Not infrequently I get requests from patients for the desire to transform a round face into a more shapelier one. One cause of a round face is that the patient is overweight. A full neck, round cheeks, and a lot of subcutaneous fat throughout the face creates a generalized fullness that creates a fat and round face. These patients know full well that they are overweight and some liposuction of the neck and buccal lipectomies may make some difference. But weight loss will probably make the most difference in these cases. And these procedures should not be performed until some weight loss has been achieved.
But the overweight patient is not what usually makes up the ’round face’ patient. Most commonly these are younger patients that are not significantly overweight and are usually closer to being more height and weight porportionate. They may have some mild fullness in the cheeks and neck but often their bony prominences (cheeks, chin, or jaw angles) may be somewhat deficient. The approach to these patients must deal with both hard and soft tissues issues to be effective at improving the face’s angularity and definition.
In addition to the fullness of the cheeks and neck, the next most important consideration in facial shape improvement should look at the chin. Often it may only be midly short in the horizontal dimension but the width of the chin is also important, particularly in the male patient. Chin implants today can provide more projection as well as width in many different sizes. Placed through a small incision under the chin bone, a chin implant can lend more definition and squareness to the lower face from subtle to dramatic results. A sliding genioplasty is another chin augmentation method that often can think out a face better than a chin implant.
Upper facial fullness, more specifically midfacial fullness, can be achieved through cheek implants. Placed into position by incisions inside the mouth under the upper lip, cheek implants can provide good highlights through three-dimensional enhancement of the bone as it wraps around the area below the eye. An amazing aray of cheek and midface implants is available to provide a lot of enhancements around this important facial landmark. When paired cheek implants are combined with a chin implant, an upside down triangle of change is created that directly opposes a more round or oval facial shape.
Jaw angle implants are always a possibility but these are rarely needed in most really round faces. They can produce some lateral facial fullness but this is not usually helpful in ‘de-rounding’ the face.
The procedures of buccal lipectomies, neck and jowl liposuction, chin and cheek implants make up the usual plastic surgery tools for facial rehaping. Which one or combination of procedures is most helpful for improving facial definition is best determined by careful computer imaging study between the patient and their plastic surgeon.
Dr. Barry Eppley
Indianapolis, Indiana