Buccal fat excision, or buccal lipectomy, is an increasingly popular surgery to help reduce heavy cheeks and slim the lower face. The youthful face is classically defined as having an inverted triangular shape: well-defined cheekbones angling down to a crisp jawline and well projected chin. As we age, volume redistributes to our lower face, creating a square or (upright) triangular frame. A bottom-heavy face can portray older age and fatigue. Heavy cheeks can also be particularly bothersome in photographs, as they are accentuated with smiling. This can affect someone’s confidence in public and with taking photos.
Buccal fat excision is an excellent solution to heavy cheeks. This is a quick and minimally invasive procedure with relatively low risks. The result is a subtle improvement in the contour of the lower face to produce a more youthful and aesthetic appearance.
WHAT IS BUCCAL FAT?
The buccal fat pad, also known as Bichat’s fat pad, is an encapsulated fat pad of the face. In babies, the buccal fat pad contributes to the round, chubby cheeks which we find adorable. The buccal fat pad partially regresses as we enter our 20s. However, some patients have a genetic predisposition for large buccal fat deposits, while others may not experience the same degree of regression in their cheek fat. The entire fat pad covers different spaces of the face, spanning from the temporal region down to the cheek.
Buccal fat does not respond proportionally to weight loss as fat in the rest of the body. Patients who make a considerable effort at modifying their diet and their lifestyle habits may feel frustrated about the stubborn fat in their cheeks. For them, buccal fat excision may be an excellent option for treating these resilient fat pads.
WHO IS A GOOD CANDIDATE FOR SURGERY?
The ideal candidate for buccal fat surgery is a patient with normal or prominent zygomatic bones (cheekbones) who has fullness in their cheeks. In these patients, buccal fat excision will enhance the angularity of the face to highlight the cheekbones and improve the Ogee curve (double S-shaped facial curvature on an angled view).
Not everyone is a good candidate for buccal fat excision. Patients who have weaker, under-projected cheekbones may end up looking gaunt and appear older if buccal fat is removed from their cheeks. It is important to know that buccal fat excision is irreversible – the volume of the buccal space cannot be replaced with fat grafting or filler.
All patients should have realistic expectations of the surgery. Buccal fat excision creates a subtle change of lower facial contour; it does not have a dramatic slimming effect. Not every patient will achieve the same results as seen in some the best before-and-after buccal lipectomy photos on the internet. It is also important to understand that buccal fat excision does not treat the jowls or improve the jawline.
BUCCAL FAT EXCISION PROCEDURE
Evaluation for buccal fat excision involves a detailed physical examination of your overall facial proportions, bony anatomy and cheek height, jawline shape and neck contours. This procedure can be performed easily and safely in an office setting, or in an operating room if combined with other surgical procedures.
Buccal fat excision is performed under local anesthesia. Oral medication can be taken for comfort and relaxation. Local anesthesia is infiltrated into the cheeks, through the mouth. After identifying key anatomic structures and landmarks such as your parotid gland duct (saliva duct), two 1.5 cm incisions are made on the inside of your cheeks. Fine instruments are used to identify the capsule surrounding the fat pad and gently release the buccal fat through the incision. The entire buccal fat pad is never removed; only the redundant fat which is easily withdrawn through the incision is removed. After excising the fat, the fat pockets are rinsed with an antibiotic solution and closed with small absorbable sutures.
After surgery, we ask our patients to continue the antibiotic rinse for a few days. There is no significant pain or discomfort with buccal fat excision. However, if necessary, over-the-counter medications (e.g. Tylenol) are sufficient to treat any discomfort. Any noticeable cheek swelling peaks on days 2 and 3 after surgery and subsides within one week. All swelling resolves by 4 to 5 months, at which point most patients can see their final result. In some cases, swelling may take longer to fully subside.