One of the techniques to help create a thinner face is that of a buccal lipectomy procedure. Because it is the largest collection of encapsulated fat on the face and its extraction is a straightforward and uncomplicated procedure, it is an easy target when it comes to facial slimming efforts.
Despite that the buccal lipectomy procedure has been around for a long time, the effects if its removal are frequently misunderstood. The first misconception is what effect it has on slimming the face. The main portion of the buccal fat pad adds volume primarily to the submalar region of the face. This lies right under the cheekbone where one would put their thumb under the cheekbone prominence. It should not be confused with the malar fat pad, which is directly below the skin of the cheek. It also does not extend all the way down to the side of the mouth or even down to the jowls.
Given its anatomy, this is why a buccal lipectomy will NOT slim the face from the cheeks down to the jawline. By itself it can not make a round face into more of a V-shape. It simply is not that powerful. This is why a buccal lipectomy is often combined with perioral liposuction to extend its effect further down on the face.
Another more recent misconception is that a buccal lipectomy will eventually lead to gauntness of the face or a prematurely aged look. While this belief does have some partial truth to it, such a facial effect depends on what type of face on which it is performed. Thinner faces that are genetically prone to eventual facial lipoatrophy would be prematurely and adversely affected by removing the buccal fat pads. But in fuller and more round faces (aka heavy face) there is no reason to believe that excessive facial thinning will eventually occur.
The last misconception is that the buccal lipectomy is an all or none procedure. While large amounts of the buccal fat pad can be removed, that does not mean it has to be. A subtotal or incomplete buccal lipectomy can be done when there are concerns about too much fat removal. There are three lobes or extensions of the buccal fat pad and in a subtotal technique only a portion or just the anterior lobe can be removed.
Dr. Barry Eppley