My philosophy and techniques in facial plastic surgery have evolved over the years and now include facial sculpting using cheek liposuction and buccal fat removal at my NYC practice. By “sculpting” I mean that I remove volume from some places, and I add it to others. This is different from facial rejuvenation for an aging patient. Facial Sculpting is for a younger patient trying to achieve an image of beauty that they may not have genetically. In these cases, we are trying to refine the features that make anyone more attractive. Generally speaking, I remove fullness from the lower face and add it to the upper or mid-face. That’s because everyone wants high cheekbones and fullness in the midface. It’s a well-described sign of beauty, and much has been written about its importance in the plastic surgery literature (Owsley, J. Q. Lifting the Malar Fat Pad for Correction of Prominent Nasolabial Folds. Plast. Reconstr. Surg. 91: 462, 1993).
Removing Fat: Against the Grain
It is also very trendy to add more volume to the face with fillers or fat. The motto seems to be “More Volume. . . at any cost.” (Facial Contouring by Targeted Restoration of Facial Fat Compartment Volume: The Midface Wang, Wenjin; Xie, Yun; Huang, Ru-Lin; More Plastic and Reconstructive Surgery. 139(3):563-572, March 2017). I disagree. In order to create a more aesthetically pleasing face, the midface should be full with nicely contoured cheekbones, and the lower face should be more slender. The overall shape of a beautiful face resembles a triangle pointing downward. This is why people are more attractive when they smile as opposed to a mug shot without facial expression. I add volume to the midface (or upper cheek) all the time, but I now remove fat from the lower face too. My understanding of facial anatomy and beauty has taken years to develop, and this is now how I see it…
First: The Double Chin Problem Solved
Starting in 2008 or so, I began performing an increasing number of facial contouring procedures including chin liposuction, buccal fat removal, and microcannula liposuction of the cheeks. At first, it was the neck and chin liposuction procedure that took off. The advent of smartphone cameras combined with the rise in social media made patients much more aware of their double chins. Videoconferencing also started to become more available. Even “regular” people found that FaceTime and Skype didn’t necessarily show them in the best light. This prompted my writing about the Selfie Chin Solution and double chin removal at my NYC practice a few years ago. The procedure has become so popular that my before and after gallery has become one of the most popular on my website. The procedure itself is the most common operation in my office right now.
Next: The Chubby Cheek Problem
As I performed more and more SmartLipo of the chin and neck area, patients began asking about chubby cheek reduction. The selfie generation is requesting more refinement of the jawline and profile features. Women seem to want to be more petite with a more V-shaped lower face. Male patients are requesting more angular and masculine features. I had to find a way to please both of them. I turned several people away for buccal fat removal because current theory teaches that we want more fat in the face as we age—and I didn’t want them to age poorly. However, it also occurred to me that we don’t want “fat faces,” we want fullness in the upper midface. A round face may be cute for children, but it is never sexy. . . and most of us want more sex appeal, not less.
Furthermore, fat in the lower cheeks eventually starts to hang over the jawline and contributes to jowls as we age, and nobody wants jowls (The Mandibular Septum: Anatomical Observations of the Jowls in Aging-Implications for Facial Rejuvenation Reece, Edward M. M.D.; Pessa, Joel E. M.D.; Rohrich, Rod J. M>D> Plastic and Reconstructive Surgery: April 2008 -Volume 121 – Issue 4 – P 1414-1420). Therefore, if I remove lower cheek fat, the patients begin to develop that triangle, and they look better. And so, I began performing buccal fat removal surgery.
Solution 1: Buccal Fat Removal
I found the removal of the buccal fat pad to be a sort of fun procedure that was very satisfying technically (as the surgeon). I also found that the results tended to be fairly modest. The truth is that we only remove somewhere between 2.5 cc and 3.5 cc of fat in the vast majority of cases. And it is always from the same region of the cheek—just at the bite line where your teeth come together with your mouth closed. The effect is similar to what you might see if you suck your cheeks in between your teeth with your mouth slightly open.
I want to emphasize here that the effect is typically subtle. As a matter of fact, as time went by, I began to wonder if there was something I could do to more dramatically reduce the chipmunk cheeks of so many of my patients. After all, I work in New York City, and my patients expect Real Results!
Truly Chubby Faces Need Cheek Liposuction
Considering the problem at hand, I thought quite a bit about the anatomy of the face. I reflected on all the facelifts I’ve done and all the various techniques for facial rejuvenation that are out there. It is also worth noting that when I do a facelift, I sometimes liposuction the jowls, but not the chubby cheeks. Why couldn’t I liposuction the cheeks?
Well, there are all the motor nerves in the area that I don’t want to injure. There is also a risk of taking too much fat from the cheek and leaving someone with a dent. Okay, so how to avoid those two problems? First, I would need a very fine cannula. One so small that it would be difficult to remove too much fat from a single area even if I tried. Second, I would have to stay superficial and be sure not to injure any nerves to the face. This would require a new face liposuction technique that hadn’t really been popularized before. At my NYC practice, I call it, “Microcannula Liposuction of the Cheeks.”
How To Liposuction Cheeks
I don’t want to get too bogged down in the details of these procedures. Patients may not want to know, and I don’t want my competitors to know exactly what I’m doing, but . . . it sure seems to be working. With this method, I can remove about 10 cc from the entire lower face (NOT the cheekbone area, the lower cheeks only). Furthermore, the treated zone is broader than that with buccal fat removal.
In patients who have truly rounded lower faces, I can use both methods. Sometimes I’ll even throw in some chin liposuction or a chin implant. This creates an even more profound outcome. We get Real Patients with Real Results!