How can the sad dog lower cheek fat be removed? (photos)

Please excuse the huge double chin. It's Kybella which I got done 1 week ago. My question is about the fat on the lower cheek area. I'm 39. Are there any newer techniques that could help me get rid of it? My only worry is that I don't want wrinkled skin there if the fat is somehow removed since that would make me look probably worse. For example Rachel Zoe's cheeks have no fat at all, but there are wrinkles instead. I don't want that. Any suggestions?

Doctor Answers 5

Perioral Mound Liposuction

The area you are pointing to is the perioral mound area. This small collection of fat can be removed by very small cannula liposuction from a small incision inside the mouth. It will not leave the skin wrinkled like the picture you are showing.

How can the sad dog lower cheek fat be removed?

 Hi, I have performed many facial shaping procedures using dermal fillers, liposuction, facial implants (cheek implants, chin implant) and or facelifts for over 30 years.  From the photos, your cheeks are flat in the front, the chin is weak and the area that you are pointing to is referred to as "jowls" which are discussed below. 

 Following the beauty principles outlined in my book on face and body beauty, women look the most feminine, youthful and attractive with heart shaped faces.  Heart shaped faces have cheeks that are full and round in the front.  Cheek augmentation with a dermal filler or using cheek implants for a permanent enhancement will create full, round cheeks that will feminize the entire face.

 A weak chin creates an imbalance making the nose appear larger, the mid face top heavy and the lower face look short that de-emphasizes the lips and allows early formation of a double chin.  Chin augmentation using a chin implant will add projection to the chin creating harmony and balance to the lower face.   I have found that placement of a silastic chin implant, through a small curved incision under the chin (also allows excess skin removal) to be very safe, quick and highly effective.

 If you have "jowls” these are sagging facial tissues and an indication for some form of a SMAS facelift.  The underlying SMAS layer, of the face, must be dissected, lifted, trimmed and re-sutured (not merely folded or suspended with threads or sutures that will not last).  The excess skin is then removed and the facelift incisions closed.   

 I have performed facelifts for over 30 years and have performed many minimally, invasive type facelifts.  My most popular facelift is the minimally invasive, short incision facelift that has all the benefits of more invasive facelifts (traditional, mid-face, deep plane, cheek lift and subperiosteal facelifts) but with these added benefits:

  • very small incisions
  • minimal tissue dissection = less bruising and swelling = rapid recovery ( several days instead of weeks or months with the more invasive type facelifts mentioned)
  • can be performed in 90 minutes or less, with or without general anesthesia
  • no incisions within the hair = no hair loss
  • excess fat can be removed
  • excess skin removed
  • cheeks, chin and jaw line can be augmented with dermal fillers (I prefer Restylane Lyft) or facial implants
  • most patients fly back home to parts all over the world in as little as 3 days post-op

I combine facial shaping with every facelift procedure.  When jowls are present, these should be done in concert and not alone or separately in order to create a naturally, more attractive face.

Hope this helps.



Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.6 out of 5 stars 24 reviews

Kybella swelling and invasiveness vs liposuction

Kybella is widely advertised as being less invasive that liposuction of the submental area.

In my opinion, the swelling from Kybella lasts much longer than that from liposuction performed under local anesthesia in patients I have observed and interviewed.  So is it less invasive or more invasive?

In your case the swelling is most likely injection related, so you may have to wait out the swelling until you can again assess how your face looks.

While the destructive approach to undesirable fat is widespread, often adjusting the fat through mini lift techniques can be superior for volume retention.  You don't want to develop an overly skeletonize appearance by removing fat that could actually benefit you if redistributed!

Brent Moelleken, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 136 reviews

Lower Cheek Fat/Jowls--Liposuction for Neck/Jowls--Ultherapy/Thermage/Sculptra/Fillers

There are many options including: liposuction of the neck and jowls which is fantastic for contouring and shaping. Volume with fillers/fat/sculptra and skin tightening with ultherapy/thermage are the also good options.  See an expert in facial contouring. Best, Dr. Emer.

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.9 out of 5 stars 165 reviews

Selective liposuction for jowls

A selective liposuction with small cannula can remove redundant fat and flatten your jowls. You should seek a consult with a very experienced plastic surgeon for this procedure. Good luck.

Zoran Potparic, MD
Fort Lauderdale Plastic Surgeon
5.0 out of 5 stars 15 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.