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The shape of the cheek area of the face is influenced by a variety of anatomic structures. This anatomic composition varies based on the level of the cheek of which there are three specific zones. In the upper cheek zone skin fat and bone are the three tissue layers and only an outer contour exists. But in the mid- to lower cheek it become a bilaminar structure with an outside (skin) and inside (mucosal) layers.

Between the cheekbone and the jawline the bony layer goes away and is replaced by a muscle layer, the buccinator muscle. It is a muscle that runs east-west and originates anteriorly from the alveolar processes of the upper and lower jaws. It extends back to the front edge of the pteryomandibular raphe. At its most anterior portion near the mouth the buccinator muscle fibers converge at the mouth corner with the circumferential orbicularis oris muscle. Given its attachments contraction of the buccinator muscle pulls the corner of the mouth back and flattens the cheek inward. This serves as an assistive function in chewing to work in concert with the masticatory muscles.

From an aesthetic standpoint many younger patients desire a more inward or concave look to their mid-cheek region between the cheek bones and the jawline. Some simulate this effect by ‘sucking in their cheeks’ which is really activation of the buccinator muscle. Defatting procedures, such as buccal lipectomies and perioral liposuction, are the common procedures to try and create this facial reshaping effect. It is more successful in some than others.

But another potential procedure in this regard is a buccinator myectomy or muscle tightening. Given that the muscle fibers run front front to back, a partial resection of the muscle in the same direction at a line at the level of the mouth corners with plication of the remaining fibers can have a modest cheek slimming effect. This is done through an intraoral elliptical excision of mucosa, fat and muscle.  The excision and closure is done below the parotid duct.

There is no adverse functional sequelae from removing this inner layer of the cheek. This is a technique I learned from doing many buccal mucosal graft harvests for urethral reconstruction for Urologists in children and adults. The mucosal scar line heals wells and I never observed an adverse scar or infection.

For those patients seeking a maximal effort in cheek slimming, buccinator myectomies can be considered as an additional treatment option along with buccal lipectomies and perioral liposuction.

Dr. Barry Eppley

Indianapolis, Indiana

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