How do I improve my profile and the sunken nose/smile line? (Photo)

Question

I am considering getting chin liposuction first because I don't have much bone structure around my jawline and then using fillers to enhance my chin and jawline and that would also make my mouth look less protruding. My neck is also quite short and I think overall it would help with elongating the look of my neck. I am 23 so I believe I would not need a neck lift, maybe a procedure that can tighten the skin. Please let me know what you think. Thank you!

Raffy Karamanoukian, MD, FACS · Answer

A non-invasive skin and soft tissue tightening treatment that is consistently amazing in our patients. We use the Morpheus to exact fractional induced RF into the skin or tissue in order to tighten collagen and stimulate contraction of the tissue. For tissue tightening, Morpheus is ideal for the face and neck and we often combine it with CO2 laser or Ultherapy to further enhance results. Chemical peels and skin resurfacing should be done at least 5 to 7 days after, but can be performed earlier, depending on treatment severity. Avoid exfoliating skin treatments before Morpheus and expect a period of 2-4 weeks for skin contraction to set in.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best, 
Dr. Karamanoukian 
Realself100 Surgeon

Jason Emer, MD · Answer

A combination approach would give the most improvement. Deep wrinkles and smile lines can be improved with a combination of Botox and/or fillers for the lines themselves and to build anatomical support with Sculptra for collagen building. Ultherapy is a great skin tightening device, but works best in combination with other treatments like J Plasma, RF treatments, lasers, microneedling/PRP, salt facials, Cosmelan for skin tightening and improve skin tone. I recommend getting a formal evaluation with an expert. Best, Dr. Emer

Emmanuel Mallol Cotes, MD · Answer

Thank you for your question, based on the picture we can improve your face contour with chin liposuction and buccal fat removal to make your face slimiest.

Respectfully,
Dr. Emmanuel Mallol Cotes.-

Daniel Barrett, MD · Answer

Dear bkshih
it is hard to tell for sure without an examination. Based on your photos, it looks like you would benefit from chin lipo. If you are considering surgery, I would suggest you consult a board-certified plastic surgeon. Only after a thorough examination, you will get more information and recommendations.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Mats Hagstrom, MD (license on probation) · Answer

Facial aesthetics are primarily based on bone structure. Soft tissue coverage tends to be very consistent from person to person and while it can vary due to things like obesity and age it is the underlying facial skeletal structure that determines what each individual unique facial appearance looks like.
Whether it be attractive, unattractive, masculine or feminine it is the bone structure that determines almost all of those characteristics.
95+ percent of individuals seeking chin and neck liposuction have a small mandible or a mandible that lacks forward projection.
When the mandible is small compared to the Maxilla patients usually have the following features.
An overbite occlusion, profile pictures shows the upper lip have a more forward projection of the lower lip, premature double chin, lack of jawline definition and premature formation of jowls. The lack of size in the mandible can be in different parts of that bone structure. The front of the mandible or the chin needs to be assessed separately from the body of the mandible.
Individuals who lack projection of the mentalis or the front aspect of the mandible typically do best with augmentation in that area. It is a substantially easier procedure than forwarding the mandible behind the teeth. Chin augmentation can be done with an implant, sliding genioplasty or the use of fillers.
Fillers is an excellent choice and is more precise, predictable and forgiving than any other treatment option. The drawback to fillers is simply that it is temporary.
Well done chin and neck liposuction can give excellent results especially in young people who have enough fat to work with. The combination you describe sounds fairly ideal.
Recognize that there are different approaches and individual providers may see things differently based on their unique training, philosophy or experience.
There are definitely different approaches to how to treat facial aesthetics in the lower 1/3 of the face.
The importance of understanding the primary role of bone structure is helpful in order for patients to recognize that soft tissue manipulation is sometimes inherently limited because it doesn’t address the primary problem. in your case adding volume into a small mandible using fillers is in a sense addressing the primary problem even though it is soft tissue manipulation it is aimed at augmenting bone structure.
There is substantial variation in skill and experience when it comes to all aspects of cosmetic surgery and procedures.
Delivering consistent quality liposuction results is more difficult than most people believe. Simply being a board-certified plastic surgeon with the overall good reputation is insufficient to assure someone has mastered liposuction.
The importance of choosing the most talented and experience provider cannot be over emphasized.
I recommend patients begin the process by having multiple in person consultations with local board-certified plastic surgeons in their community.
It’s definitely helpful to consult with providers who have the skill, background and experience to offer all various treatment options. most plastic surgeons are probably quite comfortable with the idea of placing a chin implant. Some have experience with sliding genioplasty and some do not. From my experience it seems like oral surgeons have an upper hand on the sliding genioplasty while plastic surgeons tend to prefer placing implants. providers offering fillers very based on local state rules and regulations from aestheticians to fully trained board-certified plastic surgeons with craniofacial fellowship training. approaching each consultation as if you are hiring the plastic surgeon with the authority to vet them thoroughly.
I recommend patients avoid virtual consultations whenever possible and avoid traveling long distances for elective surgical procedures if possible.
During each consultation ask each provider to show their entire collection of before and after pictures for the procedure you’re interested in. in this case you may have to look at different pictures for chin augmentation versus chin and neck liposuction. plastic surgeons may have a few before and after pictures of patients who had the combined procedure regardless of what technique was used for the augmentation.
Get familiar with what quality results look like for the procedures you’re interested in. Get proper pictures of your face taken exactly how plastic surgeons take before and after pictures. The angle of your pictures is not ideal. That should be taken at straight angles without facial expression showing a true lateral and true frontal image. look at how plastic surgeons take facial pictures and you’ll get the idea. They are basically like mug shots. use the timer on your camera or have someone else take the picture to good angles and distances accurately lined up.
Bring pictures of your own face with you for reference during the consultation. Use those pictures whenever you are looking through before and after pictures weather at home looking online ordering a consultation.
The goal should always be to find patients will have as similar facial characteristics to your own as possible. Learning how to do facial assessments is not the easiest thing but try to look for relationships between the chin, nose, mid face and fore head and you’ll start seeing repeating patterns.
During each consultation ask each provider to show you as many pictures as possible of previous patients who had similar facial characteristics to your own. for reference in my opinion a highly experienced surgeon should have no difficulty showing you at least 50 sets I’ll before and after pictures of commonly performed procedures. ask the providers to show you examples of excellent outcomes, average outcomes and less than outcomes. All plastic surgeons have a variety of results and it’s fair game for patients to ask to see lots of pictures including variety. Ask each surgeon what the revision rate is and what the revision surgery policy is. revisions happen and all plastic surgeons should have a certain revision read or they’re not delivering the best possible outcome for their patients. this is simply an inherent part of plastic surgery.
The most talented and experience providers will deliver the most consistent quality results with less indication for revisions.
Having a zero Revision Red or doing very very few revisions also means that surgeons are not setting standards for their own work high enough. we all have cases and outcomes that can be improved upon with a second procedure from time to time.
Practice reviewing before and after pictures before consultations and create a grading or rating system for results. take notes during consultations of the number of before and after pictures each provider shows you and the quality of outcomes. Take notes of each providers willingness to show you a diversity of outcomes.
Recognize that being shown a handful of preselected pictures which most likely represent the best results of the providers career is totally insufficient to get a clear understanding of what average results look like in the hands of each provider.
With patients need to see is what average results are most likely going to look like and get a confirmation of how many of these procedures that surgeon has performed with an understanding of variations in outcome.
Plastic surgeons will try to present an image of being competent and talented. It is the patient’s responsibility to properly vent plastic surgeons like you’re hiring a contractor.
Top-notch plastic surgeons will be detail oriented both during surgery and during consultations. Make a note of how much time each provider spends with you and how thorough they are regarding discussing your assessment, outcomes, review of before and after pictures, preparation for surgery, risks and benefits and aftercare.
I don’t know the right number of consultations patients should have before choosing a provider. It often simply depends on luck or if they happen to pick quality providers early in the process.
I highly recommend patients avoid scheduling surgery or committing to having surgery during the consultation. Always give yourself time to think about the decision and make sure you finished all consultations to before committing to having any one provider or procedure.
Recognize that operations like Liposuction are permanent and irreversible. if not done well it is virtually impossible to correct the outcome.
The time to scrutinize plastic surgeons it’s before the operation.
Finally I recommend reading all reviews and various physician review websites avoiding providers with any significant number of justify negative reviews. The absence of justified negative reviews is more important and more telling then having an abundance of positive reviews. justified negative reviews are always organic but positive reviews are typically not.
Providers with excessive numbers of reviews typically are encouraging review writing and this is not correlated with skill or experience.
Reviews are important especially evidence of bad experiences.
Working with fillers is far easier than surgery because fillers will eventually dissipate and the treatment needs to be repeated. The repeat process allows fine-tuning and advancing the results towards perfection in a way that’s not possible with definitive surgical procedures.
Providers typically have less before and after pictures with fillers because many patients who are content don’t follow up until they need a second treatment.
Best luck in your decision making and potential future intervention.
Mats Hagstrom MD

How do I improve my profile and the sunken nose/smile line? (Photo)

Answers (5)

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