Background: The buccal lipectomy is the most well known soft tissue cheek reduction procedure. While once deemed as an unapprorpiate facial reshaping procedure years ago it is now very popular amongst patients and surgeons alike. Its common performance is due to the effect of the en bloc removal of a discrete facial fat collection as well as the relatively direct intraoral access to do so.
Despite the straightforward nature of the buccal lipectomy procedure it can have medical complications, most notably that of an infection or a hematoma. (uncommon but possible) Aesthetic complications are more likely from asymmetries to over correction (too much fat removal) to a cheek reduction effect that doesn’t reach low enough. (misdiagnosis or failure to add perioral liposuction with the buccal lipectomy)
One uncommon ‘complication’ is failure to see an effect from the surgery. Given the average size of the buccal fat pad this can be hard to explain.
Case Study: This female had a prior history of a buccal lipectomy to treat her chubby cheeks several years previously. But she never saw much if any external cheek reduction effect. She was having new facial procedures and asked if re-exploration of the buccal lipectomy site could be done to see if all of the buccal fat pad had been removed.
Through an intraoral incision opposite the upper second molar and above the parotid duct, the left buccal fat pad space was approach after passing through the buccinator muscle and going deep until a white capsule was encountered. The caps was opened and a large encapsulated fat pad encountered. This was teased out and removed by cauterizing its base.
On the opposite right side a similar large buccal pad was discovered and also removed. Between both sides these were typical total buccal lipectomy specimens.
This is not the first time I have seen a patient who had a prior buccal lipectomy and on re-exploration an unaltered or minimally reduced buccal fat pad has been found. This has undoubtably occurred because the treating surgeon assumed the more superficial fat that is encountered immediately on making the mucosal incision. This more superficial buccal fat looks very different than the buccal fat pad with much smaller fat lobules and a very low volume. (< 1cc) It appears more like subcutaneous fat. In contrast buccal fat has very large lobules, lies quite deep beneath the masseter muscle and has a large volume. (3 to 5ccs)
1) In cases where a buccal lipectomy was performed and little to no external change is seen, the question is whether the buccal fat pad was actually removed.
2) It is possible that the more superficial fatty tissue that lies above the deeper buccal pad was removed.
3) Deeper re-exploration may reveal an intact buccal fat pad that was never removed.
Dr. Barry Eppley