Buccal Fat Pad Removal

Buccal fat pad removal is a cosmetic surgery where a portion of the buccal fat pad is removed to reduce prominent cheeks. This procedure is also referred to as buccal fat pad reduction, or cheek reduction surgery, since it is not advisable to remove the entire fat pad. The buccal fat pad is a distinct area of fat in the posterior region of the cheeks which is adjacent to where the molars are located in the mouth. The fat pad also extends into the temple region and below the central cheek to the pterygoid region (the back of the upper jaw). However, the central region is where the manipulation takes place. This area of fat is different from normal fat in regards to its consistency, or genetic makeup, as it is very fibrous and encapsulated. The buccal pad is located between the buccinator muscle and the superficial muscles of the face. Reducing the size of this buccal fat pad can provide slimmer cheeks and a better contour of the facial features.

Am I a Good Candidate for Buccal Fat Pad Removal?

A GOOD CANDIDATE for buccal fat pad removal is:

• Any patient with full, rounded cheeks who desires a slimmer facial appearance
• Patients who wish to have a bit more definition to the shape of the cheeks or a more chiseled look
• Any patient in reasonably good shape who desires to lessen the genetic predisposition of chubbiness occurring in the cheeks
• Patients who want more prominent cheek bones by reducing excess fat within the cheeks
• Any patient who has parents with fuller faces since this can be an indicator of what to expect with facial aging as time passes

Patients who are NOT GOOD CANDIDATES include:

• Patients with very full cheeks due to being overweight since this is not designed to be a weight loss procedure
• A patient whose parents have very gaunt faces since aging already causes a natural loss in volume and this procedure is not reversible
• Buccal fat pad removal does not remove parenthesis lines, lines around the lips or fat deposits in other parts of the cheeks so patients who are concerned about these issues need to explore other options

How is Buccal Fat Pad Removal Performed?

Prior to buccal fat pad removal, patients who smoke should stop at least one month before the surgery. Smoking increases the risks for any surgery and can hinder the healing process. Medications such as aspirin, Aleve, ibuprofen and Advil should be avoided two weeks before surgery since these drugs are known to thin the blood and increase bleeding risks. The surgeon may recommend an increase of protein intake, prior to the procedure, since protein can stimulate healing and collagen formation.

Buccal fat pad removal can be performed as an in-office procedure. The procedure only takes about one hour and is generally performed under local anesthesia, with sedation, by using an injection of lidocaine to numb the inner region. However, this procedure can also be performed in a surgical facility under general anesthesia. A small 2 or 3-cm incision is made on the inside lining of each cheek starting above the second upper molar at the back of the mouth and moving towards the gum. The fascia and fibers of the buccinator, or main cheek muscle, will be exposed. External pressure will be applied just below the cheekbone that causes the buccal fat pad to protrude through the incision.

The buccal fat pad is generally large like the size of a golf ball. Surgical tweezers, a laser or a radio wave device are used to remove a portion of the fat. A laser may also be used to seal the blood vessels to prevent excessive bleeding which can be problematic in this region. The remaining fat pad is repositioned back into its anatomic site. The incisions are closed with small dissolvable sutures. Since all incisions are made internally, there is no external scarring after the procedure. The surgeon may place gauze, soaked in an antibiotic, along the incision and/or wrap the patient’s head with a pressure dressing. Post-op instructions for removing or changing the gauze will be provided.

Combined with Other Procedures

This procedure can be done in conjunction with other treatments to provide an enhanced facial contour. While liposuction should never be used to reduce the buccal fat pad, liposuction can be performed in other regions of the cheeks to remove fatty deposits and provide a slimmer contour. Cheek reduction can also be performed with eyelid surgery, browlift, facial implants or a facelift surgery.

What is the Cost of Buccal Fat Pad Removal?

The cost can vary depending on several factors including the location of the facility, the experience of the surgeon and the type of anesthesia. If a patient chooses to have general anesthesia, the cost will be significantly greater since this will include an anesthesiologist fee and a surgical facility fee. Cheek reduction generally costs anywhere from $2000 to $5500. This cost may be significantly increased if the patient is having other procedures performed at the same time. Yet, this can also be cost efficient in the long run since there will only be one anesthesia and facility fee for multiple procedures.

Recovery and Downtime

RECOVERY from buccal fat pad removal is relatively quick since there are no external incisions. The patient can expect to feel some pain and discomfort which can easily be managed with pain medication. Bruising may occur in some instances but will fade over a few days. Since all patients heal at different rates, intraoral swelling can be more significant for some patients than others. Applying an ice pack to the exterior cheek can help to minimize the swelling and discomfort.

To help speed recovery, the patient should sleep with the head elevated so the cheeks are above the heart. Difficulty chewing is common but should lessen over a few days to a week. For the first 3 to 5 days, patients will be instructed to eat soft foods and rinse the mouth after each meal. Avoiding foods that are sharp or highly acidic, such as tomatoes and oranges, is recommended since these foods can irritate the incision. Numbness and a loss of sensation around the incision lines, jawline or central cheeks are common and typically subside on their own after a few weeks. Most patients can return to work after one week of DOWNTIME after buccal fat pad removal. Strenuous activities and contact sports should be avoided for approximately two months.

Results

While some results will be immediately noticeable, the results may not be as evident until most of the swelling is gone. The patient will have slimmer cheeks but some patients will see significant changes while others may only have minimal changes. The amount of changes can depend on the amount of fat removed. It can take several weeks for the swelling to completely dissipate but three months or more to see the final results. Scarring inside the mouth is not really an issue since the area is always moist and the moisture helps the scars heal quicker. If additional procedures are done in conjunction with the removal, the results could take longer to visualize due to the additional swelling and/or scarring. The results from buccal fat pad removal are permanent unless the patient puts on extra weight which could cause the cheeks to become chubby again.

Limitations of Buccal Fat Pad Removal

A big limitation of buccal fat pad removal is its own subtlety regarding the results. The procedure cannot provide a skinny face but can make a difference in the contour of the cheeks.

Risks of Buccal Fat Pad Removal

Some common risks include:

• Too much, or too little, fat removal
• Bleeding
• Infection
• Hematoma (a solid swelling of blood that becomes clotted in the tissues)
• Lumps in the cheeks
• Asymmetry
• Puckering of the skin on the cheeks
• Numbness
• Damage to the buccal branch of the facial nerve leading to a loss of taste or partial facial paralysis

Questions to Ask the Surgeon

Choosing a board-certified cosmetic surgeon who specializes in buccal fat pad removal, and has intimate knowledge of facial anatomy, can help to alleviate risks and provide a more successful outcome. Furthermore, the patient should ensure that the surgeon performs cheek reduction surgery often and with success. The patient should ask what type of anesthesia the surgeon will use during the surgery. Asking what is included in the cost of the surgery is always appropriate.

Written by Cosmetic Town Editorial Team – SP

Based on an exclusive interview by Dr. Sheila Nazarian in Beverly Hills, CA