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The buccal fat pad is as well known collection of facial fat that is the frequent site of surgical extraction. Unlike aesthetic fat removal from almost anywhere else in the body, which is by liposuction, the buccal fat pad is removed en bloc. Unlike subcutaneous fat and as the name implies it is a discrete collection of fat (pad) that has some unique anatomic characteristics to it.

It is an encapsulated mass of fat in the cheek between the buccinator muscle and the masseter and zygomaticus muscles. There are other fat pads in the face (malar and jowl pads) but they are more superficial being right under the skin of the cheek. Besides its deeper location it is also a vascularized or pedicled tissue mass. There is a distinct small artery that courses through the fat pad which would be expected in an encapsulated fat mass very similar to that of a lipoma. This is an important piece of anatomic information when it is being removed.

Because it is an encapsulated fat pad it can be extracted  through a very small intraoral incision. The capsule must first be identified which is done by blunt dissection through the small incision. The capsule/fat pad is deeper than one would think and it is easy to mistake more superficial fat lobules with that of the fat pad. The capsule is a distinct layer and one when it is entered as the large and very yellow lobules of the buccal fat pad are encountered.

Once the fad pad capsule is entered, like it is under pressure, the buccal fat pad will come spilling out. It easily pullout through the small incision even though its diameter is bigger than its width. As the buccal fat pad is pulled out the question becomes how much to take and/or when to stop. It is best to pull on it gently and stop when no more fat easily comes out past the incision. It is important to cut across the fat pad at the level of the incision with electrocautery with the specific purpose of occluding its small arterial pedicle. If not done there is a real risk of a postoperative hematoma.

Closure of such a small intraoral incision can be done with a single resorbable suture….or can not be closed at all. Because it is a high maxillary incision way up under the upper lip back along the upper jaw it is not exposed to any significant liquid or food debris. And such a small incision heals rapidly.     

Dr. Barry Eppley

Indianapolis, Indiana

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