natural results.

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While it's difficult to know for sure based on just photos, it would appear that you not only have genetic fat above the platysma muscle (which can be effectively addressed with submental liposuction), but also fat beneath the belly of the muscle (aka subplatysmal fat, which requires surgical excision and cannot be effectively addressed with liposuction alone). It sounds like you are hoping for more noticeable/maximal results. While you would definitely see an improvement in just undergoing submental liposuction given that you are young and have good skin elasticity for the skin to adhere back into place, addressing the subplatysmal fat as well would give you a more noticeable and definitive result, which requires a slightly larger incision beneath the chin. Both can be done under IV sedation. Precision Tx Neck lift is also a non-surgical option that would certainly benefit you which includes liposuction as well as melting the fat with radiofrequency energy to help tighten the skin and should be on your list of options as well. Kybella would end up costing you nearly the same as surgical interventions after all treatments, with questionably effective results - I would avoid.

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