Buccal fat removal or (off-brand) Kybella for face slimming/jowls? (Photo)

Question

I am a mixed asian 35 yr old female. I have had chubby cheeks since birth and have remained whether I was a boney size 0 till now. I have high cheek bones but my fat cheeks have become heavy creating jowls. I've had 2 consultations where Dr's suggested injectable fillers, jaw botox and ultherapy. I want a permanent option that does not add volune to my already BIG face but there aren't any experienced DR's who perform either procedure in the Seattle area. Help!

James M. Ridgway, MD, FACS · Answer

Dear UpgradeU206,The question you ask is a very important one as it relates to whole facial aging and your ancestry. When looking at the images you've provided I see the normal aging that most people have at the age of 35. you do have early jowl formation, but this does not mean that they are appearing early on you.  You appear to be aging normally.  However, placement of Botox in the jaw muscles will not help your jowl formation, and may likely accentuate it. You appear to have lost some mid facial volume and that is why fillers have been recommended in this region.  You would see a minor improvement  in the jowl, but not a definitive correction from fillers.  Just for your information, fat grafting can be that "permanent" solution that could help you with this, just for your edification. The use of Kybella in the jowl region would be off label and does present a risk for the nerve in the region.  I have used Kybella in this region, but it takes multiple treatments, hurts like heck and there is notable swelling that one must recover from. Taken together I feel that direct micro liposuction to this region of interest  would produce the most reliable, safe  and effective results.  I hope this helps you as you  find the best answer for you.Be healthy and be well, James M. Ridgway, M.D., FACSPS. And yes I agree, you should see a board certified surgeon for such considerations.

Dallas Buchanan, MD · Answer

Thank you for your pictures and questions. Although I have not been able to evaluate you in person and perform and exam and discuss your exact concerns, I can assume that if you saw two board certified (ABPS) plastic surgeons in the Seattle area and they provided a treatment plan for you, this is because this is what they thought would provide you with the results you were looking for. I can essentially guarantee you that your statement of "there aren't any experienced DR's who perform either procedure in the Seattle area" is blatantly false. Maybe it is that an off-label Kybella injection is this area would be beneficial or buccal fat removal would be beneficial, but those two doctors did not think so. I would suggest you have a couple more consultations in your area to discuss your concerns. Make sure these are with surgeons certified by the American Board of Plastic Surgery. If you keep being told that your suggestions are not the solution to your problem, then you would be best treated to heed that advice and listen to their suggestions. Best of luck!

John Mesa, MD · Answer

People in their 30s start having sings of facial aging like descend of the mid face tissues, mild jowl formation, etc. If the patients have chubby faces, this findings could be more pronounced.
Applying kybella to the jowls is ideally not recommended since the nerve that controls the lower lip is close to the injection site, thus ending up in a crooked mouth temporarily and possibly permanently
Chubby cheeks could be improved with buccal fat removal
Descend of the mid face tissues and mild early jowls could be improved with cheek bone enhancement (augmentation) with either soft tissue fillers or cheek implants
Patients int heir 30s interested in facial rejuvenation  should make a consultation with a Board Certified Plastic Surgeon specialized in plastic surgery procedures of the face

Karan Chopra, MD · Answer

You would need Buccal Fat Pad Removal and Jowl Fat Pad Liposuction through a tiny incision with 2.0 or 2.4mm Sattler Liposuction Cannula to debulk your neck and blend your jowl fat pad with the jawline. Chin and Jawline filler could be good adjunctive treatments but not good stand alone treatment. You may also need masseter botox for slimming of the posterior lower 1/3 of the face.

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Mats Hagstrom, MD (license on probation) · Answer

While I cannot give you the name of any specific doctor are you sure you give her plenty of highly competent board-certified plastic surgeon's who can help make an appropriate plan of action for you.
You should not decide your own surgical treatment plan.
There's an expression that the Doctor Who treats himself has a fool for a patient.
This is true despite doctors finishing medical school and most a full residency with board certification.
Patients are generally not educated enough to make their own treatment plans.
Facial aesthetics are very complex.
I suggest continuing consulting with new board-certified plastic surgeon is asking for an overall facial assessment with various treatment plans.
Best,
Mats Hagstrom M.D.

Buccal fat removal or (off-brand) Kybella for face slimming/jowls? (Photo)

Answers (5)

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