Best procedure to reduce wide/fat face? (Photo)
Doctor Answers 4
Facial Fat helps people stay young. Perhaps facial balance will make the lower half look less heavy.
Of the photos you posted, the one feature which is just showing below the cropped area is your lower eyelid/cheek junction. It appears to have some hollowness and tear troughs on the 1st, 3rd, and 5th photos.
If you only posted the 2nd and 4th photos, your face looks bright and youthful. All that is seen in the 2nd and 4th photos is a single convexity from the cheek prominence to the jawline. It doesn't look bottom heavy as you described.
In photos 1,3, and 5, I can see the "bottom heavy" illusion that you are referring to. I suspect the hollowing of the upper cheek and tear trough area is making the upper half of your face look "lighter." When something is hollow, it looks concave. So if the upper half of the face has concavity, and the lower half of the face has convexity, then it can appear to be bottom heavy.
If a woman is full figured on her chest, and hips, she looks balanced. If she is smaller on her chest, and has the exact same hips, then she is pear shaped. Obviously the hour-glass is more preferable than a pear shape.
So if we take this analogy to the face, perhaps the solution is not as extreme as you are listing. Imagine the typical Kim Kardashian face. In your mind you can see her almond shaped eyes, and her high cheekbones, but where did her lower eyelids go? Her cheek convexity goes up very high within 1/8"-1/4" below her lower eyelash line. This high cheekbone look can help you look more like you do in photos 2 and 4.
Definitely do not have a facelift. Facelifts on young people or people with full faces essentially look the same. Facelifts are for "sagging" or "loose" skin which you do not have. The incision around the ear on a 23 year old would not be acceptable. The improved elasticity of younger people usually results in a thicker scar. Older skin which has lost more elasticity tends to heal imperceptibly.
As far as chin liposuction, buccal fat removal and necklift, I have answered many questions about them, and my general philosophy is included in these answers. You can find them on my Realself profile under Q&A, and the topics such as necklift are all tagged. I think fat reduction to reduce "out of proportion" fat is reasonable. Over the years, I have been contacted by several patients who regretted having buccal fat removal by other surgeons. Because I wrote a web article warning against buccal fat removal, they were asking me if it can be reversed. Once the buccal fat is removed, the fat cannot be replaced. Volume can be replaced using fillers or fat grafting or a cheek implant, but not in the same way that you had it naturally.
The one comment that they always had when they had their buccal fat was that people would guess that they were much younger than their actual age. When the buccal fat was removed, people thought that they were their actual age. Their cosmetic result looked fine to me, but the concavity below the cheekbone made them look a bit older, and the saving grace of the having a surplus of buccal fat is the appearance of being younger than their actual age is gone. Additionally, other than the center of the cheeks being slightly more "sucked in" the rest of their face was still pretty full, so there was still some imbalance. Another observation of buccal fat removal, is that it can make the tear troughs worse in a certain percentage of buccal fat removal patients depending on how aggressive the buccal fat removal was.
Jaw reduction with botox is a simple and reversible way to narrow the angle of the jaw, assuming the masseter muscle is very bulky. In one of my Asian patients the front of her face is very full, and her masseter reduction is not visible behind the fullness of the front of her face, but she gets it for "bruxism" which is grinding of her teeth.
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