Soft tissue cheek reduction is most commonly associated with the well known buccal lipectomy procedure. Through an intraoral incision in the maxillary vestibule, the encapsulated buccal fat pas is accessed by passing through the upper fibers of the buccinator muscle. Once inside its capsule, the main body of the buccal fat pad is extracted after cauterizing its pedicle base. Typical volumes per fat pad are in the 3 to 6cc range for most patients.
While the buccal lipectomy procedure removes the largest single collection of fat in the face, it is not the only defatting procedure available. Small cannula liposuction can also be done in the lower cheek area known as perioral mound liposuction. This far less recognized cheek contouring procedure removes a smaller amount of fat (1 to 2ccs) than that of the buccal lipectomy. But it also targets a cheek area for reduction that the buccal lipectomy does not affect.
The combination of buccal lipectomy and perioral liposuction provides a dual approach that maximizes the amount of fat that can be reduced from the face to create a slimmer cheek appearance. But there remains a third and final soft tissue cheek contouring procedure…the buccinator mucosalmyectomy. (BMM)
Lying directly opposite and underneath the perioral mound area is its intraoral equivalent which consists of mucosa, fat and muscle, specifically the horizontal fibers of the buccinator muscle. Using a transcutaneous needle to identify the intraoral exact location of the overlying central perioral mound area a horizontal ellipse of mucosa is marked out just inside the corner of the mouth and staying below the parotid duct. The mucosa is excised full thickness removing a small central strip of the buccinator muscle with it.
The mucosa is then closed with a single layer of resorbable suture. This adds to the overlying perioral liposuction effect and pulls the lower cheek a little further inward.
The buccinator muscle originates from the alveolar processes of the upper and lower jaw and extends horizontally to converge near the mouth corners. As the horizontal fibers get close to the corner of the mouth the fibers start to overlap (superior and inferior overlap the central fibers) and it thickens the muscular layer. By removing the thick mucosa and its attached fat with a small amount of the buccinator muscle (not full thickness), the area of the cheeks at the level of the mouth moves more inward. This is a complementary effect to that of the perioral liposuction.
Because only a small amount of buccinator muscle it causes no muscular dysfunction or deficit. By adding this small procedure to that of buccal lipectomy and perioral liposuction, a triple approach to soft tissue cheek contouring is done which achyves the maximal effect possible.
Dr. Barry Eppley