Buccal Fat Pad Excision: Proceed with Caution

PURPOSE:

Buccal fat pad excision is often offered by many practioners as a means of obtaining a more aesthetic or congruent midface. This procedure is often performed by non-board certified physicians and 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 regard this underreported plastics procedure in the literature. 

METHODS:

A literature search was conducted in October 2017 through the PUBMED database for articles regarding the utility of buccal fat pad excision in the setting of aesthetic improvement of the midface. Reference articles were screened manually to obtain relevant studies. A total of 121 citations were identified in the original 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 in our search, 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 two studies was 53 patients. Neither of the two studies had long term follow up regarding patient satisfaction or related outcomes.  

CONCLUSIONS/SIGNIFICANCE:

Buccal fat pad resection as an aesthetic improvement of the midface has traditionally been described but follow up regarding loss of subcutaneous fat with aging (or cheek hollowing) and late secondary deformities have not been published in the literature.  Further research in long term patient follow up postoperatively including patient satisfaction rates and the encouragement of reporting postoperative complications is warranted.

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3. Ian T. Jackson, MD; Buccal Fat Pad Removal, Aesthetic Surgery Journal, Volume 23, Issue 6, 1 November 2003, Pages 484–485.

4. Xiao H, Bayramicli M, Jackson IT. Volumetric analysis of the buccal fat pad. Eur J Plast Surg, 1999; 22: 177-181.

5. Guerrerosantos J and A. Manjarrez-Cortes. Cheek and neck sculpturing:simultaneous buccal fat pad removal and subcutaneous cheek and neck lipoplasty. Clin Plast Surg, 1989;16(2) 343-353.