Buccal Fat Removal or Bichectomia for Facial Sculpting - Houston, Texas

Buccal fat pad is a a singular structure that is composed of fat that is located in between the facial muscles. When this is enlarged, one may have the appearance of a cherubic face or "chubby face." Thus, its removal may enhance one's facial features, enhancing the zygomatic prominences which results in an inverted triangle of beauty, and reduce a rounded face appearance. Buccal fat removal reduces midface fullness and highlight the zygomatic prominence and the mandibular body.

Buccal fat removal can be removed by an intraoral incision (inside the mouth) or with the face lift procedure. It is a very common and routine procedure in Brazil.

Anatomy

The buccal fat pad is a rounded adipose structure that is surrounded by a thin capsule which is located in the middle third of the cheek. It is composed of three lobes: Anterior lobe, intermediate and posterior lobe.

Anatomically, the lower face contour is composed of four elements: the buccal fat pad, the masseter muscle, mandibular bone and the subcutaneous fat. Thus improving the facial contour of the face may involve buccal fat removal, debulking the masseter muscle with a neurotoxin, mandibular reduction, and/or facial liposuction.

Before & After Photo of Facial Sculpting performed by Dr. De La Cruz. It's a combination of procedures that included buccal fat removal.

Before and After of Facial Sculpting with Buccal Fat Removal and Masseter reduction with Xeomin.

Buccal Fat Removal: Procedure

Buccal fat removal can be performed via an intraoral approach or by a facial approach during a facelift procedure. According to the literature, the safest approach would be the intraoral route with very minimal complications.

The intraoral approach of buccal fat removal is "performed in the maxillary gingivobuccal sulcus or in the buccal mucosa at bite level." The buccal muscle is then dissected to expose the buccal fat pad. The buccal fat pad is then removed and excised. An absorbable suture is then used to close the wound.

What are the Potential Complications of Buccal Fat Removal?

Potential complications from buccal fat removal are parotid duct and facial nerve injuries. Studies have shown, however, no injuries of the parotid duct and facial nerve. Typically, your plastic surgeon would identify the parotid duct intraorally prior to incision to avoid any iatrogenic injuries to the parotid duct. Other potential complications include hematoma, trismus, infection, and asymmetry.

Contraindications of Buccal Fat Removal

This procedure is contraindicated for patients with hemifacial atrophy.

Is there any long-term effects of Buccal Fat Removal?

So far, there is no clinical studies that have demonstrated any long term sequelae of buccal fat removal. It has been theorized that when one has a history of buccal fat removal, severe weight loss may result in deep hollowness of the cheek.

References:

Lucas-Borin Moura, et al. Buccal fat pad removal to improve facial aesthetics: an established technique? Medicina Oral S.L 2018

Dubin, et al. Anatomy of the buccal fat pad and its clinical significance. Plastic Reconstructive Surgery 2001; 83:257-64

Matarasso. Buccal fat pad excision: Aesthetic improvement of the midface. Annals of plastic surgery. 1991;26: 413-38

Tapia, et al. Combined approach for facial contour restorationL treatment of malar and cheek areas during rhytidectomy. Plastic reconstructive Surgery. 2006; 118:491-7