Is facial fat grafting and rhinoplasty the solution to my flat face, jowls, and protruding nose? (Photo)

I'm only 23, but my face has always been sort of flat. I want to have big round cheeks when I smile, and a defined jaw/ neck area. I'm always reminding myself to use my 'swallowing' muscles in pictures and generally when around people so my jaw looks more defined, but when I'm expressionless my face looks very sunken and my neck/jaw area soft and weak. If I had to pick, I would want these problems fixed before my big nose, which doesn't bother me nearly as much.

Doctor Answers 8

Face options

Dear ohmyjeasuus, My recommendation would be to start with your primary desires to correct the sunken appearance of the mid face and to improve neck/jaw area definition.  Mid face enhancement with cheek implants is a proven method for highlighting the cheek bones and improving lateral (away from nose) mid face volume that, unfortunately, does not enhance medial (closer to nose) mid face volume adequately.  For this reason I favor  fat grafting in conjunction with cheek implants in this situation.  Your chin forward projection is fine but you would benefit from additional volume at the jawline in front of the jowl area.  This can be accomplished nicely with pre-jowl implants that can be placed through a small incision under the chin - and this incision can also be used for surgical contouring of the neck.  Certainly mid- and lower facial enhancement could also be approached with injections (eg Sculptra Aesthetic; eg Voluma XC).
If you also decide to address your nose we perform Vectra 3D imaging to enable patients to preview anticipated surgery results before even deciding to proceed.

Sarasota Facial Plastic Surgeon
4.6 out of 5 stars 31 reviews

Rhinoplasty, some advices:

Thank you very much for sharing your concerns with us.

The harmony between facial parts makes us instinctively recognize the beauty... without knowing it, without defining it, just a perception that surprises and captivates us.

In this regard, I suggest perform a Closed Rhinoplasty (without visible scars) to treat the tip, base and nasal bridge.
With this procedure you get a delicate nose, better harmonize with your other facial features.

Dr. Emmanuel Mallol Cotes.-

Emmanuel Mallol Cotes, MD
Dominican Republic Plastic Surgeon
4.7 out of 5 stars 252 reviews

Cheek implants in a rhinoplasty procedure

The photographs demonstrate a flat maxilla and a flat  Cheek profile, for which cheek implants can help augment. Cheek implants are manufactured in a large variety of sizes and shapes, are composed of Silastic, and are placed through an intra--oral approach under a brief general anesthesia. A rhinoplasty procedure can accomplish narrowing the bulbous tip, shaving down the dorsal pump, and decreasing the projection of the nose. For many before-and-after results of both procedures, please see the link and the video below 

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 143 reviews

Flat Face and Protruding Nose

The combination of rhinoplasty, cheek augmentation and a small chin augmentation with neck liposuction would help reshape your face favorably. With your thinner face I would have low confidence that far grafting would produce a long-term result. I would think more about cheek implants which offer a permanent solution.

Barry L. Eppley, MD, DMD
Indianapolis Plastic Surgeon
4.7 out of 5 stars 72 reviews

What to do...

I have looked at your pictures and have looked at several of the answers that have already been posted.  Consider my answer to be one of several opinions you may receive.  I am responding in a way I would respond to most patients with your situation.  On your pictures (but really, the only way to give you a valid opinion about you is to see you in person) I see a somewhat overprojected nose with a dorsal convexity and wide tip.  I see a flattened midface and infraorbital hollowing.First, within limits, I think one should consider to correct the things that bother you.  I also think one should stick with interventions that have a limited downside and interventions that will have a limited deleterious impact on ongoing facial maturation.I think one should consider volumizing a midface deficiency with HA fillers.  They will do the job, are not permanent, and have limited risk.  In a patient with your age and nasal characteristics, I would perform a  conservative rhinoplasty.  One wants ti have something done that has limited risk and is well executed to preserve adequate long term structure in a young persons' nose.  I wish you luck, try to make the right choices, your have a lot of years ahead of you!Best regards,
Fred G. Fedok ,MD

Fred G. Fedok, MD, FACS
Mobile Facial Plastic Surgeon
5.0 out of 5 stars 10 reviews

Is facial fat grafting and rhinoplasty the solution to my flat face, jowls, and protruding nose?

From your photos it appears that you would benefit from Rhinoplasty and fat transfer . However, keep in mind that fat transfer procedure might need to be repeated as fat can disappear.  Rhinoplasty is a very unique operation and has to be performed an Experienced Rhinoplasty Surgeon.Best to seek an in person exam by an experienced Board Certified PS

Thomas Trevisani, Sr., MD
Orlando Plastic Surgeon
4.9 out of 5 stars 63 reviews

Flat face

Yes, you are correct that you have a "flat" face. Fat grafting would help you, but I think you should also consider silicone  facial implants for a permanent volume correction.Good luck

Richard Sadove, MD
Gainesville Plastic Surgeon
4.9 out of 5 stars 22 reviews

Improving your appearance

That's a great question, and one that has many different approaches depending on how you would like to tackle the problems that concern you.  I agree, the improvement you seek is really one of contouring...basically, improve the overall contour of your face while maintaining a young, heart shape to it that does not look out of place.  There are a couple of ways of doing it, first of, fat grafting is a great option.  You do need global volumization to improve the contour over your cheek and create a youthful lid/cheek junction, contour through the cheeks and into the jawline.  Fat grafting has its advantages (its long lasting, large amounts of volume which look soft and natural) as well as its disadvantages (its a procedure with downtime, swelling can take 2-3 weeks to come down, etc).  Another option is doing something in between traditional fillers and fat grafting such as sculptra.  It's a product that generates collagen in the fat pads of your face, and can be used in a similar fashion to fat grafting.  It does take time to show results (because its generating collagen) and you may need 2-3 treatments.  Once done though, however, you are in good shape for a couple years.  Once you build this soft layer of collagen, you can always feather in traditional hyaluronic acid fillers to get the contour just where you want it.  So, long story short, there are a variety of possibilities to help you.  I suggest you bring these up when you go on your consultations.  I hope some of this helps.  And once you are ready, then you can tackle what bothers you about your nose! Best of luck.

Miguel Mascaro, MD
Delray Beach Facial Plastic Surgeon
5.0 out of 5 stars 8 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.