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The buccal lipectomy is a well known facial reshaping procedure to help slim the cheek area. This area of facial fat removal is unique because it does not require liposuction to do so. In fact it is the only facial and body area where the defatting is done by direct excision rather than vacuum aspiration through a cannula. This is because the buccal fat pads are unique fat collections that are encapsulated into a relatively large mass in the cheeks with numerous extensions or fingers that emanate out into the face. Their location and shape allows for intraoral access for direct removal of volumes that are in the range of 3 to 6ccs.

The buccal fat pad, while usually discarded after removal, can be a convenient donor source for fat injections. To be useful in this regard the fat has to be pressured for injection since it is not acquired by aspiration. I have found the best method to do so is to placed the fat pads into a 5cc syringe that is connected to another 5cc syringe. The fat is then pushed back and forth until it achieves a liquid consistency. This usually takes about 10 to 15 back and forth until the right consistency is achieved.

The emulsified buccal fat pads can then be placed into 1cc syringes for injection through a small cannula. With bilateral buccal fat pads 6 to 10ccs of injectate can be obtained. This can be very useful for a variety of facial sites.

The interesting question is whether the fat that makes up the buccal fat pad has any unique qualities for transplantation. Buccal fat is well known to have a different appearance than subcutaneous body fat with larger globules and a very yellow color. These differences suggest that it has a different metabolic activity than otters fat and, an as a result, its adipose cells may offer different transplantation behavior such as improved survival or higher numbers of stem cells.

For buccal fat to be used as a donor site for fat injections, buccal lipectomies have to have an aesthetic indication to be done. Because of the effects of their removal they would not be harvested merely for convenience.

Dr. Barry Eppley

Indianapolis, Indiana

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