There is a particular subset of patients who come in and are asking for slimming in the lower part of their face. They feel that they have chubby cheeks and like the look when they suck their cheeks in or they place contour makeup in that area to make their face appear slimmer. In more severe cases, patients note that they bite down inside their cheeks and this causes discomfort, swelling and continued pain. For these patients, it may be appropriate to perform a buccal fat pad removal in order to remove some of the fat within the cheeks and create a more contoured, sultry look.
Classically, in more attractive faces, a face appears almost like a heart shape, or an upside-down triangle, with the cheekbones being the widest part and then slimming down to taper towards the jaw bone. When someone has excess buccal fat pads, this might create an inverted triangle where the patient is wider along the lower part of their face versus the upper part of their face. In other cases, the buccal fat pads can cause heavy jowling, where people feel like they have a heavy jawline even though they are relatively young as in their twenties and thirties. In our more mature patients, excess buccal fat pad can contribute to significant jowling, and buccal fat pad removal can be done at the same time as a facelift.
There is some controversy surrounding this procedure because when you do your research online you can see that some doctors do not recommend this procedure at all. They state that although you may look good in your younger years, as you get older you will have a more gaunt appearance, making you look older. My argument against this is that in the carefully selected patient, buccal fat pad removal can look great. You can have a look that you really like for at least 20 to 30 years, and if your cheeks become more hollowed as you get older, you can always replace the fat with a fat transfer. Obviously, it is difficult to tell the future in everybody, and in most cases I bet people do not even need to put extra fat there because of excessive buccal fat pad removal.
Going along with this, it is very important that you choose your specialist very carefully in performing buccal fat pad removal. A trained specialist knows how much to remove and avoids complications that can occur. The procedure is usually performed under local anesthetic. Sometimes we give our patients a medicine to relax, to make them feel better, and the incisions are made inside the mouth after being numbed really well with both numbing cream as well as a little injection. An incision is made in the cheek underneath the salivary duct, going through the mucosa of the inside of the mouth, followed by the buccinator muscle. Once we get through the muscle layer, the buccal fat pad presents itself for removal. I am not overly aggressive when I remove buccal fat pads and just remove what comes out of the cheek. The facial nerve, which control movements of the face, including puffing out your cheeks and smiling, is in this area, so it important not to dig in the wound in order to prevent injury to the nerve. Fortunately, most injuries to the nerve are temporary, but again, even having a temporary weakness can be noticeable for several months. Once the fat pad is removed, the incision is closed using an absorbable suture, which heals in about a week. There is minimal downtime and minimal to no bruising. Most patients look like they have slightly chubbier cheeks for approximately three to five days, but it is usually not noticeable to other people. Afterwards, the results will continue to improve themselves over several months for a nice, gradual contouring and increased definition. Postoperative care usually just involves swishing some water in your mouth after eating to avoid any particles from settling inside the incision.
Finally, we sometimes combine neck and jawline liposuction with the buccal fat pad removal. This happens if someone has excess fat in their neck or some jowling along the jawline. We have an example of a before and after picture of someone who had both buccal fat pad removal and liposuction to show a slimmer lower third of the face, which makes someone look more attractive.
If you are considering this procedure, please call our office at (310) 772-2866 to find out more information and to schedule your consultation.