Changing the shape of the face is largely done by altering the bony framework that supports it. Whether it be by augmentation or reduction methods, facial reshaping surgery modifies the structural support of the face onto which the soft tissues drape over and around.
There are soft tissue facial reshaping procedures as well which, beyond that of the lips, can influence its appearance. These are fat-related procedures that consist of either injection augmentation or fat removal. Unlike adding fat, removing fat is a more limited facial reshaping method. Despite the fact that fat exists all over the face, there is only a handful of procedures that exist that can selectively remove some of it.
The most recognized method of facial fat removal is the buccal lipectomy. While it can be effective it havs limitations which are often not understood. The buccal fat pad is an encapsulated area of midfacial fat that is located under the cheekbone. Its removal by intraoral open excision is always impressive in terms of what comes out. But its resultant facial slimming effects are limited to the upper midface. Contrary to common perception it is not a major or complete cheek reduction/slimming procedure. It will not make the cheeks hollow or concave between the cheeks and the jawline. This is why I often combine buccal lipectomies with perioral liposuction, which is the subcutaneous removal of fat in the lower cheek/midface area. It complements buccal lipectomies to try and create a more complete facial slimming effect.
But even with these two combined procedures, their facial slimming effects for many patients is less than ideal or not as much as expected. This is because there are other fat locations that are not accessible and the thickness of the overlying skin also plays a contribution role to facial fullness.
Dr. Barry Eppley