Q. I have chubby lower cheeks. I have never had cheekbones (I’m quite narrow in the forehead /around the eyes). I’m fit and healthy – not overweight. I’m looking into buccal fat removal which some doctors say they can do, but some say they are against it and refuse to do it. One suggested to put filler in my upper cheeks, which would create more cheekbones and maybe pull the jowls up, but wouldn’t that cause chubby cheeks to then look even more chubby? I’m getting confused, please help!
A. As you note, fat distribution in the face does not necessarily mirror your physical appearance. By heredity and genetics, the predisposition of fat in the face creates the soft tissue balance of a “upside down” egg (more youthful) or “bottom heavy” egg (older and / or heavier) appearance. With time and aging, the soft-tissues of the upper and lower cheek separate and descend creating the folds of the tear trough, the nasolabial and the marionette folds with heaviness of the jowls.
The fat lies in 2 general areas:
- superficially under the skin in varying thicknesses, and
- deep in packets separated between the upper cheek (medial malar area) and lower cheek (buccal fat pad).
Removal of the buccal fat in a thinner faced patient may accentuate the “cheek bone” prominence but in a fuller cheeked individual like yourself, buccal fat pad removal will only deepen or widen your dimple area.
My thoughts are to micro-lipo-contour the subcutaneous layer of your lower face, jawline and if you need it, the neck below the “Nike Swoosh” logo outline of your soft-tissue cheek.and lateral cheek bone. The fat would be grafted in the various layers of the “apple” or roundness of the malar cheek and along the upper aspect of the lateral cheek bone.
This will re-distribute facial fat and therefore your facial appearance to a more youthful balance. A light will then reflect off the fuller convexity of the “apple” close to your nose and under the eyelid and the highlight will continue above and along the gentle curved upward slope of the cheekbone toward the ear. A shadow will occur below the “Nike Swoosh” margin of the lower cheek and jowl achieving a more idealized facial contour.
You may augment this with additional fillers if you wish or fat from other donor sites. If you chose to use fillers only along the “apple” and cheekbone, you may improve the highlight but not the concave shadow.
Whether you use fillers, botox, other injectibles, lipo-contouring or surgery, facial enhancements are art and science. Choose a Board Certified, well experienced artful Plastic Surgeon and Injector for consultation.
I wish you the best!