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 the largest 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
Indianapolis, Indiana