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The buccal fat pad is most recognized for its role in facial reshaping surgery. Through an intraoral buccal lipectomy extraction, the main body of the buccal fat pad is removed causing a reduction in external cheek fullness. Such aesthetic procedures always produce impressive lobular fat specimens with volumes between 3 to 6ccs.

But this unique area of facial fat also has a history in reconstructive surgery as well. The buccal fat pad is unique because it is an encapsulated fat pocket that has a distinct vascular pedicle. As a result it can be released and brought out into the mouth or beyond and can be used a vascularized flap for soft tissue reconstruction. In an aesthetic buccal lipectomy procedure the vascular pedicle is severed so it can be removed. But keeping it intact allows the stretched out fat pad to be used to cover a variety of intraoral defects such as cleft palate fistula.

In aesthetic augmentation of the midface using custom mask implants, the entire surface of the maxilla is covered by the implant. I don’t like having a complete disruption the soft tissues from the bone which is why I always used the technique of perfusion hole placement. While this technique is beneficial to allow tissue ingrowth into the implant holes and re-establish some vascular connections between the bone and the overlying soft tissues, there still remains only a thin tissue thickness between the implant and the vestibular incisional closure.

A pedicled buccal fat flap provides a unique method of increasing the thickness of the soft tissue cover between the implant and the incision. Each side of the buccal fat can be brought out across the maxilla and stretched out over the implant. It is then sutured to the implant as far towards the midline as possible providing thick vascularized soft tissue coverage.

Given that the patient who gets the custom midface mask implant is trying to increase the forward projection of the midface, the buccal fat flap adds to that projection at the maxillary level. It also has the added aesthetic benefit of decreasing cheek fullness contributing to the facial reshaping goal.

Dr. Barry Eppley

Indianapolis, Indiana

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