Buccal Fat Pad Reduction
Buccal fat pad reduction (also called Bichat’s fat pad) is a common cosmetic facial surgery procedure that is performed to slim the cheeks or face. Notice I refer to this as buccal fat pad reduction and not buccal fat removal. I never recommend removing all the fat. More about that later.
The buccal fat pads (buccal refers to the Latin word Bucca meaning cheek) are walnut sized fat deposits deep in the cheeks. These fat masses are located in the cheek between the nostril and corner of the mouth. Their function is to assist nursing in infants or to provide a smooth gliding plane for the jaw muscles. It is the large buccal fat pads that give infants and young children the cheeks that grandma likes to pinch. It is also the atrophy of these areas that cause the gaunt faces of anorexia, HIV or starvation.
Some patients have a very full and round face, in part from large buccal fat pads. The buccal fat pad is a large unit with mass in the temple region, the cheek region and the pterygoid region (back of the upper jaw). There is no indication to remove the entire buccal fat pad and it is the cheek region that is most frequently reduced. I always warn about total removal as it will slim the face, but a decade later can lead to a very gaunt and unhealthy appearance. Remember, you have to live with your face the rest of your live and all fat is not “bad fat”.
I most commonly see patients requesting buccal fat reduction that have chubby cheeks in relation to the rest of their face and body. It is frequently hereditary. Although you occasionally hear about liposuction of the buccal fat pads, I don’t ever do this for several reasons. Number one, these pads have heavy fibrous capsules that do not lend themselves to common liposuction. More importantly, facial nerve branches, the anterior facial vein and parotid duct are frequently in close approximation to these fat pads and could be injured producing facial paralysis or severe bleeding. For this reason, I always perform a magnification assisted precision surgical reduction of the fat pads. It is not an area for imprecise technique and it is important for patients to select a surgeon with lots of experience and expertise in facial surgery.
The fat is located by making several small incisions on the inside of the cheek. The surgeon then locates the buccal extension of the fat pad which is generally very plentiful and protrudes into the mouth . The amount of fat to be removed is determined and the fat pad is removed using a laser or radiowave device. This is important as it seals the blood vessels and prevents bleeding which can be problematic in that area. After the fat is removed the small incisions are closed with dissolving sutures (see figures below).
This figure shows a drawing of the location of
the entire buccal fat pad within the face.
This photo below shows the incisions for buccal fat reduction.
The photo above shows the fat after dissection and before removal.
The photo below shows a depression on the cheek when the buccal fat pad is placed on traction.
The photo below shows the excised fat on an average patient.
The recovery is generally 3-5 days and some patients swell significantly while others don’t. Although the result is immediately noticeable, the final result won’t be evident for several weeks when all swelling is gone. This procedure will generally produce a slimming of the cheeks in the area lateral to the nostril and corner of the mouth. In some patients it is a very noticeable change and in others, it is minimal. While most patients are very happy with the results, some patients wish the results were more dramatic. Again, this is a procedure that demands some level of surgical conservatism as over correction can produce a very hollowed and unhealthy look. As stated earlier, this effect may not s how up for years in the future. Conservative removal has remained a safe and predictable procedure in my practice.
The procedure takes about 20 minutes per side and is performed with IV anesthesia. This procedure may be performed with other cosmetic facial procedures such as facial implants, liposuction, or facelift surgery.
The patients pictured above underwent buccal fat pad reduction. The result is subtle, but noticeable. Notice the nice depression and shadow under the cheek. This is area that will be changed with buccal fat reduction.