Buccal Fat Removal

Conveniently located to serve the areas of Beverly Hills, CA

Volume in the right areas on a man or woman’s face can make one look younger and/or beautiful.  In other areas, such as the jowl or lower cheek, it can make on look older or overweight.  The redistribution of fat in one’s face is truly an art, since it essentially can reshape entire faces from an aged or imbalanced configuration to youthful and balanced.

Before and After Photos

In some people, there is a preponderance of fat in the buccal space, located just lateral to the corner of the mouth.   This pudginess is often referred to “chuby cheeks” or “chipmunk cheeks”.  The buccal lipectomy procedure, especially when combined with facial fat transfer, can powerfully reshape the face into a younger or more attractive image by slimming this area of the face.  Doing so also generates more prominence of the cheek bone to create more angular facial features such as those seen in the beautiful young men and women that grace fashion runways.

Anatomy of the Buccal Space

The buccal space contains a fat pad called “Bichat’s fat pad”, and is located between several facial muscles.  It also surrounds the parotid duct, which is an exit for secretions into the mouth that aid in eating.   

It is important to not confuse the buccal fat pad with either the malar fat pad which sits above the buccal space and jowls which sit below the buccal space.  All three of these areas of the face are important regions to address when contouring the face, but they all play different roles in facial aesthetics.   

The malar fat pad contributes to the high cheeks that are deemed youthful.  The malar pads deflate and fall with age.  Many face lift techniques serve to lift this pad, but even lifting almost always does not completely restore prior youth.  The addition of fat to the malar with or without lift will greatly reverse the signs of aging.  With a buccal lipectomy, the molar fat pad and cheek bone become more pronounced.  Thus, subtracting from the buccal space and adding to the malar can synergistically improve the appearance and balance the face.

Jowls are a dreaded sign of aging. Jowls represent the descent of fat and skin below the jawline along with the loss of volume along the mandible. Buccal lipectomy does not influence this region.  Jowl correction can be performed with conservative liposuction of the jowl, face lift, thread lift, or fillers.  

The Buccal Lipectomy Procedure

A buccal lipectomy can be performed under local or general anesthesia is most often combined with other facial remodeling procedures such as rhinoplasty, chin augmentation, and facial fat transfer.

Local anesthesia is injected into the mucosa inside the mouth where the tissue will be incised.  The incision will run approximately 1.0 to 1.5 cm just above and behind the parotid duct. The buccal space will be entered bluntly with an instrument to spread tissue.  The encapsulated buccal fat pat once identified will be freed up from the encapsulation of tissue and gently removed through the incision.  No sharp instruments  enter the buccal space to ensure no nerve or duct injury.  The amount of fat removed depends on the desired outcome.  Of note, generally not all of the fat is removed.  The removal of too much fat can hollow one out.   The procedure lasts anywhere from fifteen minutes to forty minutes.  

Once the fat is removed, the incision is closed with a dissolvable stitch. No external dressings 

Recovery

There is some swelling that can persist for a few weeks following a buccal lipectomy.  The final result may not be apparent for six weeks.  For three days following the procedure, patients should eat only soft foods and rinse their mouth with antiseptic two to three times a day.

The stitches inside the mouth will dissolve within a few weeks.  On rare occasion, swelling may cause temporary blockage of the parotid duct and lead to swelling.  Less common that this is infection.  Nerve injury and duct injury in experienced hands is exceptionally uncommon using the techniques described here.

FAQ


What is a buccal fat removal?

Yes. In patients who can tolerate keeping their mouth open and being completely still, the procedure can be performed with the patient awake. Topical and local anesthetic agents will be used to assure a pain free surgery.


How large are the incisions?

The incision is about 1.5 cm in length.


Where are the incisions made?

The incisions are made within the mouth, just behind the parotid duct which you may be able to feel with your tongue. The duct sits just outside the 2nd upper molar. The incision may be made either above or below the duct. Sometimes, it may be made both under and over the duct if the encapsulated mass is too difficult to free with one approach.


How much fat is removed?

For most people, a substantial portion of fat is removed — but not the entire wad. Removing the entire buccal fat pad may render the cheek too hollow.


I’ve read that some doctors don’t like doing it because it can make you look older. Is that true?

Plastic surgery involves proper diagnosis, just like any other medical field. In the appropriate patient with the appropriate amount of fat removal, the results are striking. If too much fat is removed (and in the wrong person), the results can make the face look too gaunt or older. However, because patient selection is key to a successful outcome, be certain to go to an experienced board certified plastic surgeon for this procedure.


Is it safe?

In skilled hands, buccal fat extraction is one of the safest surgeries performed. If the anatomy is familiar as it should be to a qualified board certified plastic surgeon, then the risks of parotid duct injury or nerve injury are exceptionally rare.


Can you describe how it is done?

About 3 cc of lidocaine with epinephrine is injected into the mucosa of the mouth about 1.5 cm behind and above the parotid duct. A 1.5 incision is made with a needle tip electrocautery device and the mucosa and buccinator muscle are entered. From here, no sharp instruments enter the buccal space — this is to protect one from nerve injury or duct injury. Then, the tissue is spread until the capsule is identified and opened. The buccal fat at this point will either erupt through the incision or it will be slowly teased out. An estimated amount is mobilized into the mouth without yet removing it, then the same procedure is performed on the other side. Again, a portion of the fat pad is mobilized into the mouth. In this fashion, the results of such a removal can be determined before actually excising the fat. The face is then examined in multiple angles to now determine how much of this mobilized fat will be removed and how much of it will remain. Once this is determined the fat is cauterized to remove the proper amount and the incisions are closed with dissolvable stitches.


What is the downtime?

Most people will develop some swelling in the cheeks for up to 10 days. After this, minor residual swelling may persist for a few weeks. By 6 weeks, the cheeks should noticeable slimmer.


What is the cost?

The cost ranges from $4,500 and up depending on the type of anesthesia and whether or not other surgeries are combined.


How do I know if I am a candidate?

Dr. Neavin can often tell by photos if a physical exam in prohibitive based on location. The buccal fat generally feels like a sponge, or Tempur-Pedic mattress.


Why do you sometimes do fat transfer when you are taking fat out?

Beautiful faces are about harmony. Both addition and subtraction of volume are important in many cases to harmonize the face.

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