Benjamin P. Caughlin MD, FACS
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Many Faces of Chicago LLC
845 N. Michigan Ave. | Suite 923E | Chicago, IL 60611
Office: (312) 335-2070 | Fax: (312) 335-2074
Buccal Fat Sculpting
Buccal fat pad sculpting can be a powerful and instrumental procedure when done on the right patient in the right hands. To really sculpt, contour and shape one’s face it is all about volume in the right places. The ideal facial contour has well placed shadows and curves. We create those by making peaks and valleys. The peaks are often achieved by fillers, implants or fat transfer and the valleys are created by sculpting or removal of fat and or skin tightening. It is simple yet complicated at the same time. The balance of the upper and lower 1/3rd of the face is a complicated anatomical location and it has complicated aesthetic implications. You can quote me on that. It is the truth and it is pivotal to successful facial sculpting.
Chubby cheeks, round face, sagging skin and lack of definition are the phrases most patients come in saying. Many surgeons, doctors, and injectors will respond with that’s easy. I’ll take care of it. I have to disagree with the simplistic answer. Again, the balance of the upper and lower 1/3rd of the face is a complicated anatomical location and it has complicated aesthetic implications. That is worth repeating.
Let’s start with chubby cheeks. Chubby cheeks are the result of many different tissue layers. I will list and comment on them from outside to in. First we have the skin. That involves epidermis and the dermis. Different people, different skin types and different exposures all lead to varying thicknesses of this layer. The women with thin skin and little subdermal fat may not be the best candidate for buccal fat pad sculpting because the results may be too strong. The patient with thick skin, thick dermis and adequate subdermal fat can get spectacular results with just enough contouring. The skin can vary from 100 microns to 600 microns in the area of the lower 1/3rd of the face from patient to patient. That is a huge difference. It must be appreciated.
Below the skin we have subdermal fat. Subdermal fat can be our best friend when facial sculpting. It is the subdermal fat that keeps the face looking good. It allows the skin to look hydrated and plump. You may hate the word plump but on the micron level plump is good. Trust me. This is the layer we put many fillers, fat transfer and other collagen stimulators in people who have started to compartmentalize. People do not like compartmentalization. That is when the fat pads in the face start to separate and we can see the different compartments in the face. Think about the cheeks, eyes, chin, and temples. Shadows and curves allow a slow transition to these different areas, compartmentalization is when there is a sharp demarcation. Eye bags, smile lines, jowls are examples of compartmentalization. So the subdermal fat allows this smooth transition. Also key! Every person has a different amount of subdermal fat. It does seem to go along with shared genetics. So we often see certain families with more subdermal fat and others with less. It’s a learned part of the fields to appreciate this.
Below the subdermal fat we have muscles, vessels (arteries, veins, nerves and lymphatics) and ducts. These can contribute significantly to the chubby cheeks/round face appearance. Again, these have genetic predispositions. We can adjust the muscle thicknesses in certain areas but mostly this is a fixed volume space. That must be respected, appreciated and can be used to your advantage to create curves and shadows.
Below that layer we have the skeletal structure with the facial bones. It is not only the facial bone stock and thickness but the angles created by the different facial bones joining each other. A more obtuse angle will create a wider face while a more acute angle can create a sharper more narrow face. This layer is adjustable but is a larger more invasive surgery so I preserve it for those when something drastic is required (congenital, trauma etc). Similar to the muscle and vessel layer this layer can be considered fixed and can also be used to your advantage when it is properly addressed and appreciated.
So that is how chubby cheeks come about. That is what I have to say about that.
The Round Face:
The round face is typically a volume balance issue. It is all about having fat, or volume in the right places. Often times we can transfer volume from the lower to higher levels of the face. A facelift is a great example of this. This can really help people go from the egg shape to the coveted V shape. Chin sculpting and often augmentation is pivotal to this issue. Often times a small amount of chin lengthening can have profound effects on the overall facial shape.
That is what I have to say about the round face. I can expand, but will do it another day.
This issue is pretty self explanatory but think of a deflated balloon. When the balloon is deflated it allows the external most plastic portion to wrinkle and become flaccid. When there is air it is smooth and sharp looking. That is the subdermal fat that allows sagging skin MOSTLY. Also the bone absorption (which allows the skin to drape) contributes along with muscle atrophy, loss of elasticity and collagen. This issue can be complicated but the good news is we have a lot of research and options that can help us achieve near perfection with enough effort and time.
Lack of definition:
Lack of definition is most often the result of the facial bone angles and then volume in the unwanted locations. The peaks and valleys are flipped. So we can use volume redistribution, removal or addition to recreate the valleys and peaks as we want to give definition!