Despite weight loss or ideal body weight, some patient’s faces will appear fuller than ideal. There are several components of the face which can cause the face to appear overly “full” or wide. First, masseter hypertrophy is the enlargement of the muscles which surround the mandible or jaw. When these muscles are overly large, the face will appear wider, especially along the lower portion of the face. Reducing the masseter muscle often involves the use of botulinum toxin to help thin the muscle. Long-term use of botulinum toxin can actually shrink the parotid gland and bone of the jaw to create longer-lasting changes to the facial appearance.
A fuller face often involves buccal fat as well. Buccal fat is a discrete fat pocket located in the cheek area. Genetically, some patients’ faces here are fuller than ideal. Removal of fat here is based on the patient’s familial history of facial shape to help predict their pattern of fat loss over time. Removal of buccal fat can help subtly contour the patient’s face by accentuating cheek bones and a more sculpted appearance to the face.
Removal of fat along the jawline and neck can also help contour a face. Creating a better shadow along the jawline will enhance the neck and face by creating a transition between the two elements. When the neck and face appear to be one structure, the overall look of the face is fuller. Often times, conservative jowl reduction can help contour facial appearance as well.
Finally, the addition of volume to the upper third of the face can help create a more contoured look. The use of cheek implants has fallen out of favor, with some exception, and has been replaced with the use of facial fillers. Facial fillers, such as Voluma and Radiesse, can help create enhanced cheekbones and facial contouring and paradoxically can help create a thinner looking face. The illusion of a thinner face is created in part because now the cheekbone will represent the leading edge of the face rather than the cheek itself.