Liposuction is a very effective method of fat removal. While it can be used in almost any location of the body where there is fat, it does have limitations. And when applied to certain fat areas, it may even have the opposite effect of an undesired result.

The face is one such area where the concept of liposuction is largely more theoretical than practical. While the face does have fat below the skin, it is not easily removed like that in the trunk or extremities. Facial fat is more fibrous and has branches of the facial nerve lying deep to it. There are few very discrete collections which can easily be removed with the exception of the buccal fat pad and some of its numerous extensions.

Plastic surgeons frequently advertise and perform neck liposuction. And while the neck is part of the face, most patients do not think of the neck when they envision the concept of facial liposuction.

When you combine what is contained in the buccal space with the subcutaneous tissues in the neck, these are the only two facial areas where contouring can be done through fat removal. The neck can be liposuctioned while the buccal fat pad can be directly extracted through a small open incision. Removal of any other facial fat areas through liposuction  is not only ineffective but can cause a lot of tissue trauma and prolonged swelling.

When liposuction first became widely used in the 1980s and 90s, facial liposuction was both advocated and written about. It was used to try and reduce facial fullness in the lateral face and even reduce the prominent mound of tissue that develops above the nasolabial fold with aging. It was proven to be ineffective and has since become largely abandoned as a treatment for facial fullness.

For those seeking to reduce their ‘fat’ face or to deround their facial appearance, liposuction is not the answer. It simply can not do what can be done for the circumference of the thigh or the waistline. One cannot deflate the face so to speak.

Improving the shape of a very full and round face does include some fat removal which is accessible, the buccal and neck fat. But fat removal alone is inadequate as it can only change some of the contour. If a full neck is all that bothers someone, then liposuction alone is a good treatment. But for more total facial sculpting and definition creation,  it must be combined with other procedures that bring out or highlight facial prominences such as the chin, cheeks, or jaw angles. Using implants in these facial convexity areas can help bring shape to an otherwise amorphous face.         

Dr. Barry Eppley

http://www.eppleyplasticsurgery.com

http://www.ologyspa.com

Clarian North Medical Center, Carmel, Indiana

Clarian West Medical Center, Avon, Indiana

Indianapolis

I frequently see patients who desire greater facial definition. Usually these are younger men and women and much of their desire comes from having a fuller or fatter type face. Most of the time they have lost some weight but can’t lose it in the face. Others have never had a weight problem but want to have a more ‘chiseled’ facial appearance….this type of patient is almost exclusively a younger male patient. Regardless of their age, sex, and weight background, their objectives is to make their face appear less full with better accentuated facial features.

 
When looking at such patients, it is important to realize that their are only six facial landmarks which can be surgically altered to achieve these goals. They are (from top to bottom): cheeks, subcheeks (submalar), nose, chin, jaw angles, and neck. Four of these are more hard tissue (bone and hard tissue) and two of them are soft tissue or fat only. In the heavy or once heavy patient, the foundation of treatment is usually neck liposuction and buccal lipectomies. Reducing full areas by fat removal is always the first step and, for many, may be all that is really needed.They may benefit from cheek or chin augmentation as well and a good pre-surgical digital computer analysis and predictions will make this clear. A chin augmentation through an implant with fat removals in the cheek and neck is not an uncommon combination that can be highly successful.

 
In the ‘non-heavy’ or non-weight loss facial patient, fat removals may not be necessay at all. If needed, it is only in the buccal (cheek) areas only. This type of facial definition patient requires bony enhancement mainly. This may be chin, cheeks, or jaw angle implants and a computer analysis can tell which combination may be best. The order of facial implantation is chin implants are done the most, jaw angle implants next, and cheek implants the least. For the young male patient that is looking for what I call the ‘male model’ look, all three facial implants may be necessary.

 
I would be remiss in this discussion if the concept of rhinoplasty is not brought up as part of the surgical options. A broad, wide, or long nose can also be a source of facial disharmony. Rhinoplasty surgery helps put the nose into better balance with the rest of the face and a well-proptioned nose in some patients can make a dramatic difference. While it is not the most common facial change in facial definition surgery, it must always be considered in diagnosing what makes a patient’s face unbalanced.

 
Enhancing and redefining facial contours is a combination of fat removals and bony prominence enhancements. While none of these surgeries are difficult and all can be accomplished without facial scars, the most important part lies in the pre-surgical discussion and planning. These patients are highly self-conscious and, as a result, will be extremely critical of their surgical result. Thorough computer imaging and realistic goal-setting is the key in making the facial definition patient satisfied.

 
Dr. Barry Eppley
http://www.eppleyplasticsurgery.com
http://www.ologyspa.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis