Buccal lipectomies, a facial reshaping procedure once denounced as deleterious, has gained popularity in more recent times. In an effort to thin out or sculpt full cheeks, removal of the discrete buccal fat creates the most significant amount of facial fat reduction. The cheek subcutaneous tissues are not particularly favorable for liposuction due to its fibrofatty tissue composition and the presence of the buccal branches of the facial nerve.
The size of the buccal fat pad has been previously studied based on specific weights/volumes. Most buccal fat pads have been down to be in the 3cc range. For some patients that volume is facially significant while for others the external change are more moderate in effect.
In the December 2020 issue of the American Journal of Cosmetic Surgery an article was published on this topic entitled ‘Buccal Fat Pad Sculpting for Lower Facial Contouring With 3-Dimensional Volume Assessment.’ In this paper the authors conducted a prospective study on fifteen (15) isolated buccal lipectomy patients (mainly females) using three-dimensional (3D) imaging allows for quantitative and objective assessment of the facial volume changes over a two year period. VectraXT 3D imaging and software was used to compare preoperative and postoperative facial volumes. The mean length of follow up was almost 8 months.
As expected all patients showed facial volume reduction in the area evaluated. The mean volume reduction in the frontal view was 7.2 mL on the left side and 7.5 mL on the right side. There was no difference between the volume change of the two facial sides.
The authors did not compare the volumes of the buccal fat pad removed with that of the measured external facial change. Knowing that most buccal fat pads are not as great in size as the external facial volume changes seen in this study indicates that the space collapse underneath is ultimately greater than the volume of fat that was removed. This demonstrates the power of the buccal lipectomy procedure in many patients. I suspect, although not specifically evaluated in this study, is that the rounder the face the more external volume reduction that is seen.
What would have also been interesting in this study is to have mapped out the exact zone of midface volume reduction. One of the most disappointing aspects of some buccal lipectomy patients is that the thinning effect does not go as low on the face as they desire. This is because the buccal lipectomy does not have much of an effect in the lower midface which would be below the level of the corner of the mouth. Few buccal fat pad are located that low unless they have inferior herniation…which is rare. This is also why perioral liposuction is a good complement to the buccal lipectomy as it removes subcutaneous fat below the level of the corner of the mouth to create a more complete facial sculpting effect.
Dr. Barry Eppley