Age 42, strange mound of skin/fat, not interested in fillers as a fix

Question

Hi and thanks for your time. I am in great distress over this bump that makes my face look like melting wax. I have been told by good surgeons that I'm not a candidate for a FL yet, which is fine bc I'm not sure I want one. But I hide my face with my hair and avoid socializing. Can this bump just be excised, leaving a small scar? I'm okay with a scar.. If so, how does one find a dr willing to do such an unorthodox procedure, and what is that procedure called? Thanks

Ruslan Zhuravsky, DO · Answer

Hello,Before I answer and make any suggestions, I'd like to point out that you are very pretty and the things we notice about our own faces usually much more apparent to is, than to others.If you are talking about the bump near the corner of the mouth, it looks like the modiolus. This is where the facial muscles come together. A simple excision would not be likely to change this and would result in unnecessary scarring. This would only help if it was truely a collection such as a cyst or lipoma. An ultrasound may help rule these out. If it is the modiolus, the question would be why is it hypertrophic. Is there extra muscle activity on that side from habit or mouth closure? Tightening the lips and other mouth movements might help determine if anything makes this muscle better or worse. A conservative amount of botox would be my first attempt at this if it is the modiolus. Don't give up and jump to direct excision unless there is a clear answer of what is being treated. This is also the area where nerve injury is a risk.I hope that helps.

Timothy M. Rankin, MD, FACS · Answer

If I am interpreting your concerns correctly, you're talking about a small bump best seen in the first photo just next to the corner of your mouth. This area is called your modiolus and corresponds to where many facial muscles converge. In general, I'm not a huge fan of using botox below the level of the eyes as weakening lower facial muscles tends to create slightly changes in function (temporarily of course). It also appears that the lip depressors (DAO, and platysma) are relatively strong in your resting pictures and may benefit from botox to soften the appearance you don't like. 
The next more aggressive route would be facial fat transfer. You have wonderful volume in your face and the amount you need would not be much, but adding a little fat to the other areas directly around the modiolus (nasolabial fold, marionette line, etc) may help to make the "bump" less noticeable.

Lucian Ion, FRCS · Answer

Thank you for your question and photographs.

The distribution of the volume is somewhat unusual and the photographs do not seem to show it equally well depending on the lighting.

You have the option to try and get more clarity regarding the nature of the lump using ultrasound. Soft tissue high resolution ultrasound can produce quite valuable information leading to a better decision. Sometimes this is related to buccal fat prominence which can be addressed through an access inside the mouth. Sometimes the buccal fat itself can show a small lipoma.

In some instances, there is an aggregation of fatty tissue under the skin which can be treated using micro liposuction.

One quick test that you can carry out yourself is to have a look at the appearance of the face when you lie down and therefore when the soft tissues of the face shift slightly. If the bump persists, it is more likely to be lipoma, but even such lesion sometimes can be treated with micro-liposuction.

As a final consideration, injections that dissolve the fatty tissue have been shown benefits for localised areas of fatty tissue deposition.

This gives you the orientation that the first step would be to make sure what you're dealing with and build the treatment decision from there.

Michelle Zweifler, MD · Answer

There are several types of facial bumps.  Lipomas are benign fatty tumors and cysts are fluid filled sacs that are commonly excised with an external scar that usually fades with time.  Lower cheek bulges may be related to excess buccal fat that could be removed from within the mouth in appropriate candidates.

Gary M. Horndeski, MD · Answer

The lump on your face is an unknown source. It could be fat or it could be a cyst. A physician should be able to examine you and be able to come to a conclusion as to what this may be. You may need an ultrasound to see what it is. It may be as simple as to aspirate it.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Kenneth D. Steinsapir, MD · Answer

It is a same that you are not open to fillers because that is the state of the art for addressing issues like this. A small amount of filler just below this area of fullness would help it blend. Many of us benefit from this type of service. Please understand that not all filler services are the same. You are asking for your face to be sculpted. They do not teach that in Nursing school, PA school, or even medical school. Caution is advise.

Lexie Wang, MD · Answer

Hi beautiful - first of all, you ARE beautiful just like your username. Interestingly because you did not describe anywhere where the bump is, I don't even know what you are talking about, which should give you confidence that there is nothing that stands out to me that "needs" to be removed. Chances are that you are overthinking and overfixating on it, especially if you are hiding something with your hair and avoiding socializing. I bet that most people around you don't notice it unless you direct their attention toward it (again, this is a trained surgeon looking at your photos and without knowing where the "bump" is, I don't even know what you are talking about). If you feel like you are at your wit's end in terms of learning to accept it, then I suggest seeking the help of a therapist who can guide you through the process.

Adam Hamawy, MD · Answer

Plastic surgeons possess an array of techniques to address facial aging comprehensively. Achieving the most natural and optimal results involves a strategic combination of these tools. The process is intricate, extending beyond a mere choice between a facelift or fillers. Even these terms encompass various facelift types, ranging from office-based minilifts to extensive deep plane facelifts.

Unfortunately, fillers have acquired a negative reputation due to their misuse and overuse. However, when administered judiciously, they can yield remarkable outcomes. In your specific case, I would recommend a blend of multiple modalities to restore the structural integrity of your lower face, reinstating the definition that is presently lacking.

This holistic approach may involve skin tightening through Renuvion helium plasma technology, mini liposculpting, the firming of underlying neck and facial muscles, and augmentation to accentuate the angles that are currently less defined. Remarkably, these procedures can be executed in an office setting without leaving visible scars and all a span of approximately 60-90 minutes.

Andrew M. Ress, MD · Answer

The bump that you are concerned about is the buccal fat pad which is in your case more prominent. This is easily taking care of through an incision inside the mouth which can be done under local anesthesia with some light sedation. No need for a facelift yet. I would recommend that you have some fillers or fat transfer in the cheeks and the nasolabial folds to give you a little bit more volume otherwise your looking good!

Mats Hagstrom, MD (license on probation) · Answer

After looking at the pictures, I can’t find Waldo.
I think your facial aesthetic concerns are primarily supratentorial.
I don’t think you need surgical intervention.
If you were a young man, I would suggest spending less time looking in the mirror, but I know that is an inappropriate thing to say to women.
I don’t think anyone sees what you see when you look in the mirror. I think the problem you are concerned about is not something anyone else recognizes.
I think you need reassurance and I think you should stay away from plastic surgeons.
Best,
Mats Hagstrom MD

Age 42, strange mound of skin/fat, not interested in fillers as a fix

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