Recessive chin and fat cheeks - SMAS face/necklift and/or genioplasty? (photos)

Question

I’m in my mid-30s; inherited mom’s recessive chin and fat cheeks. Had a chin implant and neck liposuction done 7-10 years ago with the goal of getting a more defined jawline and visible chin (w/o looking like a witch’s chin). Was a smidge happy, but should have done more research. I’m interested in doing an SMAS neck/face life with buccal fat removal. Do you think that’d be more appropriate for my situation? What about genioplasty?

Jacob Tower, MD · Answer

Hello, hope you are well. Thank you for submitting your photos and questions! Despite your surgical history, your chin remains disproportionately small and a revision genioplasty should be considered. Obtaining an op note that describes the implant that was used 7-10 years ago would be very helpful. A neck lift can be performed at the same time to address the bulge underneath your chin. The one view we lack in your photos is the standard A-P ('frontal') perspective which shows the face straight on. That view is needed to advise further on your questions about buccal fat removal, facelift options, or other options for facial contouring.
Best,Dr. Tower

J. Timothy Katzen, MD, FACS · Answer

Hi. Thank you for your question regarding a recessive chin, fat cheeks, and whether you should consider a SMAS facelift and neck lift. Thank you for your history and your pictures. In analyzing your pictures, you would do best with chin augmentation. Two forms of chin augmentation are reliable: a chin implant or a sliding genioplasty. During a sliding genioplasty, the bone is cut and advanced, then anchored with screws. This should be your first procedure. You could also need neck liposuction if this does not correct your neck. In addition, I would also suggest a facelift with SMAS plication and buccal fat removal. All these procedures can be done in one operative setting. The surgery should take approximately 6 to 8 hours and can be performed under twilight or general anesthesia. Plan for a two-week recovery. Therefore, most plastic surgeons would suggest chin augmentation (either bone or an implant), neck liposuction, SMAS facelift, neck lift, and buccal fat removal. Good luck. I hope I’ve answered your question regarding what procedures are suggested for your facial anatomy.

Sincerely,

J. Timothy Katzen, MD, FASMBS, FICS
Plastic and Aesthetic Surgeon

Sincerely,

J. Timothy Katzen, MD, FASMBS, FICS
Plastic and Aesthetic Surgeon

Anil R. Shah, MD · Answer

I recommend a deep necklift  or a deep plane lift with buccal fat removal in order to address all of your concerns. I am happy to speak with you in more detail virtually or in  person. Please fell free to reach out to my office to set up a consultation. Hope to hear from you soon.

Ali Riza Öreroglu, MD · Answer

Considering your photos, SMAS neck/face lift and buccal fat removal may be suitable for achieving a defined jawline and visible chin. These procedures can further enhance your facial contours, providing a natural result. After physical examination, I can decide if you need any revision for your chin implant. Combined procedures can yield optimal results, but this requires careful planning.

Gianfranco Frojo, MD · Answer

I would recommend a facelift/necklift. I do not recommend buccal fat pad removal unless there is frank psuedoherniation of the buccal fat in the facelift approach. In that scenario, it is carefully removed in very minimal amounts to help contour the cheek.

Lucian Ion, FRCS · Answer

Thank you for your enquiry and sharing your photographs.
In general, a combination of deep plane neck lift and facelift can contribute volume reduction along the jawline and under the chin as well as redistribution of the volume in the cheeks and lower face.
Enhancement of the chin projection would contribute to the definition of the jawline whether it is by means of a genioplasty or chin implant. Depending on the size of your current chin implant it may be possible to increases and use a larger one.
Buccal fat reduction also contributes to contouring in the lower part of the cheeks and can be combined with the procedures listed above.

William Portuese, MD · Answer

Even though you've had a chin implant, you still have a recessive chin, so consider placement of a larger chin implant. You also have significant fat deposits in your neck, located both above and below the platysma muscle. You will also require a neck lift procedure to remove both fat compartments in the neck, in addition to a platysma – plasty. At age 35, your skin tone should be acceptable, and skin removal should not be required. You should also have a BMI of less than 32 before undergoing any of these facial and neck procedures.

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