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The buccal lipectomy is a well known cheek reductive contouring procedure. For those patients with fuller cheeks and rounder faces, it is an obvious target to create some facial slimming effects. Done through several intraoral incisional options, it is easy to access underneath the buccinator muscle. What can be removed can be impressive but, given its deep location in the midface, it is not possible to tell how much volume needs to be removed and how much fat pad volume remains.

In the June 2019 issue of the Aesthetic Surgery Journal an article was published entitled ‘The Excision of the Buccal Fat Pad for Cheek Refinement: Volumetric Considerations’. In this paper the authors compared before and after surgery ultrasound studies of the buccal fat pad to determine how much reduction was obtained with the buccal lipectomy procedure. Transbuccal ultrasounds were done before and six months after the procedure. The ultrasounds showed that the mean preoperative volume was around 11.5 ml (+/- 1.4 ml) and the mean after surgery volume was around 8.5 ml. (+/- 1.4 ml) The mean volume of the removed fat pads was 2.7 ml. (+/- 0.7 ml)

The authors conclude that the buccal lipectomy procedure is an effective procedure at improving the cheek silhouette in those patients who have large buccal fat pads. They recommend removal of only the excessive  portion of the fat pad.

This is the first study that has ever evaluated the before and after volumes from the buccal lipectomy procedure. The volumes reported are consistent with what I have measured in the many buccal lipectomy specimens I have removed (3 to 5 mls in volume) It is not clear to me how one would know what the ‘excessive’ volume of the buccal fat pad would be in any patient. But it suggests that what one removes is what comes out easy without undue effort and not to chase it deep into the buccal fat pad cavity.

What is most interesting to me about this study is the sheer volume of the buccal fat pad which is around 12mls. That is probably bigger than most would think it is. But being able to only remove 3 to 5mls indicates that a subtotal buccal lipectomy is always performed no matter how ‘aggressive’ one may think they are being.

The other important anatomic issue with cheek contouring by buccal lipectomy is that the buccal fat does not extend down as low as many patients and surgeons think. While it is called in this article a lower cheek contouring procedure, patients often expect the procedure to create a slimming effect down past the oral commissure level. This is not as low as the buccal fat pad extends, rather this is a separate subcutaneous fat layer known as the perioral mounds. And if you get low enough it becomes the jowls.

Dr. Barry Eppley

Indianapolis, Indiana

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