Buccal Fat Pad Reduction

Some patients have a very round face due to a large fat pad. The buccal fat pad has multiple locations on the face: at the temple, pterygoid, and cheek levels. The correct treatment is fat pad reduction, not complete excision. Excessive reduction can result in a sunken face that is not beautiful, especially at older ages when fat atrophy naturally occurs.

The suitable patient for this procedure is someone with a heavy round face, heavy cheeks, and an abnormal ratio between the cheeks and the rest of the face. It is usually a hereditary problem. Liposuction of these deep fat deposits is a risky procedure that I do not recommend, due to the increased risk of traumatizing important nearby structures such as facial nerve branches, the parotid gland duct, and the facial vein.

The fat pad at the cheek level is reduced through an intervention inside the cheek where a small incision is made at the mucosa level, after which penetration occurs through the interior of the buccinator muscle inside the cheek, and immediately behind the muscle the fat is found. The amount of fat is evaluated preoperatively; usually the reduction is done conservatively – the entire amount of fat is never excised. The incision is sutured with absorbable sutures. Usually the intervention is performed under local anesthesia enhanced with sedation.

Generally, recovery is 3-5 days; some patients swell significantly while others less so. The final result can be evaluated at 3 months postoperatively when the edema has completely subsided and the scar has matured. Generally, the procedure will result in a slimmer face laterally from the nasal wing to the corner of the mouth. Usually the procedure takes 1 hour and can be performed simultaneously with other procedures such as facelift, facial liposuction, or facial implants.