The Truth About the Rise of Face Liposuction

Wrinkles and fine lines may be the bane of your existence, but stubborn facial fat can be a major bone of contention for others. Although non-invasive treatments promise to melt, zap or shrink away these tiny pockets of fat (at around 20 percent at most), nothing compares to the gold standard of fat removal: liposuction. As the trend of overfilled, doughy, puffy faces fades into the sunset, the look of a well-sculpted face is making its mark in aesthetics, and this time for good.

The intention of liposuction (both for the face and body) is never as a weight loss tool but rather to fine-tune trouble spots like those under the chin and along the jawline, almost like taking an eraser to them. However, as more emphasis is placed on slimming the face, 'popping' the cheeks and getting a snatched jawline, facial liposuction is becoming favored over other non-invasive treatments offering short-term effects. According to board-certified plastic surgeon Oren Tepper, Director of Cosmetic & Reconstructive Plastic Surgery at Montefiore, how people look in social media filters is quickly becoming the aesthetic goal, leading patients wanting to slim their cheeks and jawlines. "There's a desire to look like that, with people trying to mimic the effect."

To separate fact from fiction and understand how face liposuction works and what to expect, we put together the ultimate guide on the procedure and answered every possible question. Consider this your guidebook on all things facial liposuction related.

What is face liposuction?

No matter where liposuction is done, the ultimate goal is to remove the fat that lives directly under the skin for a more sculpted appearance. With age, fat tends to accumulate in the lower part of the face causing a loss of definition under the chin and in the area where the lower cheeks meet the jowls. Exercise won't make the fat disappear and lifting procedures won't help much either. The only way to diminish the effect of age-related aging fat and fat pockets caused by genetics is by removing it once and for all with time-tested liposuction.

But how much fat should be removed with liposuction without causing a major deficiency that can lead to a gaunt-looking face? Board-certified plastic surgeon Lara Devgan, MD explains that subcutaneous fat is important to preserve unless it is bulky in a given area. “Facial fat is a Goldilocks problem—we don’t want too much, we don’t want too little, we want just the right amount. This is the ultimate concept of facial optimization and sculpting.” There's naturally less fat in the face than in the rest of the body, so for facial liposuction to be effective, it must rely on smaller instruments and consist of minor volume removal. "We must take extreme care to ensure not to disrupt the delicate facial contours and balance or remove too much fat," explains board-certified facial plastic surgeon Jonathan Cabin of SkinDC.

Not every area of the face is fair game for the procedure. "By far, the areas where liposuction works best are the neck and jawline," Dr. Tepper says. "Fat in those areas can obscure where the lower jaw and neck meet, and removing it can significantly improve how the jawline and neck look."

Chin liposuction is the most popular part of the face to perform liposuction. Dr. Devgan shares that the area yields excellent outcomes in slimming the profile, defining the jawline and debulking excess fat. And while the cheeks can be a lipo target area, they’re the trickiest to treat, which causes plenty of plastic surgeons to stay away from liposuctioning them as a primary slimming procedure. Instead, Dr. Devgan says she often uses liposuction in the cheek area to debulk excessive fat grafting done elsewhere.

Like the cheeks, the jowl can be a somewhat challenging area to remove excess fat via liposuction. “The fat is more fibrous in quality, making it harder to break up and extract,” Dr. Cabin shares. “There is a slim margin of error, given the proximity of critical motor nerves that move the face.” Still, removing clunky fat between where the jaw and neck meet can dramatically improve the definition.

One area where liposuction is entirely off-limits is under the eyes. "Liposuction is never indicated for that area given that no significant fat accumulates and the skin is very thin," Dr. Tepper adds.

How does face liposuction work?

Face liposuction is a quick outpatient procedure (done in one hour or less) that requires local anesthesia. However, general anesthesia can be used, too, and a small cannula to gently “vacuum” excess fat from the lower face for a more streamlined profile. Dr. Devgan explains that body liposuction has larger margins because excess fullness on the body is in the range of centimeters, while extra fullness on the face is in the range of millimeters. As a result, the amount of fat the surgery removes can vary from 25 ccs to 200+ ccs depending on the area and the patient.

Facial liposuction aims to create a slimmer-looking, more contoured face by permanently removing small amounts of fat from the area under the neck, the jawline or the middle of the cheeks. The smaller the area, the smaller the cannula, which is why face liposuction sometimes goes by the name of micro-liposuction or micro-liposculpture. “It helps to reduce double chin fullness, improves the cervicomental angle seen on profile view, defines the mandibular border and jawline, and improves tautness of the skin overall,” Dr. Devgan says.

Some plastic surgeons use specialized liposuction or various energy-based devices, like laser or ultrasound liposuction, to further break down fat for easier removal or contouring the skin and fascia around it for less laxity post-procedure. While every surgeon has their preference regarding these technologies, not everyone uses them alongside liposuction. For example, Dr. Cabin almost always uses InMode’s radiofrequency technology (FaceTite and AccuTite) to assist with lower face and neck liposuction. “It works great to create ideal post-operative contours around the fat that have been removed.”

How to tell if you're a candidate for face liposuction:

Not everyone needs face liposuction, nor is everyone a candidate for the surgery. However, when excess fat in the jowls or chin is bothersome and caused by genetics or aging, then liposuction may be the solution to get rid of it forever.

Skin quality plays a big part, and for the result to be pretty much perfect, the skin should be elastic with little looseness. Dr. Tepper explains that skin with good elasticity will tighten or shrink following fat removal. On the other hand, if the skin is too thin, removing fat from the face may leave it with nothing to hang on to for support, giving way to substantial looseness.

Determining the root cause of heaviness in the lower face with your plastic surgeon is important for a good result. “Heaviness and contour issues in the lower face and neck are often related to the unfavorable position of structures deeper than the fat layer treated by liposuction,” Dr. Cabin says. “We cannot access these muscles, glands and deeper pockets of fat with liposuction cannulas.” Put simply, sometimes fat isn’t the problem, and liposuction can’t fix structural issues. “We see this a lot in older patients with neck laxity. Liposuction won’t do anything for them because the real problem revolves around loose muscle and skin in the neck and has nothing to do with fat.”

 Those best suited for facial liposuction are on the younger side, with minimal aging changes in the lower face and neck but tenacious pockets of fat. Unfortunately, even when someone is at their ideal weight, this fat does not fully resolve.

 If you’re not a contender for facial liposuction, other non-surgical procedures can help whittle unwanted fat. However, Dr. Tepper says alternative solutions are preferable for patients with minor to moderate fat. Most fat-reducing treatments use energy to heat or freeze away fat or an injection to destroy it. The downsides? These treatments are expensive, require multiple sessions and the results can be inconsistent. They're also never an apples-to-apples comparison to what liposuction can achieve. Options include CoolSculpting, which uses targeted freezing to destroy fat cells and naturally excrete them from the body to give the area under the chin a less bulky appearance over several sessions, and Kybella, an FDA-approved injectable for obliterating fat under the chin. Although Kybella can work well in the right patient, it requires multiple treatments that cause significant swelling after each one—and the results are far from instant.

What happens during a face liposuction procedure?

During face liposuction, which can be performed as an outpatient surgery (you’ll go home afterward and generally won’t be under general anesthesia), small areas of fat are suctioned out of the face via a cannula, a small metal tube attached to a suction device that’s moved back and forth to dislodge fat. 

Before your plastic surgeon wheels you into surgery, he or she will mark up the areas on the face where they will remove the fat. Next, local or twilight anesthesia is administered, which numbs the area, so you won’t feel a thing even if you are somewhat awake during the surgery (you may hear suctioning sounds).

A few small needle head-sized incisions are made in the chin's crease or the hairline behind the ears to access the fat. Then, a small cannula is inserted through the incisions and weaved in and out of each area where the fat lives to suction it out. Finally, the incisions are closed with either small sutures or a bandage. You’ll likely go home wearing a compression garment on your face to help control the swelling, which will last about one week to 10 days post-lipo. As it and the bruising resolve, the contours of the face are better seen, and the definition starts to take shape.

What's the difference between face liposuction and buccal fat removal?

Cheek liposuction and buccal fat removal remove fat from the face but in different areas and ways, which is why they are considered different procedures. Dr. Tepper explains that buccal fat is a discrete compartment in the face (near the mouth's sides), requiring surgical removal. “But buccal fat cannot easily be removed with liposuction.” Unlike some facial fat which loses volume or shifts with age, buccal fat can stay in place or grow larger over time. 

Whereas cheek liposuction uses a cannula to suction out fat from the area carefully, buccal fat removal surgically excises the entire fat pad through incisions on the inside of the mouth for more of a chiseled-out result that’s seemingly all over Hollywood at the moment. While some plastic surgeons perform cheek liposuction, Dr. Devgan says buccal fat pad removal is preferable for those who hope to slim the cheeks without compromising the smoothness of the face.

What's the recovery from face liposuction like?

Face liposuction is a quick and easy recovery compared to other facial surgeries, so you'll be out of commission for about five to seven days. Directly after the procedure, there will be mild to moderate swelling, redness, bruising and soreness, lasting anywhere from a few days to one week. Over-the-counter anti-bruising and anti-swelling supplements, like arnica and bromelain, can help, while an over-the-counter pain reliever like Tylenol can reduce pain, which should be minimal. The lower face will feel numb for a while (it can last a few months), so you’ll want to take it easy and avoid heavy or strenuous exercise for at least two weeks.

Sleeping can be challenging, and it’s best to take pressure off the face by sleeping on your back rather than the side or stomach. To make that more doable for non-back sleepers, prep your bed and bedside table at home with plenty of head and neck pillows and support wedges.

Most face liposuction patients need to wear a facial compression garment that looks like an Ace bandage for a few days, and the longer you stay in it, the better. The swelling takes time to subside, so while you may see a noticeable difference immediately, the results will continue to improve for the next three months.

Dr. Cabin says his patients are often socially presentable, or “restaurant ready," one to two weeks after surgery (right around the time when any sutures placed are removed), wearing a little bit of coverup and makeup to conceal any lingering bruises.

How much does it cost to get face liposuction?

Plastic surgery doesn’t come cheap, and face liposuction is costly. Of course, who’s doing the surgery and where they practice will drive up the overall costs. Tacking on additional cosmetic surgeries will increase the overall price. Good plastic surgery is always individualized, and Dr. Devgan says your surgeon should consider the complexity of the techniques needed and each patient’s unique anatomic characteristics, which may be factored into the price. Most facial liposuctions start around $5,000 and can go as high as $15,000.

What are the potential side effects of getting face liposuction?

Like all elective cosmetic surgeries, face liposuction comes with potential side effects. “Surgical judgment is paramount in procedures like this,” Dr. Devgan warns.

For starters, removing too much fat from the face can cause it to look hollow since fat is the underlying structure that gives cushion and supports the skin. In addition, a fat deficiency can be an instant ager. Dr. Tepper adds that patients who have had over-resection of fat may need fat replacement with grafting techniques to correct it.

Aggressive facial liposuction can result in divots and irregularities and negatively impact how the face ages. Dr. Cabin says the layer of fat below the skin is beneficial in creating soft contours around the face and preventing the muscles or other anatomical structures from showing through the skin. “Accelerated aging is not an issue if liposuction is done thoughtfully and conservatively.” But if it is overdone with excessive volume loss, he says it usually manifests with overly lax skin, irregularities and an unnatural appearance to the lower face and neck. “This is a tough problem to fix, but it can be attempted using a combination of surgical lifting, collagen stimulation technology and volume replacement through fat grafting.”

The bottom line:

Even though facial liposuction can define the lower part of the face for a sharp-as-glass jawline and fat-free chin, it won't improve the skin nor how it ages, so complimentary facial procedures may be necessary as the skin quality changes. But, Dr. Devgan adds, “a surgical procedure will turn back the clock, but it won’t stop it from ticking.”