The blood supply from the BFP comes from branches of the internal maxillary, superficial temporal, and facial arteries. This complication may be associated with deep dissection of the oral space or a vascular avulsion injury from traction on the BFP. If local measures such as compression and blood vessel suture fail to achieve hemostasis, other methods to stop bleeding should be adopted immediately to prevent further severe complications that can be life-threatening. 13,14 Careful removal of this structure should be performed with precise indication for its removal. 21 Although bichectomy is being widely performed on a clinical basis, there are not enough long-term follow-up studies that can evaluate the effect in facial aging, function, and report complications. 22 A retrospective study analyzed data regarding buccal fat pad excision highlights the importance of long-term patient follow up to access information about satisfaction level and postoperative complication. 17 A recent systematic review evaluated eight articles in order to identify the indications, complication types and rates, surgical techniques, and outcomes, all of it achieved a high risk of bias, and none of them were retrospective or prospective clinical trials. 7 CONCLUSIONComplications need to be prevented, and knowledge is required for the management and treatment of these complications.

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