Do I have fluid buildup or excess fat? (Photo)

Question

I am 29F. Since around 23-24, my jaw has become increasingly puffy and round. It sometimes feels like I have jowls. Is this something I need to surgically take care of, or is my puffiness more to do with inflammation? What treatment could I do? My jaw is basically totally obscured.

Eric M. Joseph, MD · Answer

Bruxism is excessive clenching of the drawer or teeth grinding. Your masseter muscles may be a bit enlarged, however, if this is the case, jawline slimming with Botox or another neurotoxin may be helpful. Wishing you well, and thank you for your question. Sincerely, Dr. Joseph

Mats Hagstrom, MD (license on probation) · Answer

I do not think your jaw is obscured. You don’t have a problem with inflammation, edema, or swelling.
What you have is your own normal anatomy.
Facial aesthetics are primarily determined by bone structure.
It’s facial skeletal structure the differentiates each individual person making them unique and recognizable.
 Soft tissue coverage tends to be much more consistent from person to person.
Based on the same BMI, most people have pretty close to the same layers of subcutaneous fat in the face and neck.
There are differences, but not as much as we see in bone structure.
 Bone structure is in the end the foundation that holds the rest of the face.
When the foundation is weak, so is the ability to have aesthetic desirable well defined contour. If you look at the face of individuals who are known for good facial aesthetics like Carmen Del’Orafice or Michael Clooney you’ll see that they have prominent large mandibles.Individuals who have a strong mandible are protected from developing signs of premature, aging, like losing jawline definition, developing double chins, early jowl formation, or deep nasal labial folds.
In many ways facial skeletal structure, can determine what people will look like as the age, and is the inherit foundation of our aesthetic identity.
Whether people like it or not, it is Primary. 
Growing a bigger mandible isn’t really an option for most people. That being the case options, become limited because they don’t address the primary problem.
For example, many plastic surgeons may recommend liposuction.
Is Liposuction a good treatment when the problem is that the jaw is insufficiently small?
It can be in some people, especially when done by somebody who is especially talented at that procedure.
Still, we need to recognize that fat distribution was never the primary problem and anytime we prescribe a treatment that doesn’t address the underlying primary problem the results are going to be partial. When it comes to cosmetic surgical treatments, operations that address the primary problem tend to work best with the most consistent results. This would include procedures like breast augmentation for women with small breasts, hair transplants in men who are balding or liposuction for individuals who have an undesirable fat distribution. 
Treatment options for your concerns are a little bit limited, but most likely Liposuction is going to be the most likely recommended procedure. In older generation and neck lift becomes a better procedure. Young individuals tend to be better suited for Liposuction.
If you are sufficiently bothered to the point you are willing to have surgical intervention, then my best word of advice is to be more selective regarding provider selection than you may think is necessary. Finding the right plastic surgeon when done correctly takes a significant amount of time and effort.
The discrepancy in skill and experience among plastic surgeons for this type of work is fairly substantial.
Any procedure that involves removing tissue should be viewed as permanent and irreversible.
I think your face looks fine, and you don’t need surgery.
Lots of people get it, so I recognize that those who desire surgical intervention probably deserve some guidance in order to minimize the chance of making a poor decision.
Delivering consistent quality, liposuction results is more difficult than most people realize.
Poorly done Liposuction can leave people disfigured. Well done liposuction on patients who are good candidates can lead to fairly striking outcomes.
Fighting the right provider, generally involves having in person, consultations with plastic surgeons, who seem to have a strong track record for chin and neck liposuction.
Start the process by having standard pictures of your face the same way plastic surgeons take before and after pictures.
Angles need to be lined up correctly in the angle of the camera should be accurate.
Think of perfect mugshots.
Bring printed pictures of your face to use as a reference during each consultation.
During each plastic surgery consultation, ask 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.
 They should be of about the same age, have about the same amount of subcutaneous, fat and fairly similar skeletal proportions.
Being shown a handful of pre-selected images, representing only the best results of a providers career, maybe insufficient to get a clear understanding of what average results look like in the hands of each provider, what your results are likely to look like, or how many of these procedures they have actually done.
 In my opinion and experience provider should have no difficulty showing you the before and after pictures of at least 50 previous patients for commonly performed procedures.
Take careful notes during each consultation, especially regarding the quality and quantity of before and after pictures.
Start looking at a lot of results online to help determine what quality results should look like.
Always use pictures of your own face for reference when reviewing results.
There’s no correct number of consultations needed to find the right provider.
The more consultations you schedule the more likely you are to find the better provider.
Considering that this procedure is permanent and irreversible, it makes a lot of sense to invest serious time and effort in the vetting process before considering scheduling surgery.People who have liposuction will be reminded of the outcome every day for the rest of their life.
It’s very much like getting a tattoo in that way.
Ideally, the rest of the world will not know, other than that you look better, but you will.
From my perspective, having five or six consultations before selecting a provider, seems about right.
The biggest mistakes patients make is first having only one consultation and then scheduling surgery.
The second biggest mistake is assuming that a plastic surgeon with board certification, several years of experience, and an overall good reputation has mastered most plastic surgical procedures.
The third mistake would be assuming Liposuction is an easy procedure to do well.
Best,
Mats Hagstrom, MD

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