Many patients present to me with a desire to look thinner. Or for a "snatched" jawline. That Kylie Jenner look, perhaps. In fact, many of these patients are young patients who feel that their chubby cheeks and full face detract from their beauty and make it harder to land some jobs. Buccal fat pad removal is a very popular procedure because it is relatively straightforward, and confers a gentle improvement in the mid-facial contour.
But doesn't all this make you look gaunt? The buccal fat pad is made of pure fat. When I perform radiofrequency procedures and liposuction on the face, I am taking away subcutaneous fat in the face. When I take this much fat out of somebody, does that mean I am making them look older? Will these patients regret this procedure as they age, and their facial fat volume is depleted?
Maybe. As time goes on, age-related and hormonal changes cause shifts in fat volume in the face and elsewhere. For example, fatty deposits on the inner upper eyelid become larger as do the fatty deposits in the lower eyelids. Jowls and nasolabial mounds become larger, but fat in the temples can thin out, as does the fat underneath the cheeks. It is hard to say whether global fat content changes significantly, but we do notice age-related changes - in both directions - in facial volume.
It is a disservice to my patients, then, to remove facial fat, knowing full well that this could accelerate the aging process? Not necessarily. Targeting fat deposits, for example along the jawline and underneath the chin, confer favorable features on patients who do not desire fat in those areas. Removing buccal fat pads confers a slimming effect, and concavity to an area where patients do not want fullness. Will the resulting skin become looser? Probably not. This is because the skin has a tendency to drape itself over what is left behind. In addition, technology such as radiofrequency skin tightening can offer some degree of shrink wrapping. In extreme examples, a facelift will do even more.
At the end of the day, it is difficult to have your cake and eat it too. It is difficult to ask for a slimmer face and a slimmer jawline without removing facial fat. At some point in one's life, additional procedures may be warranted to continue to preserve the facial appearance such as skin tightening, skin excision, or volumization elsewhere with fillers or fat. In the meantime, patient satisfaction remains very high with conservative procedures that are done artistically and with restraint, such as the one shown in the video today. I hope you enjoy this video, and are as grateful to this beautiful patient as I am for letting us follow her journey.
