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Contouring of the full or chubby cheeks consists of soft tissue reduction methods. Since it is not possible to remove skin in the cheek area focus is exclusively on fat extraction techniques.There are two facial fat extraction procedures (minus any fat removal that is done from around the eyes in blepharoplasty surgery) which are the buccal lipectomies and perioral liposuction

The most well known cheek fat reduction method is the buccal lipectomy. This is the removal of a discrete encapsulated fat pad that lies between the buccinator and masseteric/zygomaticus muscles in the mid cheek region. It is a dramatic appearing  procedure because of the visual removal of bright yellow strands of fat from inside the mouth. Reduction amounts are usually in the 3 to 5ccs range which is helpful in having a visible slimming effect on the cheeks.

But the most misunderstood aspect of buccal lipectomies is where on the cheeks that effect occurs. Some illustrations show that it goes as far down as just above the jawlone. This is an anatomic misunderstanding as the buccal fat fat pad simply does not go down that low. A good way to visualize it is to draw a line  between the corner of the mouth and the tragic of the ear. Above that line is the cheek areas where the buccal lipectomy has its effect. Below that line is known as the perioral region which is to affected by buccal fat removal. One could be generous and draw that line between the corner of the mouth and the attachment of the earlobe. But still there is a good portion of the cheek that resides below that line.

Below that line down to the jawline is the perioral region, a fatty cheek area far less appreciated than the buccal fat pad. This is a sucbcutaneous fat layer which has less fat volume than that of the buccal fat pad. But using small cannulas through a small mucosal incision inside the corner of the mouth 1 to 2ccs of fat cab be extracted from this lower cheek region. It is a good complement to the buccal lipectomy and provides a more complete cheek reduction effect. Since there are no facial nerve branches in this areas it is perfectly safe to treat it.

An unheard of cheek contouring procedure is that of the buccinator myectomy. Rather than extracting fat this is an intraoral procedure where a horizontal ellipse of mucosa and a strip of buccinator muscle are removed. This removed tissue area is done exactly along the line that is created when one sucks their cheeks inward. This is the point of maximal buccinator muscle activity over the mid portion of the ‘trampoline’ cheek area. This helps pull the cheeks a bit more inward with a more modest effect than actually sucking one’s cheeks inward. Like the perioral liposuction procedure it adds another element to cheek reduction to help maximize the inward contouring effect.

The concave contour between the cheekbone and the jawline is an often desired facial appearance. This is the trampoline area of the face as it is not supported by bone but consists of soft tissue structures only. Removing fat is the main stay of soft tissue reduction in the trampoline cheek area but buccinator muscle manipulation also has a minor role to play.

Dr. Barry Eppley

Indianapolis, Indiana

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