Best Option for Lower Cheek/jowl Fat?

Thank you for submitting the photos with your post. Your situation is a little out of the norm because we do not usually see this degree of marionette lines (jowling) in a thin healthy 20 year old. I do not like removing facial fat in younger individuals because the fat thins on its own as part of the aging process. Removing it will make you age more quickly so to speak. The only exception being those who start out with a lot more - cherubic faces.

On the oblique view you have an age appropriate outline until you get just to and below the level of the corner of the mouth. You most likely have pseudoherniation of the buccal fat pads. This is a deeper cheek fat that extends from the deep temple area down to the outer corner of the mouth level. In some people the ligaments holding it in place weaken and it falls further downward. If that is the case the fat you see you should be able to push back upward with your finger or the fat should fall back into place in a head down position. Since reefing the fat back up is a logistic nightmare requiring large skin incisions the preferred treatment is to remove only the lower most part of the fat pad through an incision in the mouth.

Before you consider liposuction, you should see an expert in facial volumization with fillers. It looks like you don't have much midcheek support so if liposuction were done on the lower face, your face would become too thin. Conversely, if the mid face were filled there might be an elevation of some of the "weighted'" lower cheek sructures.  Liposuction of thelower cheek/jowl does have a risk of nerve injury, although this is very rare.

You need chin help. What looks like jowls is from a weak chin. By building up the chin with filler, the face will be much better balanced. The area below the corner of the mouth (just in front of what looks like a jowl) needs the most volume. Even 2 ml of Perlane will make a huge difference here. Unlike a product like Sculptra, the result of service is immediate and the product can easily be adjusted. This type of treatment will last on the order of one or two years.

Hi Anon,

Since you are only in your 20's, I would recommend holding on to as much facial fat as you can. I would recommend using Sculptra to fill your cheeks, chin, and jawline which would restore lost volume to your face and lift the "sagging" areas. You may also benefit from a chin-jowl implant augmentation.

Good luck and be well.

Dr. P