LAM FACIAL PLASTICS

Hi Dr. Lam,

I am a 21 year old caucasian female and have a prominent mouth, that juts out more than normal (although I am caucasian I have noticed many African Americans have this facial structure). I do not want to have surgery to correct this because the entire procedure will take over a year because of the jaw surgery and having to get braces again. I also have very flat cheekbones that seem to recess backwards; this seems even more evident because my mouth juts forward. Also, I do not seem to have much fat at all on my cheekbones; it is all located in the lower face. I believe this makes me look older, as if my face is falling downwards, and heavy, which I am not. I was wondering what you would recommend in order for it to look like I had attractive cheekbones. I am worried that if fat is just placed on the cheekbones that it will look too much of a soft look and that with continued aging the fat will move downwards with the aging skin. Would you recommend having a combination of cheek implants and fat grafting to help balance out the upper face with the lower face?

Thank you very much.

first, i would probably recommend a detailed revisit with the bony orthognathic work because that may be enough to create balance to your face. in general i am stuck with 20 year olds wanting change in the cheeks that are too thin for 2 reasons:
1. cheek implants in the long run are safe because if you don't like them over time you can remove them. however, in gaunt faces, the look bad because that is just more bone there. second, as you age, they will become more and more stuck out because you continue to lose soft tissue.
2. fat grafting for someone your age to rebuild fat is probably not the safest option. i am worried that if you gain weight over time that you will then have too big a cheek which would not age well. in most cases i prefer to do fat in someone over 30 years of age if at all possible.

in short, i don't have a lot of safe and good options for you per se. i know that is not an answer you would like to hear but i want to stay safe with you. accordingly, i would truly revisit the jaw bone surgery even though it is a big ticket and big recovery item. you can also try temporary injectable products as a start. not ideal but safe and easy.
best,
sml

Thank you very much for your response. I was wondering if I would be able to privately e-mail you my photos?

sure, but as i said i probably have no good options for you.
best,
sml

Yes, I guess I am hoping that I am exaggerating the mouth protrusion. I see there is a way to post pictures on here, but how would I send them to you privately? is there an e-mail I can use?

send it as a private message to me here on this forum.

I just sent them to you. Thank you very much once again.

hi,
i just read your private posts and also looked at your photos. i would say that cheek implants would not be a bad idea to give your face more projection. i think you should be certain that you are not going to have the lower face bony work first before deciding on cheek implants. probably in 10 to 15 years when you start to lose some more fat we can talk about fat grafting which may be necessary to cover the implants as you start to age. i really in general do not prefer to do fat transfer in someone as young as you given possible weight gain, e.g., during pregnancy too.
best,
sml

You’re truly revisiting the jaw bone surgery even though it is a big ticket and big recovery item. How about trying some temporary injectable products as a start but I guess it would be good.

thanks joseph.

I guess that you have very flat cheekbones that seem to recess backwards but you don't really wanted to have a surgery to correct it, so you better happy with what you have right now since that entire procedure would take a very long time to be done.

ok, thanks joseph. let's now leave her to her own conclusions. thanks though for your thoughts.

Thank you dr. lam. I plan to revisit the orthognathic surgeon once more and begin looking for surgeons who specialize in cheek implants and see if that will help me.

best wishes,
sml