Dr. Sam Lam Plastic Surgery Forum

hey, i'm of half-asian descent and i've got a rather ethnic profile with a prominent mouth. yet my teeth don't seem to be more forward than anyone else so it's really the skin that covers them which is too thick or whatever and my cheeks that are too thick as well. what can be done to improve this?

Hi,
It is always difficult for me to give a reasonable answer to a question posed without seeing you in person. However, if you are young and have fullness then that fullness is generally an attribute of youth which will change over time. If you have time, go to my video lectures section and watch my video that I gave in Hong Kong. The first 5 minutes will give you a good idea about how the face changes over time. That being said, if your face is full due to youth I would not touch it. In general, liposuction of the face is something that is unsafe in almost any age. I don't perform invasive bony reduction surgery but that would probably make things worse if you are having more soft tissue fullness instead.

Dr. Lam, i saw most of your videos and i'd really love to know what you'd suggest i do. can i post pictures and more detailed explanations somewhere? thanks in advance

I really don't do many email consults anymore. It is always better to meet someone in person to make a determination. It is only the fair way to make a real judgment.

i do think so too but i'm now in europe so that would be complicated. actually what i'd need is to know your opinion after seeing my photos to determine if it's worth coming over to the US

okay, send them to me.

Ok I sent you an email. Thanks

Hi Kiwiboy,
I have taken the time to review your detailed email to me with accompanying photos and thought it would be better if I responded in this forum for the benefit of others to read. Here's my take:
1. I can see that your lower face does protrude further than your upper face. Of course, there are two possibilities: advance the upper face or recess the lower face. In my opinion you do not want a forehead further out, it will look like a neanderthal and the nose is not bad either. Possibly slight augmentation. However, I think the real imbalance lies in your lower face. I do not perform bony setback surgery so you really should seek help from a oromaxillofacial (OMFS) surgeon or at least start with an orthodontist if you haven't already. I can't remember your age but obviously if you are a minor you need to have your parents guide you in your decision making process regarding all of the above.
2. In regard to your lips and nose, they should not be touched until you figure out what you are doing with your lower face. That takes priority.
3. Same with your cheeks. Also, I would highly discourage your removing the "bichat balls" (which for the layperson out there, he is referring to the name for the buccal fat pad named after Bichat). Yes, I know they do that all the time on Extreme Makeover but I would highly highly recommend you don't do it for two reasons. First, it will make your jaw look even larger relative in size. Second, you are young and will start to lose some of the fat over the next 10 to 15 years. No one likes their baby fat in youth. Have patience. It will settle down over the next decade. I know that is no consolation but ask anyone if they like their cheeks in their teenage years.

Okay, my opinion is that you are a good looking young man who has some reasonable questions. However, I am not the surgeon to help you at this point. You need to have your parents (if you are under 18) and an OMFS surgeon help you with your concerns.
Hope that helps,
SML

Hey there. Thanks for your help and answers.
A few more things:

-Do you have any slightest idea how much that kind of procedure would cost? Any maxillo-facial specialist you'd recommend?

-I understand Point 2. Can you just tell me one more thing : is it possible to reduce in size the alar cartilage? you've seen the picture, they're pretty thick..
If I manage to find a maxillofacial surgeon willing to perform this on me I'd still be interested in having the rest done by you

-""""First, it will make your jaw look even larger relative in size.""""

Well actually a large jaw is okay for me. The problem was the protruding mouth etc viewed from the side

""""Second, you are young and will start to lose some of the fat over the next 10 to 15 years. No one likes their baby fat in youth. Have patience. It will settle down over the next decade. I know that is no consolation but ask anyone if they like their cheeks in their teenage years.""""

I know and understand this point. However, I have family members who are 50 and still haven't lost those fat pads.
Second, I don't know if you can tell from the photos but they're fairly big.. Maybe removing only a part of them?


Anyway, thanks so much for your time. I'll be looking forward to meeting you sometime in the future then if I eventually get to do this thing to my face. By the way, do you think it's feasible?

Best regards

1. I don't know how much OMFS surgery is or whom I can recommend.
2. I don't remove facial fat in general because I don't think I can really get much out without risk of having a problem and don't believe in it. You will have to find another surgeon to do that for you.
3. Your nose could be enhanced but I would first address the lower face with an OMFS person first.
best,
sml

Ok. Thank you very much

you're welcome.

One more thing I'd like to know actually: surgeons - you included - told me extracting the Bichat balls would probably make me look like a skeleton afterward when I'll naturally lose fat. The thing I don't understand : Bichat is a fat pad. If you extract it then what fat could I possibly lose if it's already gone?

the fat that overlies it called subcutaneous fat, i.e., the fat that is naturally part of the skin. bichat's is much deeper.
sml

Then what would be the difference? When people get older, they lose both Bichat balls and subcutaneous fat, right? So the result would be the same wouldn't it