What procedures would you recommend and in what sequence to address my heavy lower face and flat cheeks? (photos)

I am 31, look older & look tired. Met 4 well known facial PS, all agreed low cheek volume, got 1 sculptra, 2 juviderm and 3 kybella, with some improvement but want permanent results. Now a well known surgeon is recommending cheek implants, neck liposuction, buccal fat reduction and chin implant. I am worried about cheeks being too big when I smile after implants. Thinking maybe I should get chin lipo and buccal fat reduction first and then see? Maybe still some filler in face (last 5 month ago)?

Doctor Answers 1

What procedures would you recommend to address my heavy lower face and flat cheeks? = buccal fat + cheek enhancement #buccalfat

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Heaviness of the lower anterior face with mild excess of lower facial skin, specially starting in the 30s is secondary to fullness of the lower face and lack of mid face skin support. 

Lower anterior face fullness is usually secondary to buccal fat, in most of the cases. Therefore buccal fat removal is the plastic surgery procedure of choose to address that issue.

When there is "excess of lower facial skin" , the cheeks should be enhanced with either fillers or implants to "lift" the face and thus give a rejuvenated and not tired look to the face.

In my practice, when a patient is not sure that implants are the way to go ( because they are permanent) I highly recommend the patients to undergo cheek enhancement with soft tissue fillers like Voluma. Voluma has the advantage that is 100% reversible with the injection of a enzyme. therefore, if the patient doesn't like it, it can be "melted away' ( very unlikely since all my patients come back for more fillers). Voluma last two years. Then, when the effect of the voluma disappears and the patient trusts that cheek augmentation in deed helps to address their concerns, then cheek implants could be placed since they are permanent and down the road they are more cost effective than Voluma injections every two years. 

Male patients interested in buccal fat removal  should make a consultation with a Board Certified Plastic Surgeon specialized in plastic surgery procedures of the face for Men

New York Plastic Surgeon
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