Excess fat in jowl area. What are my options? (photo)

Question

I'm wondering what can be done about this--I'm at a healthy weight and have always had this, the skin isn't loose it's just like bulges of extra fat. Is there a way to improve the look with filler? Ideally I'd like to lift or remove the fat to suck the area in a bit but I've heard liposuction isn't done in this area because it's very risky. What are my options? Thank you!

Raffy Karamanoukian, MD, FACS · Answer

Morpheus 8 is a non-invasive skin and soft tissue tightening treatment that is consistently amazing in our patients. We use the Morpheus to exact fractional induced RF into the skin or tissue in order to tighten collagen and stimulate contraction of the tissue. For acne scars, it is quite useful to build collagen in patients who have atrophic scars but is not very productive for ice-pick scars which require TCA Cross. For tissue tightening, Morpheus is ideal for the face and neck and we often combine it with CO2 laser or Ultherapy to further enhance results. Chemical peels and skin resurfacing should be done at least 5 to 7 days after, but can be performed earlier, depending on treatment severity. Avoid exfoliating skin treatments before Morpheus and expect a period of 2-4 weeks for skin contraction to set in.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best, 
Dr. Karamanoukian 
Realself100 Surgeon

Kimberly Butterwick, MD · Answer

You have a bit of jowl fat that is squaring off the shape of your face and is likely a genetic trait. You’re correct, we don’t usually perform liposuction here but there are some good options. Often, just a small amount of Kybella here can reduce the jowl just a bit. Too much fat removal will replace the fat with wrinkles, so small quantities injected in 1 – 3 sessions conservatively are best. In addition, filler placed in the upper outer face and near the ear (see my Instagram on picket fence) will lift the fat up and out. The third option is to pull it back with the Silhouette InstaLift thread lift. All of these are great options, but the best one will depend on your examination and consultation.

Kenneth Hughes, MD · Answer

Hello, thank you for your question. Non-surgical options for improving the jowls, neck area, and jawline include botox to thin the muscles, and a threadlift to help redrape the skin in a more vertical direction. Ultherapy can also help tighten the skin using energy to shrink the dermis below the skin. It is best to have an in-office examination to determine which treatments will have the most effect on your particular skin type. Hope this helps!

Vincent N. Zubowicz, MD · Answer

I'm not really sure what's bothersome to you. There appears to be a modest amount of surplus fat in the chin area that can easily be removed by liposuction under local anesthesia. Suctioning above the jawline is generally considered not to be a good idea except in select cases. Some hollowing of the cheeks can be accomplished by reduction of the buccal fat pad which is done under local anesthesia and through the inside of the mouth. Again selection of procedure is really going to depend upon the outcome that you desire.

Mats Hagstrom, MD (license on probation) · Answer

Each individual’s facial appearance is primarily based on the shape and proportions of their facial skeletal or bone structure.  Some people have mandibles that are short or lack vertical heights.I don’t think that you particularly have more fat in the jowl area than the average person. If you want an accurate assessment then you really need to do a proper consultation. Without seeing proper photos or knowing your age it’s going to be difficult to give you an accurate comprehensive assessment or recommendations.As patients get older liposuction or fat manipulation becomes less effective in skin surgery is by far a better option.Liposuction can be done in the jowls but a branch of the facial nerve goes right through the area and can be damaged from this procedure. When it happens it’s typically temporary but if the procedure is aggressive it can go on for so many months. If done carefully with small cannulas the chance of having nerve damage is fairly small. when the buccal branch of the facial nerve is damaged the mouth will not move evenly on both sides.It’s not an absolute contraindication to do Liposuction in this area. Some plastic surgeons do and some don’t.Personally I have in the past but currently would not.Kybella Is even worse in regards to causing nerve damage So I don’t suggest looking for that as an option.I suggest having several formal consultations with local board-certified plastic surgeons in your area.Having all the information needed and discussing this in person will serve you much better.Best, Mats Hagstrom MD

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