Background: The shape of the face is controlled by a variety of anatomic structures. Its foundation is influenced by the size and contour of the deeper facial bones, the thickness of the muscle and fat that lies above it and the amount and tightness of the overlying skin which envelopes it all. While everyone’s facial shape is unique, there are general types of facial shapes that are well known from oval, oblong, round, rectangular, square, triangular (inverted and heart-shaped) and diamond shape.
While the beauty of any of these facial shapes can be debated, many people find that a more inverted triangular or heart-shaped face is the most aesthetically pleasing. Having cheeks that are more prominent n width and projection that the portions of the face that lie below it is the hallmark of this facial shape. For those with a round face that desire such a facial change, one looks to fat removal to help with this transition.
Fat removal of the face is not like the rest of the body. It is more localized into various compartments and has multiple motor nerves to consider when doing it. It is also not a high volume or voluminous source of fat that is capable of making by itself dramatic facial shape changes. Historically facial fat removal was associated with the buccal lipectomy procedure which is large volume by facial standards but does not require liposuction to remove. Other more superficial and lower volume facial fat areas exist, such as the perioral mounds, which can only be treated by small cannula liposuction.
Case Study: This 28 year-old female wanted to create a thinner more v-shaped facial shape. While she already had more of an inverted triangular facial shape, she did not like the fullness below her cheeks and by the sides of her mouth.
Under general anesthesia, high maxillary vestibular incisions of 1 cm length were made below the parotid ducts. Splitting the buccinator muscles exposed the buccal fat pads which were teased out and removed. Through small incisions (3mms) inside the corners of her mouth, after having been initially infiltrated with a lidocaine and epinephrine solution, small cannula liposuction was used to remove fat from the nasolabial fold down to the jowl area. Each side produced about 2 to 2.5 cms of fat from each side.
It usually takes about 6 weeks until the full results from these fat removal procedures were seen. The final results of any facial liposuction/fat removal procedure are seen when the treated tissues feel soft with no hard areas, it feels completely normal to smile without stiffness and the overlying skin sensation feels completely normal. (not numb)
Facial fat removal can be effective at reshaping a somewhat fuller face but it can not really take a round full face and make it substantially thinner. It works best in moderately full to thinner faces where small fat reduction volumes make a more noticeable difference.
Case Highlights:
1) Reshaping or thinning a rounder face can be successfully done by specific site fat removal in properly selected patients.
2) A buccal lipectomy removes upper cheek fat while perioral mound liposuction removes lower cheek/jowl fat.
3) These procedures can make a round face less round and a thinner face more defined based on the limited amount of fat that can be removed.
Dr. Barry Eppley
Indianapolis, Indiana