Cosmetic Surgery Question From Palm Beach Gardens, Fl.

Dr. Pane evaluates the case of a patient whose facial fullness is an ongoing concern even after bariatric surgery.


The Question

With bariatric surgery becoming more popular as a corrective option when normal diet and exercise simply doesn’t work, cosmetic after effects may require further fine-tuning to achieve the optimum results. One example of this is the focus of our Ask Dr. Pane segment this week. This question came in from a female Facebook viewer who writes: “I’m 32, and my cheek/chin fat is genetic. It does not get better with age, it gets more pronounced. My family stores fat in the lower cheeks and chin, giving us a very “full” face. Not cute! My lower cheeks need to scoop in and not out. My jawline and lower cheeks need to be thinned. Also, losing weight does not affect the fullness. I have had the gastric sleeve, and lost a lot of weight. My face is still fuller than I would like.”

The Case

The patient offered pictures for the doctor’s consideration. Dr. Pane evaluated these images and determined that the skin of the cheeks is actually in excellent condition. However, the submental area, or the area beneath the chin, did show some fullness.

The Answer

In this case, Dr. Pane says the skin quality of the patient’s face is very good, making it “surprising” that intensive weight loss occurred. Due to the fullness of the submental area he noticed on the pictures, there is some subcutaneous fat there. Dr. Pane feels this could best be dealt with using traditional liposuction.

The reason he is advocating traditional liposuction in this case is due to the fact that while there are noninvasive and less invasive treatments on the market, including injections and electronic fat-eliminating technologies, the results from these treatments are difficult to predict ahead of time. A surgical intervention known as buckle fat pad removal may also garner good results. However, the potential drawback to this technique is the risk that it may cause the cheeks to be more hollowed out than intended. Buckle fat pad removal is a procedure which is used rarely, on a case-by-case basis, because of the potential unpredictability, but is still on the table as an option.

Generally, liposuction is the safest, most predictable and most easily controllable fat reduction measure available. Often when significant weight loss occurs as a result of bariatric surgery, patients may want or even need surgical intervention to correct loose skin and irregular fat deposits left behind. Because of this, it is far easier, safer and simpler to create very small incisions beneath the cheeks and chin and perform liposuction while the patient is already under local or general anesthesia. This is because the patient is already sedated and it helps minimize healing time to perform a single combination procedure as opposed to multiple invasive surgeries at spread-out intervals.

As with any other type of cosmetic surgery, photographs are at best a poor substitute for in-person clinical evaluation. This is because images can only suggest what is going on beneath the skin. Evaluating a patient requires not only sight, but touch and the ability to analyze movement in realtime. Because of this, photographic examination is not entirely reliable or revealing, although it may produce a baseline from which to proceed.

It is also important not to become too invested in any particular procedure until all the available options have been discussed, evaluated and ranked in conjunction with a cosmetic surgeon. Sometimes patients learn of a specific type of procedure and don’t realize that for some reason they may not be ideal candidates for it. Because of this, we generally caution patients to keep an open mind and consider not only the immediate effects, but what long-term results they can expect and what procedure or combination of procedures is most likely to achieve the results they want and need.

If you have a question about cosmetic surgery or anything related to it, the clinical and medical staff of Atlantic Coast Aesthetics is always pleased to discuss your interests, concerns and questions. Simply follow us on Twitter and Facebook, call us at (561) 422-4116 or email us through our website at Your question may even be the focus of an upcoming Ask Dr. Pane segment, helping us to provide information to you and other patients who want to know the same things you do. Remember, at ACA, we believe the only bad question is the one you don’t ask!




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