Liposuction of the cheeks can be an effective procedure for reducing lower facial bulk when there is an excess of subcutaneous fat in that part of the face, in an area known as the jowls in the lower cheeks. However, it must be done very carefully in order to achieve smooth contours and avoid uneven contours with grooves and depressions. It must also be done in such a way that skin laxity is minimized.
These objectives can be achieved by using modern and effective liposuction technique known as Vaser Liposelection.
A tiny incision is made just behind the earlobe and directly into the fat layer. The area to be addressed is first infiltrated with a saline solution containing a long acting local anesthetic and adrenaline. The fluid causes the area to become swollen (tumescent), causing physical expansion and loosening of the fat and constriction of blood vessels by pressure. The tumescent effect thus facilitates fat removal and reduces bleeding. The local anesthetic ensures that after the surgery pain is well controlled. The adrenaline further reduces bleeding by causing blood vessels to go into spasm.
After the tumescent infiltration, the fat is liquefied by treating it with ultrasound energy, which is delivered via a fine ultrasound probe inserted via the same incision. The probe is moved back and forth in a fan shaped pattern while the ultrasound energy is delivered. The solid fat is broken down by the ultrasound energy into liquid fat, after which it is carefully removed by low vacuum suction using a fine suction tube. This helps to ensure that the fat is thoroughly removed but with a resulting smooth contour. The ultrasound energy also produces some skin tightening, which is an important effect as it prevents or minimizes skin laxity. It typically takes about an hour to complete, and can be done under local anesthesia or intravenous sedation as a day surgery procedure. The incisions are closed with fine sutures.
Pain is minimal, but there will be visible swelling and bruising. The bruising takes about two weeks to subside, at which time the swelling will usually have reduced by about half. A facial compression garment is worn for the first one to two weeks. This helps to contour the treated areas and reduce swelling. Downtime is therefore about two weeks. Once the majority of the swelling has subsided, the jowls should look smaller and the face should look slimmer. Exercise can be resumed after three weeks.
This is a safe procedure, with minimal blood loss and a low risk of infection. Using Vaser technology, the risk of creating an uneven contour is minimized. The risk of injuring branches of the facial nerve is also low. There is a theoretical risk of skin burns from the tip of the ultrasound probe due to the ultrasound energy translating into heat energy, but with correct technique and safety precautions, this risk is very low.