Buccal Fat Pad Excision: Proceed with Caution

Abstract

Background:Buccal fat pad excision is offered as a means of obtaining a more aesthetic midface. This procedure has been documented in the form of countless videos on Instagram and other social media platforms with no long-term patient follow-up. We performed a retrospective analysis of published data regarding buccal fat pad excision and sought to better elucidate pitfalls regarding this underreported procedure.Methods:A literature search was conducted in October 2017 through the PUBMED database regarding the utility of buccal fat pad excision in the setting of aesthetic improvement of the midface. Reference articles were screened to obtain relevant studies. A total of 121 citations were identified in the search but after eliminating duplicate studies and abstracts and utilizing predefined inclusion/exclusion criteria only 11 articles were satisfactory. None of these articles demonstrated any long-term patient follow-up.Results:Out of the 121 relevant citations identified, only 2 studies published describe a case series of > 5 patients regarding cheek or midface sculpturing with buccal fat pad excision for aesthetic purposes, the total sample size between these 2 studies was 53 patients. Neither of the studies had follow-up regarding patient satisfaction or related outcomes.Conclusions:Buccal fat pad resection as an aesthetic improvement of the midface has been described, but follow-up regarding loss of subcutaneous fat with aging and late secondary deformities have not been published in the literature. Further research in long-term patient follow-up including patient satisfaction and the encouragement of reporting postoperative complications is warranted.

Buccal fat pad excision for cheek refinement: A systematic review

“…After applying the study criteria, 27 publications were excluded because of other associated surgical procedures ( 9 - 12 ), other therapeutic applications of BFP ( 2 , 13 - 15 ), technical notes ( 4 , 16 - 24 ), studies with less than 10 patients ( 7 , 25 ), case report ( 26 , 27 ), article reviews ( 28 - 30 ), and absence of the outcomes of interest ( 31 , 32 ), respectively.…”

“…Indeed, as BFP involutes with age, its removal may accentuate the appearance of low-lying jowls and expedites facial deformations commonly associated with ageing. Hence, additional procedures such as autologous fat grafts and scaffold injections might be needed in order to rejuvenate the face ( 30 ). Due to their limited follow-up, none of the included studies evaluated those features.…”

“…Based on the observations of 19 total hemiface dissections, Hwang et al . ( 37 ), concluded that because of the presence of anatomical variations, there is a 26.3% chance of injury to the aforementioned structures during the complete removal of the BFP, which may lead to negative consequences ranging from food having a metallic taste, ptosis, and/or tinging or numbness in the face, jaw, or neck ( 30 ). Furthermore, it has to be taken into account that since most of the procedures were carried out by experienced clinicians, caution is recommended when extrapolating the results to other clinical scenarios such as general practice.…”

Management of Complications Related to Removal of the Buccal Fat Pad

“…Thus, a complete reding was done and 9 articles was included in the final review. There were 5 papers with case reports and case series, associated or not with a literature review, 9,11–14 2 clinical trials, 15,16 1 retrospective study, 17 and 1 systematic review without meta-analyzes 7 …”

“…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 …”