Facial cosmetic surgery is one of the most popular aspects of my New York City plastic surgery private practice. While these operations can be life-changing procedures with an extremely high degree of patient satisfaction, they are also a complex topic. This was an invited article for online physician magazine Healio.com about the ins and outs of contouring the face. The intended audience is medically oriented, so some portions of this article are more technical. -Dr. Devgan

A Three-Step Approach to Contouring the Face:

Buccal Fat Pad Excision, Cheekbone Augmentation, and Submental Liposuction

by Dr. Lara Devgan

The aesthetic ideal of a slim, sculpted face has gained wide acceptance over time. With the popularization of makeup contouring techniques, feature-amplifying filters on social media, and genetically blessed celebrities, many patients are focused on subtle ways to improve their facial contours.

My approach to contouring the face is a three-tiered one. Of course, aesthetic judgement must be used to custom tailor any procedures to determine what is right for a given patient. Generally speaking, my approach to sculpting and contouring a slimmer, more attractive face is as follows:

1. Buccal Fat Pad Excision

The buccal fat pads are the fat deposits of the cheeks. Originally intended to help nursing babies form an effective seal during breastfeeding, they persist in adults and can contribute to the appearance of chubby "chipmunk" cheeks.

The buccal fat pads extend from the angle of the oral aperture to the temples. Selective reduction of a walnut-sized aliquot of fat from each cheek can slim the face and create a more sculpted, chiseled, attractive look.

Buccal fat pad incisions are hidden inside the mouth, and all stitches are fully dissolvable. The procedure takes about 30 minutes and can be easily done under local anesthesia in selected patients. Results are noticeable as swelling regresses, which can take weeks to months, depending on the patient's facial anatomy.

2. Cheekbone Augmentation

Cheekbones are thought to comprise 70% of facial beauty, and prominent cheekbones on both men and women can be strikingly attractive.

In order to augment diminutive cheekbones, I typically use either autologous fat grafting or injectable filler to create a beautiful, sculpted look of the upper face. Not only does this help resuspend sagging and depletion of the malar fat pads, but it also minimizes the appearance of the nasolabial folds.

Cheekbone augmentation with autologous fat grafting is permanent. It involves liposuction and centrifugation of abdominal fat, and reinjection of that fat over the zygomatic arches. Injectable filler, such as Juvederm, Voluma, Radiesse, and Sculptra, has no downtime and can last anywhere from 1-2 years.

Both submental liposuction and cheekbone filler can be performed under local anesthesia. Results are noticeable immediately, although full settling of swelling takes 2-3 weeks.

3. Submental Liposuction

Submental liposuction is the gold-standard approach to sculpting and refining the area under the chin, where excess fat and fullness develop over time.

Although Kybella, an injectable to dissolve stubborn double-chin fat, has gained popularity in recent months, submental liposuction remains the most durable and thorough way to sculpt the lower face and add definition to the jawline and angle of the mandible.

Submental liposuction can be performed under local anesthesia, with an extremely high level of patient satisfaction and results that are noticeable within weeks of surgery.

ombining Modalities

A tripartite approach to facial refinement and sculpting, involving buccal fat pad excision, cheekbone augmentation, and submental liposuction, is an excellent, thorough, and elegant way to subtly refine the features of the male and female face. All three of these procedures can be done under local anesthesia or sedation anesthesia, and all three work synergistically to create a beautiful end result.

For questions about this article, I can be reached via www.LaraDevganMD.com.