Another attractive feature of a woman’s face is the slight depression just underneath the cheekbones.
The buccal fat pad, was described by Bichat, is a collection of fat that occupies a position in the facial middle third of the cheek, just below the cheek bone. It is more noticeable in childhood, and as the individual ages tend to shrink so we lose the ‘chubby’ cheek looks.
In patients with a heavy or cherubic, round face improvement can be achieved by a relatively simple procedure called Bichat (buccal or cheek fat-pad) resection. It gives a hollowing and ‘waif’ look just under the cheekbones that is more attractive. Patients often complain that they look fat even when they are at or below their ideal weight since the cheek fat-pad is often diet and exercise resistant.
The fat pad is accessed through an incision inside the mouth, similar to the one used to insert cheek implants. the cheek fat can be removed at the same time as a face-lift or when inserting cheek implants.
Risks are rare and include nerve injury and bleeding.
The Mid-40’s Make-over
More recently Prof. Kirwan has combined this technique with a brow lift in patients in their mid-forties.
Many women at this age are already using regular maintenance treatments such as a Retinoid-based skin program with regular peels, Botulinum Toxin injections, fillers and other non-surgical treatments such as Thermage and Fraxel. And yet they still aren’t satisfied. They are usually beginning to see heaviness in the upper face, around the upper eyelids and the brows as well as loss of fat in the cheek bone and lower orbital region. Often they may have a round face which fails to respond to dieting.
Now Prof. Kirwan is recommending three treatments, separate or combined, to improve facial aesthetics and rejuvenate the face in a durable fashion until the inevitable face-lift at a later point.
The three-point program:
1. Endoscopic Brow Lift with the removal of the Corrugator and Procerus (frown) muscles.
2. Removal of Cheek Fat Pads to give some hollowing of the cheeks and definition of the cheek bones.
3. Fat Injection to replace fat into the cheek bone area and lower orbital area. This also markedly improves skin quality.
Obviously, a facelift is also an option but many women are not ready for this psychologically or physically in their fifth decade.
I call this program the ‘Mid-40’s Makeover.’
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