I hate the lower third of my face, how can it look more sculpted, would buccal fat removal work? (photos)

Question

I am 20yo slim female. However, I have always had an issue with how big and droopy my cheeks are in the lower third of my face. My jawline is nonexistent and I have a chin implant and a laser liposuction. Is this a buccal fat removal issue, or my pre jowl succulus? What can be done to permanently fix this ( as opposed to fillers or anything of that sort)? How would buccal fat removal affect the shape of my face? Would it improve my profile?

Emmanuel De La Cruz, MD · Answer

Hello rma1998,
It’s a pleasure to answer your questions! Based on your pictures, you seem to be a good candidate for buccal fat pad removal combined with Botox injections to masseter muscle, for a more sculpted facial appearance. Buccal fat removal, also known as buccal lipectomy, is a simple and very safe 1-hour face contouring procedure, indicated for patients with a rounded and wide face. The goal of buccal fat removal surgery is to thin the cheeks, specifically in the area of the cheek hollows, resulting in a harmonious middle and lower third of face. This procedure can be safely performed in-office, under local anesthesia with sedation. Downtime is typically 24-48 hours, which make this facial plastic surgery very convenient to my patients. I usually recommend combining buccal fat removal surgery with neurotoxin injections (Botox, Dysport or Xeomin) to masseter muscle to achieve slimmer, more contoured cheeks plus a chiseled jaw line. Injecting botulinum toxin into the masseter muscle is an excellent and safe nonsurgical option to reduce the size of the muscle, resulting in a desirable oval face. Consult with an experienced plastic surgeon to assess your candidacy for buccal fat removal and Botox injections and discuss your specific needs and cosmetic goals. Best wishes! Dr. De La Cruz.

Benjamin Caughlin, MD, FACS - Account Suspended · Answer

You have many options. It is all about fat (or volume) in the right places. In addition to facial cosmetic surgery I do feminization procedures in the transgender population and it applies to all sexes and orientations really. The key is Hot is HOT! Buccal fat removal and/or manipulation can be a great and transformational procedure in the right patient.  Oftentimes fat transfer or filler injection in conjunction with this procedure is able to give a more “ideal” heart shaped face. This can make a significant difference in patients as a combo. We are able to create shadows and sharpness where you want it. It may seem counterintuitive to add fat when you say your problem is chubby cheeks but what we do is add volume to the highest and most projected point of the cheek bone and taper it to the lower face. This helps to create a shadow just under the malar area.  This is especially helpful in thin patients and in combination with buccal fat pad removal is a powerful maneuver. Liposuction of the jawline and sculpting is also helpful in some patients. It really depends on your specific anatomy. All of this can be done in clinic with some calming medications and local anesthesia.
I recommend getting a consult with a surgeon who does this procedure frequently to get a full facial analysis to make sure your specific goals are addressed.
Hope this helps.
Best of luck.
DrC

Omar Lazos, MD · Answer

You are a good candidate for 
BFPR (Buccal Fat Pad Removal)
When
 a patient has a full and round face and despite weight loss the 
fullness persist or if the patient is in his normal weight and the 
chipmunk faces has stayed all the time, a bichectomy or buccal fat pad 
removal is useful. It´s true that with aging the buccal fat pad tends to
 diminish in volume do to atrophy, but if the volume is excessive a 
bichectomy will not hollow the cheek overtime. Many patients are happy 
with the results, a proper selection is a very important manner. Usually
 the procedure takes less than 10 min and you can go homethe same day. 
You'll be able to go back to work on the 3rd day post-op but 1 week off 
would be more comfortable.

Raffy Karamanoukian, MD, FACS · Answer

Treatment of ‘chubby cheeks’ cannot be achieved alone with buccal fat pad removal; a fact that I encounter time and time again when seeing patients in consultation for lower facial sculpting. My approach is to use a combined protocol that redefines aesthetic contours of the face. This includes the following: 
  
 
  
Buccal Fat Pad Removal 
  Non-surgical Muscle-Fascia Tightening
  Venus Legacy or Venus Viva
  Ultherapy
  Submental Liposuction or Coolsculpting
   
  
The combined approach is ideal. Buccal fat pad removal is a exceptional procedure that can remove excess fat from the cheek pads. Using an intraoral approach, a small incision is carried through the mucosa to remove a small fat pad within the cheek. Closure of the incisions is minimal with an absorbable suture and patients will experience some swelling post-operatively. We use SwellX tablets post treatment. Once healed, the contour of the cheek is improved and we begin Non-invasive tissue tightening to further enhance results. 
  
 
  
Best, 
  
Dr. Karamanoukian
  
Realself100 Surgeon

Jonathan Kulbersh, MD · Answer

Buccal fat excision is an appropriate surgical procedure for patients that of overly full and wide cheek areas. In common terms, it is good for patients who have chipmunk cheeks. In reviewing your pictures, it is difficult to tell if you're a good candidate because your cheek area is slightly full but not overly full. You are a patient that would need an in person consultation for a complete evaluation and explanation of the positives and negatives of this procedure in your situation. I hope this helps.

John Mesa, MD · Answer

To improve the lower third of the face it is necessary to find out what physical characteristic is causing the dislike.If fullness of the lower anterior face (chubby cheeks) is the cause of the aesthetically unpleasant lower third of the face, buccal fa removal could improve this finding. The video below helps to understand who could be a candidate for buccal fat removal.If a small or nor well anteriorly projecting chin is the cause, then either a chin augmentation with implant or soft tissue filler like voluma could greatly improve this finding.

Sarah Saxon, MD · Answer

Your situation is one that I see quite frequently in my office. To de-emphasize the lower third, you need to first augment the middle third (cheeks) to lift all of the soft tissue below. This can be done with either cheek implants or filler. 
Working our way down, I do think that your cheeks are full enough to see some slimming with a buccal fat pad excision. I don't think that you will have an overly contoured look from doing this, though. 
My big question regarding your jawline is whether your teeth come together normally. Your chin implant is causing quite a deep sulcus between your implant and lower lip. This can often be seen when someone has a severe overbite. Despite having the implant in, your chin is still set a little far back. A solution to improve both the soft tissue and jaw and chin contour issue is to have orthognathic surgery to realign your teeth and bring the jaw farther forward. The skin in the jowl area would not have quite so much laxity afterwards. 
Best of luck to you!
Sarah Saxon, MD

I hate the lower third of my face, how can it look more sculpted, would buccal fat removal work? (photos)

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