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

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.

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!

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.

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?

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Answer: Facial surgery

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Answer: Facial procedures

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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)

Answer: Facial surgery

Answer: Facial surgery

Answer: Facial procedures

Answer: Facial procedures

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Recommended reading

Everything you need to know about Rhinoplasty

Our mission is to create a world where every investment in modern beauty is Worth It.