Hello, and thank you for your question regarding whether you would benefit from cheek and jowl liposuction. I appreciate you sharing your history and pictures. Based on your photos, you appear to have excess fat in the cheek region, specifically in the buccal fat pad and malar fat pad. The malar fat pad is positioned higher on the cheekbone and gives the mid-face fullness, while the buccal fat pad is located lower in the cheek, near the mouth, contributing to a rounder facial appearance. Excess fat in these areas can be genetic, weight-related, or due to hormonal factors. Additionally, some patients develop fullness in these areas due to past procedures like filler, fat transfer, or cheek implants. For facial contouring, the best approach to removing cheek fat is buccal fat removal combined with direct malar fat reduction, performed through a small incision inside the mouth. This method is safer than blind liposuction, as cheek liposuction can be dangerous due to the presence of the facial nerve. If the facial nerve is damaged during liposuction, it could lead to temporary or permanent facial paralysis on one or both sides, causing asymmetry and difficulty with facial expressions. A buccal fat reduction procedure is relatively quick, taking about 2 to 3 hours, and can be done under local or general anesthesia. Recovery typically lasts about two weeks, and since the incisions are inside the mouth, the risk of visible scarring is eliminated. Most experienced plastic surgeons prefer direct removal of buccal and malar fat over liposuction in this region to avoid damage to critical facial structures. If your primary concern is excess fullness in the jowl area, lower face liposuction with radiofrequency skin tightening (such as Renuvion or FaceTite) may be a better option to contour the jawline. However, liposuction in the upper face is not recommended, as it can cause skin irregularities and nerve damage. If you are considering buccal fat removal or facial contouring, I strongly encourage you to consult with a board-certified plastic surgeon experienced in facial procedures. I hope this helps answer your questions regarding cheek fat reduction and facial contouring. Good luck! Sincerely, Dr. J. Timothy Katzen, MD, MBA, FACS, FICS