I have fat jowls and 1 side is significantly uneven from previous surgery. Best procedure to get a contoured face? (Photo)

Question

I had buccal fat pad removal as well as jawline liposuction about 2 years ago. I liked the results but I later wished I understood more about the procedure and asked Dr to also liposuction my jowls too. I also realized I was left significantly uneven (as seen in the photos) on one side of my face. The right side is chubbier than the left side. I want to get rid of my chubby jowls on both sides though and have a more contoured face. Is facial liposuction a good option? Would Kybella work?

David Hansen, MD · Answer

Your only real option is micro lipo with facetite RF under local. It is so dramatic and easy with only 1 day downtime. Don't waste money on worthless kybella.

Jason Emer, MD · Answer

FaceTite can internally tighten the skin in the lower face and neck. After all the skin has been heated and contracted, we shape the neck with liposuction to give definition and remove stubborn pockets of fat. In one quick treatment, we can tighten skin, remove fat, and contour the lower face, jawline, and jowls with only a weekend of downtime.​  Keep in mind that combination approaches will give you a more significant improvement as opposed to a single procedure. I recommend getting a consultation with a board-certified cosmetic dermatologist and facial sculpting expert.

Other options include for skin tightening :
Thermage radiofrequency to heat skin and tighten it over time and prevent the aging process
Ultherapy high intensity ultrasound to contract muscle and tighten the face and neck and prevent the aging process
PDO nova threads or instalift threads for immediate lifting without surgery and long term collagen production
Sculptra injections for collagen production to areas of the face and neck with crepe skin or early sagging
BTL exilis ultra, venus legacy, thermi250 , or inmode forma/contoura  for constant collagen stimulation monthly with facials
Facelift/necklift with fat grafting/fillers if you need a big improvement
ThermiRF or J plasma /Renuvion or Inmode FaceTite   internal heating and tightening to long term internal heating and tighting with or without surgery
Platysmaplasty to tighten the muscles of the neck long term and create contour
Facial implants or fillers to contour the jawline and chin to improve the appearance of the neck
Fractora/Morphenus8 or Intensif microneedling RF for improve superficial tightening, neck and chest wrinkling and crepe skin 
You need to see an expert in facial sculpting and age prevention.  Best, Dr. Emer.

Robert M. Tornambe, MD · Answer

I appreciate your concerns and frustration and it appears from your photos that micro liposuction, expertly performed, utilizing very small cannulas, should improve symmetry and overall contour of your face. I do not recommend Kybella, as results are extremely varied and there is no control over how much fat is or is not dissolved and often times results are asymmetrical and unacceptable. Consult with a board-certified plastic surgeon in your area to greatly increase chances for the best and safest possible result. Good luck.

Jeffrey Nelson, MD · Answer

Thank you for your question and photos. Certainly your midface asymmetry may have been present and uncovered by the buccal fat removal or possibly slight differences in how that procedure settled out may have led to your current appearance. Kybella is a perfectly fine product, but can be expensive and much less reliable than precise liposuction of the face and neck with syringe liposuction technique with fine cannulas and meticulous precision. This is commonly done with local anesthesia and mild oral sedation in an office setting and proves far more reliable then Kybella or other noninvasive results.

Mats Hagstrom, MD (license on probation) · Answer

Everyone has facial asymmetry. It is present in all people. The asymmetry is primarily based on skeletal structure and forms during embryology as the two sides of the face develop independently and fuse in the center midline.

Treating to underlying skeletal asymmetry by manipulating soft tissues creates two sets of asymmetry both do natural underlying skeletal asymmetry and now a soft tissue asymmetry.

For this reason it’s often better to accept natural asymmetry as being appropriate and normal.

There are important branches of the facial nerve that becomes superficial right through the center of the Jowl.

Patient’s risk having facial nerve damage with having liposuction in this area.  Often when it happens the nerve damage is temporary but can last several months and it’s usually upsetting or potentially devastating until it heals. Typically the outcome is a very uneven smile resembling the look of having had a stroke.

There are techniques to minimize the chance of nerve damage but it is always a risk when doing liposuction in the proximity of where the nerves are.

Kybella has a very high incidence of nerve damage and for this reason it is not FDA approved for anything other than under the mandible.  It is also unpredictable and causes an immense amount of inflammation.

Plastic surgeons will have different views on doing facial liposuction in regards to facial nerve injury. You’ll have to have consultations with local board-certified plastic surgeons and see how they feel about doing it. Regardless if surgeons are willing to do liposuction of the jowls or not you will have to except some risk with having this procedure.

Best,

Mats Hagstrom MD

I have fat jowls and 1 side is significantly uneven from previous surgery. Best procedure to get a contoured face? (Photo)

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