Would Cheek Lipo Give Me Profile Improvement? Had Buccal Fat Removal and Chin Implant 4 Years Ago. (photo)

I had a buccal fat removal and chin implant (X large) in 2008, i am 30 now (asian). The fat pad that bothers me is below buccal fat area. One surgeon recomm micro lipo with a mini face lift, another- removing chin impl and moving jaw forward, third-deep facial reconstruction (under cheek muscle fat removal with mini face lift). I am confused. Is mini lipo safe (facial nerves)? If i do a mini lift, would the scar disappear within a year? Also,is there a way to improve my profile, upper lip?

Doctor Answers 2

Perioral Mound Liposuction

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The specific area to which you refer below the buccal fat pad are known as the perioral mounds. This is a subcutaneous fat layer that is a completely different fat layer than that of the buccal fat pads. It is commonly perceived that buccal fat removal will address this area as well...but it will not. It requires small cannula liposuction done through a small incision on the inside of the mouth. Chubby cheeks frequently need buccal fat pad reduction and perioral mound liposuction to get the best reduction possible. Any type of a mini-facelift (aka jowlift) will not make a significant effect on the thinning of your cheeks. It has an effect lower than the cheek area in the jowls and neck. 

Options for bulges in jawline

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There are a several issues at play here, so I will try and address them  separately.  I am assuming that the photos above reflect your appearance now, after your chin implant.

First, you still have quite a weak chin (your jaw is retrognathic).  Especially since you have had a prior chin implant, this suggests that you may have a congenitally small jaw which is set too far back as well.  This may be associated with some orthodontic issues.  I would recommend consultation with a oral maxillofacial surgeon as you might very well require orthognathic surgery to get the improvements you are looking for in the chin and upper lip appearance.  By the way, this type of surgery is  different (most likely) than the procedure recommended by the second surgeon (i.e. sliding genioplasty) which does change the chin position, but doesn't change tooth/jaw position.

Regarding the bulges under the buccal pad, I think this bulge is not fat, but instead it is  your masseter muscles.  When they are large,  they can create bulges near the angle of the jaw, especially in the asian face.  I can't tell for sure from the photos, but if this is the case, Botox can be used to weaken these muscles and smooth the jawline.  If this is appropriate for you, you'll really like the results.  Be sure to see an experienced injector for this.

Finally, regarding you recommended treatment options, I think you are far too young to require a face lift of any kind, and I don't see signs of aging in your face which would be helped by such a procedure (mini-lift or otherwise).

Michael Bowman, MD
Roanoke Facial Plastic Surgeon

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