Would more filler help in fixing my heavy lower third? (Photos)

Question

I have a heavyish lower third that becomes more obvious when I smile (my lower cheeks expand out so that my face loses its V shape). I’ve been trying to correct this issue by adding filler to my upper cheeks (current pictures with blonde hair I have 2ml voluma in each cheek; brown hair is before anything). I definitely see a big improvement, but my lower cheeks are still wider than my upper when smiling. Would more filler help? The part that expands is NOT my masseters.

Ellen A. Mahony, MD · Answer

The Voluma has definitely given your face a more balanced look than before, but there are other options as well.  If it is true that the masseter muscle is not contributing to the bottom third fullness of your face, then other culprits to consider include the buccal fat pad and/or your natural subcutaneous fat. Both issues can be evaluated at your consultation. The buccal fat pad can be thinned with a simple procedure under local anesthesia.  The result is a permanent slimming appearance of the bottom third of the face.  If your genetics (subcutaneous fat) are the issue, it would definitely take a consultation to determine the best options.
  
The best thing for you to do would be to visit a board certified plastic surgeon who can help determine the etiology of the fullness, so the appropriate treatment is chosen. Best of Luck! 
  
In good health,
  
Ellen Mahony, MD

Misbah Khan MD, FAAD, FACMS · Answer

Im not sure if adding more filler is your answer. the lower 1/3rd of the face is heavier. as u said. its a good question. I would have to see you in person to be able to better assess. Im honestly not sure about adding more filler to the mid face. there has to be another way

Jason Emer, MD · Answer

Yes, symmetry and contouring of the face can be improved with well-placed fillers (Voluma, Radiesse, Bellafill) and Sculptra. Fat or implants are alternatives. I recommend getting a formal evaluation with a facial sculpting expert. Best, Dr. Emer

Lucas Bryant, MD · Answer

Thanks for your question. I would not recommend you add volume (filler) to your face since your goal is to decrease the volume of the area. The photos appear to show you could benefit greatly from buccal fat extraction. This is done through a small incision inside your mouth.

Yes, you can decrease some jaw volume with masseter botox injections, but your photos appear to demonstrate the buccal area is what you really want/need addressed. A brief consult with a plastic or facial plastic surgeon would be the next place for your. Warm regards.

Malena Amato, MD, FACS · Answer

I think the filler has added more to the midface and improved the balance. There may be some role in Botox to the mid face in addition to fat transfer or filler to the upper face. Buccal fat may be contributing as well. The best way to assess is a consultation with a facial plastic surgeon to examine you and give your your optimal options tailored to your needs.

Shaun Patel, MD · Answer

Thanks for sharing your photos and question. I know you said that the bulkiness is unrelated to the masseter muscles but I recommend you have that confirmed by an aesthetic physician. Combining filler treatment to the midface with Botox or Dysport to the masseter muscles will widen the midface and define the cheekbone while slimming the lower face and softening the posterior jawline.

Karen Leong, MD · Answer

Hello, thank you for your question. A more square lower face can be caused by a combination of factors. You have may more soft tissue/fat in this area, you may have strong masseter muscles (do you grind your teeth?), or the bony structure of your jaw may be responsible for the wider appearance of your lower face. Treatment depends on which of these factors are contributing to your anatomy. It may involve neurotoxin (Botox) to weaken the muscle, fat removal, or reshaping the bone. An in person consultation with a qualified dermatologist or plastic surgeon should give you the assessment you need and the chance to ask any questions you may have in a more intimate setting. I hope this helps. - Dr. Leong

Nicholas Gentry, MD · Answer

An exam is helpful as you state not your masseters but from your photos I highly suspect the masseters are contributing to the shape of your lower face. Botox in the masseter can help this. Also, fat extraction can help in the lower face as well.

Michael H. Gold, MD · Answer

Thanks for your question and the photos – and we always recommend that you have a consultation with a board certified dermatologist or plastic surgeon to fully evaluate the area and to determine if you are a candidate for more filler or if, in fact, the masseters are involved and a toxin would be more appropriate --- this can be determined with the proper evaluation.  Good luck.

Oleh Slupchynskyj, MD, FACS (retired) · Answer

Hi,To contour your face and reduce lower third fulless, you can do several things. First you can reduce cheek fullness with a buccal fat extraction and inject the masseter with botox. This will narrow your cheek area. You could also consider cheek implants to give yourself a more contoured look in the upper half of your face.Best,Dr.S.

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