Fullness in the midface, or a rounder area beneath the cheek bone, is partially the result of the prominent of the buccal fat pad. Most people do not realize that their is a large ball-like collection of fat under the cheek bone that in some patients can create lack of definition in the midface-cheek area.
The buccal fat pad has many ‘fingers’ that extend out from it to reach up to the temple area as well. Its exact role is not precisely clear and it appears to be similar to the appendix or your wisdom teeth….you can live just fine without it. Removing the buccal fat pad, a procedure known as a buccal lipectomy, is a very simple and uncomplicated procedure to perform. Through a very small incision just opposite the upper second molars, the buccal fat pad is teased out and removed. Portions of it or almost all of it can be removed. A single dissolvable stitch closes the incision. There is nothing special to do after surgery. One can eat or drink whatever and whenever one wants. There may be some mild swelling, and occasionally a small amount of bruising, but this completely clears within a week or so. It may take several weeks to see the results but some patients seek improvement even in the face of early swelling.
I often perform buccal lipectomies in younger patients in an effort to help change a rounder face and reduce cheek fullness. It may be performed alone but is usually done in combination with other adjunctive facial procedures such as neck liposuction, cheek implants, chin implants, or rhinoplasty. Buccal lipectomies create a subtle improvement and for this reason are not usually done alone….although it can be. When performed alone, I can do them in the office under local anesthesia if the patient desires.
The size of many buccal fat pads can be impressive and their removal can be quite substantial. One has to carefully look at the patient’s face and be certain that this procedure would really be helpful as it is easy to create the opposite problem (gaunt sunken-in look) which can develop over time in some patients. This is why I only usually use it in very full round faces with prominent cheeks. It is not a substitute for the patient who really needs a cheek augmentation instead. When done in the cheek-deficient patient, you are only flattening out the midface further.
Dr. Barry Eppley
Indianapolis, Indiana