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Reshaping of the soft tissue of the cheek for a less full or thinner facal appearance has long been the promise of the buccal lipectomy procedure. While effective for some patients the procedure is often misused with the belief that will it affect the entire cheek/midface region from the bony cheeks down to the jawline. As the buccal fat pad sits higher up in the cheek soft tissue region that many appreciate this is why a more complete soft tissue reduction requires the addition of perioral liposuction.This addresses the subcutaneous area of fat that is more at the level of the mouth area below the location of the buccal fat pad space.

As a result I find the combination of a buccal lipectomy combined with perioral liposuction to be the best approach to soft tissue cheek thinning for many patients as it addresses the maximal amount of fat removal in the face. But there is also an additional adjunctive procedure to perioral liposuction that helps improve its effect in the lower cheek region…the buccinator myectomy procedure. It is an internal lower cheek procedure that addresses fullness on the inside surface of the perioral area.

The buccinator myectomy is a broader modification of the cheek dimple procedure. The objective of a cheek dimpleplasty is to bring closer together the external skin and the internal mucosa by creating a muscular defect in one very specific spot for a distinct external indentation. The buccinator myectomy takes that concept but expands it to a broader region with the goal of an overall more inward or thinner contour to the owner cheek region. It can be done as a standalone procedure but is more ideally done combined with perioral liposuction. 

Once the initial perioral liposuction is completed the central area of the desired indentation is marked. A needle is then passed through the skin internally to locate the center of the horizontal ellipse of mucosa and muscle.

A 2 to 3cm ellipse of mucosa and muscle is excised with electrocautery and the mucosa edges closed.

An external lightly compressive bolster of xeroform is created by a through and through resorbable suture tied down externally. This compresses the two sides of the lower cheek together, not only to reduce swelling but to help then stick together for the desired contour effect. The bolster will remain int place for one to two days after the procedure.

Many young patients desire a more contoured soft tissue cheek region that has inward/concave shape between the bony cheeks and the jawline. This can be challenging to create in some patients in which a buccal lipectomy may prove ineffective as it is more highly positioned in the cheeks than is often perceived. This is where perioral liposuction has its role either by itself or combined with buccal lipectomies based ion the challenges the patient’s soft tissues presents. The buccinator myectomy procedure improves the result of perioral liposuction in thick tissue patients to optimize lower cheek soft tissue reductive contouring.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

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