I frequently get asked by patients in consultation or online what they can do to make their face look thinner. Besides the obvious answer of weight loss for some patients, they are specifically asking about facial fat removal either through liposuction or removal of the buccal fat pads. While liposuction can make a great difference in the neck, it is not a good method for removal of fat in the face. This has been tried a lot in the past and all that usually happens is a lot of swelling with little to no results. So that leaves the buccal lipectomy procedure as the only true fat removal procedure of the face.

What is a buccal lipectomy and what can it really do? The term, buccal, means cheek and we are talking about a very distinct collection of fat that sits right under the cheek bones in the appropriately named buccal space. It is situated between the cheek skin and the cheek lining inside the mouth. It is a very large fat collection, about the size of a golf ball, and actually has fingers of fat that go beyond the cheek into other areas such as the temples. It does provide fullness to the cheek area but is not responsible for fullness at the level of the corner of the mouth or beyond. The exact reason we have this buccal fat is not really known but most believe it serves as cushioning between the chewing muscles.

Removal of the buccal fat pad is really quite easy through a small incision inside the mouth. The fat is easily teased out and a surprising amount can actually be removed. How much to remove is a matter of judgment. If the patient has a really full round face, I will try and remove as much as possible to create an effect that can be seen through their thick overlying skin. You have no worries that you will make them too ‘thin’. In thinner people one has to be careful to not remove too much for it is possible to give someone a very gaunt or hollowed look months or years after surgery. Certainly in a very thin face, this procedure should not be done.

The results from a buccal lipectomy is to create a flattening or indentation of the area beneath the cheek bones. This effect is mimicked by the application of makeup that women use to contour the cheeks. (darker makeup underneath the cheek bone) While this helps thin out or narrow this part of the face, other procedures are usually needed to create an overall facial change that makes it appear thinner, such as liposuction of the neck and chin augmentation.

Dr. Barry Eppley

http://www.eppleyplasticsurgery.com

http://www.ologymd.com

Clarian North Medical Center, Carmel, Indiana

Clarian West Medical Center, Avon, Indiana

Indianapolis

 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

http://www.eppleyplasticsurgery.com

http://www.ologyspa.com

Clarian North Medical Center, Carmel, Indiana

Clarian West Medical Center, Avon, Indiana

Indianapolis