I'm 21, female trying to figure out what procedures would be best for me. I want to still look natural and like myself. Advice?

Question

I am thinking buccal fat removal, rhinoplasty for bulbous tip, jaw Botox. Maybe blepharoplasty? The concerns I have with my face are I dislike the boxy shape of my face, I dislike my smile and the way my nose widens so much when I smile (how can I fix that??). I also dislike the amount of chubbiness I have in my cheeks, despite being a healthy weight / healthy BMI. And I can't quite put my finger on it but I feel like my eyelids are really puffy and make me look angry.

Donald Groves, MD · Answer

Hello and thank you for your question. First, addressing your eyelids- a blepharoplasty or other eyelid procedure would not be indicated for your case- you do not have significant upper eyelid skin redundancy or lower eyelid bulging with fat herniation, so there would be no benefit.
I would not recommend buccal fat pad removal just in general, although many surgeons would. The reason for this is there is a potential risk for damaging one/more branches of the facial nerve resulting in weakness or paralysis and asymmetric movement of several facial muscles in your midface. To me, that risk does not justify the potential aesthetic benefit of the procedure.
The rest of this response is regarding your nose. It sounds like your main concerns are the size/width, as well as the bulbous tip. Addressing the shape of the nose (particularly the nasal tip) is one of the most common reasons people seek out and undergo a rhinoplasty. Many people similarly complain that their nasal tip is too "bulbous" or "boxy" or just poorly defined, and that they would like it to be smaller, cuter, more defined, or more feminine. An open septorhinoplasty can best address the entire nose, and is particularly effective for addressing the issues you are concerned with. 
In addition to addressing your aesthetic concerns, your septal cartilage would be harvested (removed) and turned into multiple cartilage grafts, which would then be secured into different areas of your nose for structural support- this reinforcement can help your nose resist deformations when you animate your facial muscles (as in your nose widening with smiling).
The open approach is very effective in facilitating complex, precise maneuvers to refine the nasal shape and size to a particular aesthetic and look. Rhinoplasty is arguably the most difficult procedure to perform in all of plastic surgery. That said, I would recommend only going to see a surgeon who feels very comfortable with both primary and revision rhinoplasty procedures, and who has significant training and experience in these types of surgeries. This is a surgery of millimeters, so if the surgeon you're going to only does 1-2 per month, you are not going to get the best result possible. 
Regarding the anesthesia, my personal preference is similar to most- full general anesthesia to assure the most controlled environment and facilitate the best possible aesthetic results for such a complex procedure. Everything ultimately comes down to surgeon and patient preference, so always have the conversation with your surgeon so you both know exactly what to expect, and so you both feel comfortable with how the procedure will be performed prior to proceeding. 
Of course it is always difficult to provide tentative surgical recommendations, as there is only so much information to be gained from the photos and description provided. I recommend for you to come see me or another plastic surgeon comfortable with rhinoplasty procedures for a formal consultation to thoroughly discuss your surgical goals, undergo a formal examination, evaluate all your options (surgical and nonsurgical), and decide on the best procedure(s) and type of anesthesia for your specific case. I hope this helps! 
Best wishes, 
Dr. Donald Groves 
Plastic Surgeon

Bora Ok, MD · Answer

Hello from Istanbul! I would suggest considering rhinoplasty to refine the bulbous tip of your nose. Buccal fat removal could also be beneficial for you to address the fullness in your cheeks that you mentioned. Regarding the boxy shape of your face, it appears you might have prominent Masseter muscles. Administering Botox to this area over approximately four sessions could help slim down your face. Of course, an in-person consultation is best in determining how viable these procedures would be. Best wishes on your journey!

John Michael Thomassen, MD · Answer

A rhinoplasty to refine and narrow your tip and ala would be a nice procedure for you.  This would correct the wide appearance when you smile.

Ronald J. Edelson, MD · Answer

I can understand the rhinoplasty for the bulbous tip. The other procedures I don’t think would be of benefit.

Victor Manuel Agudelo, MD · Answer

Hello Scarlet.
When a nose is narrowed with a rhinoplasty, the whole face looks slimer after. Try to look before and after pictures on patients with wide noses and you will see this effect. I do not believe you need a blepharoplasty or a buccal fat pad removal. Buccal fat removal is useful on round faced patients and this is not your case, you have a nice oval shape.

William Portuese, MD · Answer

A closed rhinoplasty approach can accomplish narrowing the bulbous nasal tip and reducing the dynamic flaring that you're having when you smile. All the incisions are placed on the inside of the nose, and there's no painful packing required. You also appear to have thick skin in the nasal tip, which is going to reduce the amount of refinement in that area. It is Important have realistic expectations. You do not appear to need any of those other procedures.

Mats Hagstrom, MD (license on probation) · Answer

Understanding the facial aesthetics is not always straightforward and I suggest you get input from professionals in the field.
Patients should avoid the temptation of making their own assessments and prescribing their own operations.
Facial aesthetics, I primarily determined by facial bone structure. Soft tissue coverage tends to be very consistent from person to person and what makes each person have their own unique look in appearance, weather, attractive, or not is primarily based on bone structure.
Because of this reason solutions based on soft tissue manipulation tend to be limited because the problem is based on bone structure.
In your case, you have a fairly prominent for head and strong mandible.
While having a large mandible can be seen as a masculine trait. It is far preferable to having a small mandible.
A small mandible leads to premature jowls and double chin information.
I recommend you not have a buccal fat removal. Facial aging typically is accentuated when fat has been removed, and this can be very counterproductive later in life.
Your nose is highly feminine, excellent in size and proportion. You have a slight bulbous tip and tip definition could be a nice improvement but otherwise I think your nose is almost perfect.
The pressure women to be attractive is quite intense. I recommend you hold off permanent to irreversible surgical changes for as long as possible.
If you feel strongly about making permanent changes and start the process by having multiple in person, consultations with highly experienced plastic surgeons, who specialize in facial aesthetics.
If in doubt stay on this side of being conservative, avoiding permanent, irreversible solutions.
If you really want to get an understanding of your facial aesthetics, you should probably consider consulting with oral surgeons who can do a comprehensive cephalometric assessment.
If you opt for rhinoplasty surgery, then don’t have them do too much.
Rhinoplasty surgery is a finesse operation. Patients should be very selective in choosing providers for this procedure.
Buccal fat removal is an attempt at treating facial, skeletal issues with a soft tissue solution that ends up causing problems later in life.
These are just my opinions and a good assessment always includes a formal examination and should be based on it thoroughly in person consultation.
Be more selective on providers than you think you need to be.
During consultations asked each provider to open up their portfolio and show you their entire collection of before, and after pictures of previous patients who had similar facial characteristics to your own.
An experienced plastic surgeon that should have no difficulty showing you the before, and after pictures of at least 50 previous patients. Being shown a handful of pre-selected images, representing the best results of the providers career is insufficient to get a clear understanding of what average results look like in the hands of each provider, or what results are likely to look like with your facial characteristics.
When, in doubt, slow down a schedule more consultations.
Best,
Mats Hagstrom, MD

I'm 21, female trying to figure out what procedures would be best for me. I want to still look natural and like myself. Advice?

Answers (7)

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