Buccal fat pad resection is a trending procedure that has gained increasing popularity nationwide and in my own practice. I see a recurring pattern where patients ask for the procedure based on their cosmetic goals, are quick to book the procedure because it is relatively affordable and low risk (in expert hands) and confers a sense of instant gratification. However, it is not uncommon for patients to obtain advice from other plastic surgeons, stylists, aestheticians, and nurses, that warn patients against the cosmetic risks of this operation. The most common concern my patients have is that they will be over-resected and obtain a deflated midface that may contribute to premature aging. Other patients have concerns that they will have bags that sag where the buccal fat pad used to live. Finally, some patients wonder if this can be reversed in time. I often tell patient’s that the operation is desirable because it is subtle in its very nature. Most patients do not see drastic results as only 3-4 cc of this 6mm thick buccal fat pad are actually resected. I tell patients quite often that I will remove as much buccal fat pad is I can. What this actually means is I remove all of the buccal fat pad that is easily delivered with gentle palpation with my finger. Many studies have shown that the buccal fat pad is anywhere from 8-10 cc in volume, however upon removal of the most easily accessible portion, 7-8 cc remains. In other words, we are taking 40 to 50% of the entire volume when we remove all that is easily deliverable. 3-4 cc has an important but subtle improvement for the midface. This will allow convexities or chipmunk cheeks to become flat or even concave and to really show off the cheekbones where they may have been previously obscured by midfacial fullness. It is important to identify and properly treat volume that occurs in the posterolateral portion of the face over your masseter muscle and the angle of your jaw from the anterior medial fullness of the buccal fat pad and jowls. Young patients with thick, healthy skin and strong cheekbones are ideal candidates. However, buccal fat pad removal is an important adjunct to my facelift as well. In older patients, I do need to be more careful and conservative with the fat that I resect, and in these patients, I only resect the fat that is not easily removable but that herniates on top of the existing tissues. During your consultation all be honest with you as to whether not I believe you are a good candidate for the procedure. If you are a good candidate, and I tell you I am going to remove as much of the buccal fat pad as I can, this still only amounts of 40 to 50%. Because the buccal fat pad may have important functions in gliding with the muscles of chewing and speech, it may not be prudent to remove at 100% of the buccal fat pad in any case. By removing only the cosmetically significant portion, this can help preserve the foundation of the fat in the remainder of your face, as well as many of the cushioning and gliding features of the buccal fat pad. In my practice my patients are nearly universally happy with my approach and the conservative result they see. This procedure can be performed, oftentimes, within 30 minutes in the comfort of our office. While most patients choose to do this under oral sedation, this can be performed without as well.
Submental liposuction is just that removing fat under the chin (mentum). Liberal sculpting under the chin and jawline enhances existing features (plus I take a little more at the site of the jowl fat). This young woman had 4.5 cc buccal fat pads removed, and 65cc of liposuction. We can’t wait to see her before and after!