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Reshaping the full or round cheek area is most commonly treated by a buccal lipectomy. This now popular procedure, performed intraorally and with a very low rate of any complications, has often misunderstood aesthetic effects. It has its effects in the upper cheek which is defined by what lies north of a line drawn between the corner of the mouth and the attachment of the earlobe to the face. (cheek equator) It is not a full cheek soft tissue reductive procedure. What lies south of the cheek equator line requires a different treatment approach.

Fullness caused by fat below the cheek equator line can only be improved by perioral liposuction. This treats the subcutaneous fat that lies below the skin but above the buccinator muscle. From a nick incision inside the corner of the mouth small cannulas are used to access and reduce this thin fatty layer. While it can be performed alone for isolated perioral mounds it is a good and often needed companion to the buccal lipectomy procedure for a more complete soft tissue cheek reduction effect.

More recently I developed the buccinator myectomy procedure as a complement to perioral liposuction. On the opposite side of the buccinator muscle lines another fat layer and the intraoral mucosa. By removing an elliptical segment of buccal mucosa and some of the underlying buccinator muscle a further lower cheek contouring effect can be obtained. This is a good complement to perioral liposuction for those patients who have significant lower cheek fullness or are seeking a maximum contouring effect.

The buccinator myectomy procedure, however, does create dead space. This means that underneath the intraoral mucosal closure a temporary space is created between it and the underlying muscle layer. This will initially fill in with fluid that is eventually resorbed and hopefully results in an inward retraction. But like all dead space creations that are created by various plastic surgery procedures it is best to either have them drained or compressed. Since drain use in this area of the face is impractical, the compressive approach is used instead. This is done by the use of a bolster technique used soft dental rolls sewn over the perioral liposuction/buccinator myectomy area with through and through silk sutures.

These cheek bolsters help prevent fluid collections and reduce the amount of swelling that would otherwise occur. (The operative word is reduce not completely eliminate) The bolster are removed 24 to 48 hours later, depending upon the patient’s tolerance of them.       

Dr. Barry Eppley

World-Renowned Plastic Surgeon

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