Lower face fat. Buccal fat removal or Facelift? (Photo)

Question

I've had the same chubby cheeks since childhood. I'm now 27. I'm 5'8" and 115 lb. so I am skinny and this will not go away with weight loss. Its the lines/folds by the corner of my mouth extending down toward my chin (making me look like a bulldog when I smile) that bother me. I just want to lose the fat around this area so that my smile lines end at the corner of my mouth. Is this all buccal fat? would a removal solve this? Or would I need a facelift? Lipo? etc?... any suggestions?

Peter Lee, MD, FACS · Answer

At age 27, you are too young to undergo a facelift, and I don't believe this would address what bothers you in any event.  Removal of some of the fat from the buccal fat pad will reduce the volume of your lower cheeks somewhat, but it will not remove the folds of which you complain. Liposuction of the subcutaneous fat may also reduce the size of the upper portion of your cheeks. Part of the issue is that what bothers you is not merely excess fat of your cheeks, but the way the skin of your face drapes and folds when you smile. The depth of your nasolabial folds can be softened with the injection of filler, but this will not make them go away completely, nor would you look natural if they did. You could also try subcision of the folds that are present beneath the oral commissure, where I suspect the deeper layers of the skin are adherent to the muscle fascia, followed by fat transfer to the site of the subcision, in an effort to prevent reattachment of the skin to the fascia.  This may help somewhat, even if it is not definitive. In any event, you should try to address your problem with smaller procedures first before moving onto more invasive approaches.

John Mesa, MD · Answer

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

Joubin Gabbay, MD · Answer

I think a buccal fat reduction will help achieve your goals.  By reducing your lower cheek volume, the laugh lines you complain of may diminish, and you will have a more slim face.  Please ensure that you're seen by a board certified plastic surgeon.

Miguel Mascaro, MD · Answer

Thank you for your pictures! To be honest with you, this is a very common question - as a matter of fact, I have answered many questions on this very topic!  Someone your age certainly does not need a minilift or a facelift whatsoever. The buccal fat pad and the area that concerns you has a lot of fibrofatty connections - meaning that isolated liposuction does not yield an even result, and often times can cause permanent damage to some of the important structures found in this area, such as the facial nerve and parotid duct.  Buccal fat reduction surgery would give you the improvement that you are seeking with more definition and contour from cheek and jawline highlight.  Clearly a full physical exam would be needed before making any definitive decisions.  I hope some of this helps.  Best of luck!

Lower face fat. Buccal fat removal or Facelift? (Photo)

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