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

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.

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