Explore Plastic Surgery

THE BUCCAL FAD PAD IN FACIAL SURGERY

In select patients, removal of the buccal fat pad (which lies immediately under the
cheekbone and is about the size of a golfball in most patients) can help contour a fuller
face. I have performed this procedure, in conjunction with liposuction of the neck and
chin implants, many times in patients whose desire is to thin out their fuller faces.
In numerous anatomic studies, dissectors have detailed the known relationship
between the facial nerve, buccal fat pad and the parotid duct. Given the frequent
proximity to this area during many types during aesthetic and reconstructive facial
surgery, it is useful to have a better appreciation of this midfacial crossroads region.

Like most cadaveric studies, there are no absolutes for each person’s anatomy.
However, it is clear that several buccal branches of the facial nerve interlace with the
multi-lobed buccal fat pad. Most commonly, this is on the superficial (outer) aspect of
the buccal lobe, away from intraoral approaches of manipulation. For this reason,
aggressive buccal lipectomies may inadvertently damage these branches. I have never
observed facial nerve injury from a buccal lipectomy procedure but this attests to a more
limited resection. Complete removal is usually aesthetically undesireable but also places
these nerve branches at risk. Since the parotid duct shares a similar pattern
of proximity as that of the nerve, injury to it is also theoretically possible. However, it is a
much larger structure that is tethered by its attachment to the oral mucosa and, as such,
not as easily avulsed from its anatomic bed.

In performing buccal lipectomies, it is important to bear the anatomy of the facial nerve
branches in mind and adjust the amount of buccal fat resection accordingly.

Dr Barry Eppley
www.eppleyplasticsurgery.com
www.ologyspa.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis