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Dr. Barry Eppley

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Double Board-Certified Plastic
Surgeon Dr. Barry Eppley

Posts Tagged ‘buccal lipectomies’

Case Study: Thinning the Round Face

Sunday, May 15th, 2011

Background:  The shape of one’s face is influenced by many bony and soft tissue elements. The size of the facial bones and the prominence or deficiency of the lower jaw provides a support framework that serves as a foundation. The soft tissue that drapes over the bones also plays a major role in its shape with much coming from the thickness of the facial muscles and how much fat lies under the facial skin.

There are numerous facial shapes, some of which are flattering and others which are not. The one facial shape that is disliked by many people is a round face and, if big enough, may be called fat. Not only is the shape round but it usually lacks distinct facial highlights. Most round faces include fullness in the neck tissues as well. One of the anatomic features of the round face is that it has more fat beneath the skin creating a thicker subcutaneous layer that masks the prominence of the underlying facial bones.

Facial and neck fat is not just one uniform layer underneath the skin. There are numerous fat compartments that make up certain prominences or collections that are accessible to surgical removal. While fat exists underneath all areas of the facial skin, much of it is thinner and not easily removed. Unlike the abdomen or the thighs where broad areas can be treated by liposuction, facial fat can not be treated the same way or so effectively.

Case Study: This 25 year-old female did not like the shape of her face. She felt it was too round and never liked it. Despite her perception of a round fuller face, she was not overweight and had a thin to moderate body build. She felt that if she could just get rid of some facial fat she would be much improved. She was otherwise happy with her facial bone structure.

She underwent a three compartment facial fat removal approach under sedation anesthesia. Her submental and neck area was treated by small cannula liposuction. A large amount of cheek fat was removed by buccal lipectomies done from inside the mouth. Through small incision under the earlobe, the side of the fat over the parotid gland and into the jowl area was also liposuctioned.  

She wore a neck and jowl compression garment to help with swelling for the first 48 hours. She was able to shower and wash her hair the next day. By one week after surgery, she looked ‘non-surgical’ and was able to see the results of the surgery after three weeks. The final results could be fully seen by six weeks after surgery. She was pleased with the results of the surgery and achieved a facial shape that was less round and more distinct

Case Highlights:

1)     The round face has greater amounts of compartmentalized fat in the cheeks, neck and side of the face which may be surgically treated. Much of the round facial fat has extensive subcutaneous fat which can not removed.


2)     The round face can be improved by cheek, neck and lateral facial fat removal using a combination of liposuction and direct lipectomy.


3)     The amount of ‘derounding’ that a face can achieve by fat removal alone can be minimal to moderate improvement. If combined with facial bone augmentation , if needed, the results can be more significant.

Dr. Barry Eppley

Indianapolis, Indiana

Surgical Options for the Chubby Face (Fat Face)

Monday, February 15th, 2010

It is not uncommon to hear a patient’s concern about their chubby or ‘fat face’. For some of these patients their face matches their body habitus and some significant weight loss will do wonders for those concerns. But there are people who do have a chubby face that are not necessarily significantly overweight and they may seek a plastic surgery consult to see what their options are.

 The chubby face differs from other facial types in that the entire face appears full. From the cheeks down to the neck, the face assumes a definite round shape. Patients with a chubby face will often complain that the shape of their face makes them appear heavier than their body really is.

There are numerous non-surgical facial fat reduction methods that are marketed and sold. I can not comment on whether these work or are effective as they are not used in my Indianapolis plastic surgery practice. But should you try them and find them unsatisfactory, you can consider the following surgical options.

Almost all chubby face patients have thicker and elastic skin. This is a double-edged anatomic consideration. Such skin has the ability to shrink and contract (snapback if you will) which is good for getting better contours, particularly in the neck. Conversely, thick skin is also heavy and is prone to prolonged swelling.

The strategy for the chubby face is not one of overall fat reduction through liposuction. This is not possible in the face contrary to the perception of many. Select or spot fat reduction must be done instead. This would include submental and neck liposuction and buccal (cheek) lipectomies. These are very consistent procedures that are effective but patients should not expect them alone to produce a dramatic facial change. Fat pockets around the eyes and excessive skin can also be helpful if they exist but these are complementary procedures, not a primary modification maneuver.

There are no other fat areas of the face that can be effectively reduced. While significant changes can be made, for example, through a superficial parotidectomy and submandibular gland removals, these are extreme procedures which are not justifiable for cosmetic changes. Attention must be turned to bringing out facial prominences to aesthetically work in the opposite direction.

The cheeks, chin and nose must be carefully look at to see if their accentuation would be beneficial. The chin is the easiest one to assess as a weak chin is readily seen. Chin augmentation, even if it is only a minor amount, can complement the contour pullback from the neck liposuction. Cheek augmentation is more difficult to determine its potential benefits as it is not a profile structure. Unlike the chin, cheek augmentation in some patients may actually make their face look fuller or heavier. A cheek implant to help make a face look thinner must be placed high on the cheekbone and not be overdone in amount and location of projection. Too much anterior or too much lateral projection creates undesired midfacial fullness.

A rhinoplasty with dorsal augmentation and tip narrowing can help make the face look thinner by an optical illusion effect. Thinning of the nose is the one procedure that affects the central face whose appearance is not based on how much fat is present. Patients with chubby faces rarely have a narrow nose or a nose with a high dorsum. Usually they have a broader dorsum with a wider tip to their noses.

To change the appearance of the chubby face, multiple soft and hard tissues procedures are needed. These can include neck and cheek fat removal, blepharoplasty, and facial bone prominence highlighting. Piecing together these procedures into an effective facial surgery plan is as much an art form as any definitive science.   

Dr. Barry Eppley

Indianapolis, Indiana

Dr. Barry EppleyDr. Barry Eppley

Dr. Barry Eppley is an extensively trained plastic and cosmetic surgeon with more than 20 years of surgical experience. He is both a licensed physician and dentist as well as double board-certified in both Plastic and Reconstructive Surgery and Oral and Maxillofacial Surgery. This training allows him to perform the most complex surgical procedures from cosmetic changes to the face and body to craniofacial surgery. Dr. Eppley has made extensive contributions to plastic surgery starting with the development of several advanced surgical techniques. He is a revered author, lecturer and educator in the field of plastic and cosmetic surgery.

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