Plastic Surgery, Beauty, Skin Care Message Boards & Blogs
Our message boards are for all of us who want to talk, listen, share, and support fellow women and men interested in discussing plastic surgery, beauty treatments, pregnancy, gynecological concerns, aging, and various health conditions. You can read messages without logging in. To post a message, please log in or register. It's free...and being a member gives you access to important information. By using the Message Boards, you agree to the Message Boards Policies.
Ask Dr. Yang any questions about facial plastic surgery, including facelifts, necklifts, eyelid surgery (blepharoplasty), browlifts, otoplasty, and non-surgical treatments such as Botox and injectable fillers.
How can one tell if cheek liposuction would be beneficial? I've read many doctors are reluctant to do it, but I believe I may benefit from it. Is there some kind of test I could do by myself, or do I definitely need a consultation with a doctor? Also, would the fees for that be included in regular neck liposuction, or would you have to pay significantly extra? Thanks greatly for any help.
Very good questions. These answers are written assuming that you are in your 20's. Let me know if I'm wrong about your age.
Curtis24 wrote:How can one tell if cheek liposuction would be beneficial? I've read many doctors are reluctant to do it, but I believe I may benefit from it. Is there some kind of test I could do by myself, or do I definitely need a consultation with a doctor?
If you suck your cheeks in a little bit, this is what a buccal fat removal would be. You can google buccal fat removal to look for more before and after photos. Most plastic surgeons are unwilling to liposuction the fat directly under the cheek skin. If you feel that you have "chubby cheeks" a more refined operation is a buccal fat removal/reduction. Buccal fat is a discrete pocket of fat about the size of a walnut. When some of the fat is removed through and incision on the inside of the mouth where the upper lip meets the gums, the fat can be carefully removed, and create a flattening of the cheeks.
That being said, I do not offer this procedure. Since my main focus is to try to help my patients "look younger" I am reluctant to perform this procedure. Plastic surgeons are heros of the moment. It may look good now, but most people don't think about future consequences. So you may like it now, but in a few years you may regret doing it and want fat put back in. That would be both a waste of money, and counterproductive. Although it may look better right now, in the future your body will most likely naturally shrink the buccal fat, unless you are significantly overweight to obese. People who have baby faces usually have more buccal fat. Usually when they are in 20's they look like in their teens, 30 like their 20, and almost always about 10 years younger than their age.
Most of my patients want to look 10 years younger than their age. In fact, once you are past 30-40 almost everyone wouldn't mind looking 10 years younger. If I can help them maintain that 10 year gap, by explaining long term consequences, how the face ages, and future benefits, and not even need to operate on them, hopefully the patient will appreciate how their face looks now, and how they will age well over their peers. Time flys, before you know it 10 years will have gone by. Younger people just don't realize it. Just as I wouldn't offer buccal fat removal on a child, I think that young people just don't realize how quickly it will happen anyway. I don't just want to be the hero of the moment, I want my patients (even if they don't have surgery) to think back and say, "boy, I'm glad that Dr. Yang talked me out of that procedure, now I'm looking younger than my friends."
I wrote a post about buccal fat removal in response to a question about whether or not it is a good idea.
That's okay, I really appreciate the thought out response. If I sent you pics of myself, could you give me your opinion about what would be best? I'm actually trying to restore myself after a long illness, so I would send pictures from before and after, wanting to get to the before. Thanks a lot.
Also, and I'm trying not to self-diagnose, but I read some things about alcohol releasing high levels of cortisol. Not sure if that's to blame, though, since I've had blood tests recently(not even sure if the blood tests would pick up on that though). Something about pseudo-induced Cushing's syndrome. Though even if that's to blame, I don't think that once it went away, the fat would too.
To diagnose Cushing's you need a 24 hr urine test, which it sounds like you have not had. Don't be so focused on the cosmetic side until the medical issues are completely resolved. Although you may think that the alcohol made your face and neck this way, but alcohol can actually make your face lose fat. So something else going on.
In fact, some doctors don't believe that pseudo-cushing's even exists. They think that the Cushing's causes the drive for alcohol, instead of the other theory that alcohol caused the Cushing's.
Either way, ask your physician to do a work-up for Cushing's with the proper testing.
Since it is Friday morning, you should make some phone calls today and get a professional medical opinion, instead of looking things up over the internet over the weekend. It's just a urine test. Not a big deal.
This is my last reply until you get checked out. I am a physician as well as a plastic surgeon. If I see a medical problem, or I am worried about it, I will not make any cosmetic recommendations until the patient is cleared by their primary care or internal medicine physician.
If you don't understand that, then I cannot help you. You can get a second opinion from Dr. Naderi, but I would guess when he sees your current photos with upper body weight gain and round face that he will also suspect the same thing. These things are not obvious to all physicians. We look at patterns of symptoms, and make educated guesses. You may feel fine and not have to have all of the symptoms of Cushing's to have it, you only need a couple of them which would lead to further tests. Other people may start having different symptoms and not have the facial weight gain, but they also could have it. Everybody is different and can have a different set of symptoms for the same problem
The symptoms that you are having are early symptoms and the other ones can come later when the problem is more serious.
People who have arthritis or certain medical treatments are put on steroid pills (Prednisone related medications) and can develop the same appearance that you have. My brother-in-law had the face and neck fat accumulation within a short time after starting the steroid pills. When he stopped it, the fat eventually went away, and he looks the same without any residual signs of the moon face or neck fat.
You only have some of the symptoms, but it is an indicator that more is going on. People don't just gain weight on their face and neck and not on the rest of their body, with regular weight gain and obesity. Also, Cushing's can make the person crave alcohol and sugar. So your original issue from alcohol, may not even be your fault, but another sign of the Cushing's. I found a link about it yesterday: http://cushings.invisionzone.com/index. ... opic=25891
Look at this model who developed Cushing's:
No matter how much a PS liposuctions her face and neck, it will not get her back to her original state. Only curing the underlying problem will.
I know you feel fine, which could mean that you facial weight gain is only the earliest signs and it is very treatable.
http://faculty.etsu.edu/currie/adrenal.htm wrote:Cushing's Syndrome (excess glucocorticoid activity) Cushing's syndrome occurs due to an excess of ACTH and/or an excess of adrenocortical steroid production, especially cortisol. Cushing's usually occurs in mid to late life and, once again, is more common in women than in men. The onset is usually slow and insidious. Here is a before and after picture of a professional model who developed Cushing's.
Some of the effects of Cushing's are hyperglycemia, nitrogen wasting, increased fat synthesis, hyperlipemia, weight gain, moderate or severe obesity and the face becomes round and red (moonface). Because of the red face, some persons are initially perceived to appear as alcoholics. There is also inhibition of growth, suppression of Vit D3 activity and osteoporosis, tissue fragility and thin skin which is easily bruised. The glucocorticoids suppress the immune system and there is inhibition of inflammatory response and an increased frequency of infections. In addition, infertility, weakness, hypertension, diabetes, backaches, acne, hirsutism, mood swings and irreversible cardiovascular damage (due to hypertension and enlargement of the heart) are observed.
One thing that is very evident upon testing is the elevation in cortisol and the resultant reduction in ACTH due to the negative feedback of cortisol. The adrenal or pituitary tumor, whichever has occurred, should be removed. Cushing's syndrome is fatal after a few years if untreated, due primarily to the irreversible CV damage (again, due to the hypertension and heart enlargement).
Please, tell your medical physician about my suspicions.
If a facelift patient comes to me with a skin cancer on their face, how in good conscience can I ignore the skin cancer and go ahead talking to them about having a facelift, they feel fine too. I can't. What more can I tell you?
Okay. I understand and appreciate your position. Can we talk about what the underlying problem might be, though?
There has been fat gain in my abdomen as well. However, there's been no overall weight gain, which is puzzling. I'd much rather solve the problem naturally then get plastic surgery. If it was just a matter of losing weight, I would happily do it. But I've been rock-solid at 160 pounds predating the 'before' picture I showed you.
Also, all this didn't start till after I started drinking...
Yeah, Dr. Naderi said I should get my liver, kidneys, etc. checked out.
As for the cheek liposuction, he said basically 'under no circumstances'. Also, that because I'm a young man, I should avoid any facial surgery, since it can have adverse consequences in the young and especially in men. "Conservative neck liposuction" if I really wanted it, but he still didn't recommend it. He didn't think I should get any surgery. What are your thoughts?
As for the Cushing's, there seems to be a lot of confusion surrounding it. The forums are often no help since most of the people who go there have not actually been diagnosed with the disease. Indeed, a common complaint is that many people are sure they have it, but have to keep going to doctor after doctor until they're diagnosed(and most don't seem to have yet been diagnosed besides going to doctor to doctor). They also claim many of the tests are inaccurate, that you can't just get a 24-hour urine test, you need to get them all, at different times of the year, since Cushing's is known to be 'cyclic'(which no professional seems to have bought into yet) etc. I don't know if what they're saying is right...
At this point I have to dry out for a few weeks before I'm going to get checked out.
Apparently it is not easy to diagnose. The best specialist for this actually an endocrinologist, or a hormone specialist. You don't need to dry out before seeing the doctor, tell them what Dr. Naderi and I suspect may be happening.
"Don't put the cart before the horse" "First things first"
For example, what color should you paint your first child's room, which pre-school should they go to, which college savings fund is best? You don't have to worry about that now (I do), but wouldn't be strange if you started to worry about these things before you even have a child? There are too many what if's in life.
Figure out what's happening, let your body recover from the illness, then see how you look. My guess is that you will most likely not need to do anything, and you will feel much better about everything.
Information and services provided through Make Me Heal and this Site are intended for educational and informational purposes and are not a substitute for the advice of your physician or other medical professional. If you need medical assistance, you should contact your medical care provider. For more information, please read Our Policies.