Aesthetic Facial Contouring or simply modifying the profile of the face is a difficult but extremely satisfying procedure. Patients with a heavy set or square face request procedures to thin the face and give a more chiseled appearance.

We at Divine Cosmetic Surgery use the combination of VASER liposuction of the face, buccal fat removal, Botulinum toxin with or without fillers for specific enhancements. VASER is the cornerstone of such procedures. VASER is the application of internal ultrasound energy distributed to the fat cells in a sine wave pattern, to allow emulsification of the fat, with the least effect on nerves and blood vessels. One of the biggest advantages of VASER is the immediate and permanent contraction of collagen elements of the skin leading to skin contraction. For the face, we use a 2 mm x 15 mm canula used in a Vasering mode and not the continuous mode at energy levels of 60 percent.

Procedure

All of the procedure is done in one go and under local anesthesia. The first step is a Botulinum injection into the massetters. I usually inject a total of 40 units of Botulinum toxin in the first go, and if needed, touch up later, after a month or so. This is followed up by infraorbital blocks and local infiltration for the buccal fat removal. This step is very fast, and a typical buccal fat surgery takes no longer than 3 to 5 minutes. The standard incision on the upper jaw is made, taking care to prevent injury to the parotid duct, and a right angle forcep is used to open the buccinator muscle. Immediately, the buccal pad of fat is visible and teasing out with removal of the pad takes less than a minute to perform. It is absolutely mandatory to avoid any forceful tug to prevent any injury to the facial nerve, or the parotid duct. Absolute homeostasis is essential before letting the fat slip back. An assessment of the removal can be made by tapping the skin from outside to feel the space.

The next step is to infiltrate the skin from the cheek down to the neck and the other side with local anaesthesia solution. VASER is then done for a period of 2-3 minutes. Liposuction is then done very gently with a 2 mm canal. I try never to cross the mid pupillary line, and if I do, it is extremely gentle. The advantage of VASER is that the fat is emulsified completely and no excess pressure is needed to suck the fat out. No stiches are required either for the buccal fat or the face liposuction entry site.

Compression of the neck and lower face is done for 48 hours. Hot compressions are started 4-5 times a day after that along with Arnica tablets twice a day for 2 weeks to reduce swelling.

The final results can take 4 weeks or more.