Overview of Buccal Fat Pad Reduction
The buccal fat pad, otherwise known as Bichat’s fat pad, is a crucial part of our face’s structure. It’s what makes our faces look the way they do, and it also helps our facial muscles move. Picture the buccal fat pad as a layer of soft, squishy tissue that sits inside our cheeks.
Scientists have done a lot of research on how the buccal fat pad can be used in medical procedures to fix damaged or injured parts of the mouth. In some cases, it can even be used as a ‘graft,’ which is a piece of healthy tissue that is moved from one part of the body to another to help heal a wound.
But the buccal fat pad isn’t just important from a medical point of view – it can also play a big role in how we look. In some cases, doctors can adjust or remove the buccal fat pad to change the shape of a person’s face, making their cheekbones look more prominent.
The following details will help you understand about the buccal fat pad’s structure and role, why and how it might be removed to change a person’s appearance, and what risks or problems might arise from this procedure.
Anatomy and Physiology of Buccal Fat Pad Reduction
The buccal fat pad, located in your cheeks, has been a topic of interest for researchers for hundreds of years. In babies, it’s particularly prominent and helps them suckle. As children grow and start to chew food, the buccal fat pad assists in the movement of the chewing muscles. It also acts like a cushion, protecting essential structures, like blood vessels and nerves, from damage. Interestingly, it plays a key role in shaping the appearance of your face too! This ‘suckling-supporting’ structure was first precisely described by a scientist named Bichat in 1802, and in some parts of the world, it’s often called Bichat’s fat pad.
The buccal fat pad is embedded between two muscles in your cheeks – one is the masseter, another is the buccinator. On average, it varies from roughly 7.8 to 11.2 milliliters in volume for males and 7.2 to 10.8 milliliters for females. Up to the age of 20, it grows significantly and then starts to shrink over the next 30 years. This fat pad is closely linked to certain nervous and muscular structures of your face. Knowing about it in detail helps doctors to safely work with it during cosmetic and reconstructive surgeries.
Technically, the buccal fat pad consists of three separate parts, or ‘lobes’ – the anterior (the front), the intermediate (the middle), and the posterior (the back). Each of these lobes is surrounded by a distinct membrane, and all are anchored in place by ligaments. These ligaments also provide a passage for blood vessels, ensuring a rich blood supply to all parts of the fat pad.
The anterior lobe, a triangle-shaped mass, lies below the zygoma, a bone in your cheek. It extends upwards, with one end reaching up to the lower edge of a muscle near your eye. Another endpoint reaches the front border of the buccinator muscle and meets another cheek muscle. This lobe surrounds certain blood vessels and nerves and includes the facial veins and ducts. The intermediate lobe lies close to the centers of your upper jaw bones and connects the front and back lobes. In adults, it’s thinner and mostly made up of fat tissue and isn’t always identifiable.
The posterior lobe of the fat pad, the largest of them all, is surrounded by chewing muscles. It is made up of four extensions: the buccal, pterygoid, pterygopalatine, and temporal extensions. The buccal extension is the most superficial, lying below a duct in your cheek, and it is usually the portion removed during buccal fat pad reduction surgery.
Overall, these fat pads are necessary for essential functions; they support chewing and protect delicate structures in our face. Understanding these pads allows doctors to perform various facial procedures with more precision and safety.
Why do People Need Buccal Fat Pad Reduction
The buccal fat pad, a chunk of fat located in your cheek, can be treated or removed for different reasons. For instance, the buccal fat pad can be used to close up an “oroantral communication,” which is an unexpected connection between your mouth and a nearby sinus behind your cheek. This connection can happen for several reasons, like dental procedures, infections, injury, or radiation therapy.
Small oronatral communications, those less than 2 millimeters, often heal on their own; if the hole is greater than 3 to 4 millimeters, it may require a surgical procedure to seal it. One way to close this hole is by using the buccal fat pad.
Another reason to deal with the buccal fat pad may be for cosmetic purposes, particularly to adjust the shape of a person’s face. A surgery to remove the buccal fat pad can help diminish full cheeks and accentuate the cheekbones. This procedure is especially suitable for people with prominent cheekbones hidden by full cheeks, thus giving the face a more angular look.
However, if a person has flat or underdeveloped cheekbones, known medically as malar hypoplasia, removing the buccal fat pad can cause their cheeks to appear hollow. Thus, it’s worth noting that buccal fat pad removal is not a fitting alternative for bringing out or augmenting underdeveloped cheekbones.
How is Buccal Fat Pad Reduction performed
The safest way to access and remove the cheek fat pad (also known as the buccal fat pad) for facial enhancements involves going through the mouth. The Stenson duct is an important structure that needs to be identified first. This duct opens into your mouth from your parotid gland, which is a large saliva gland found near your ears.
The process begins by making a small cut either above the duct, in the upper part of your mouth, or below the duct at about the level where your teeth meet when you bite. This gives the surgeon access to the part of the buccal fat pad nearest the back of your mouth. The cheek fat pad can be accessed either below or above the Stenson’s duct, depending on what is needed for the facial changes being made.
At the Oral and Maxillofacial Surgery Program at Madigan Army Medical Center, they typically choose to access the fat pad below the Stenson’s duct. A device called a Minnesota Retractor is used to pull back the cheek, making the area easier to work on. Then, a local anesthetic (numbing medicine) is applied to the inside of your cheek.
After the Stenson’s duct has been properly identified, a small 1.5 cm horizontal cut is made in the inner layer of your cheek. This cut is made half-way between the level where your teeth meet when you bite and the Stenson’s duct. When this cut is made, the surgeon’s other hand is used on the outside of your cheek to put pressure on the buccal fat pad which helps move it towards the mouth. A tool called hemostats are then used to gently separate the muscle and access the buccal fat pad.
Once the narrow space inside your cheek has been accessed, the yellow fat pad is exposed. The surgeon then gently pulls out about 3 to 5 cc (small amount) of the fat pad from the cheek area. Hemostats are then used to hold the fat pad and the inner skin layer of the cheek together, while a tool called a 15-blade or surgical scissors is used to cut the fat pad away. The skin inside the mouth is then stitched back together with 2 absorbable sutures that will dissolve over time.
It’s important to note that the buccal fat pad shouldn’t be forcefully pulled on during removal. Only the portion of fat that easily comes out into the oral cavity should be removed.
Possible Complications of Buccal Fat Pad Reduction
Getting your buccal fat pad reduced — which basically means removing the fat from your cheeks — is usually a safe and straightforward procedure. However, like any surgery, there may be rare complications. The reason for this is that the buccal fat pad is located close to various vital structures such as blood vessels, a facial nerve and the parotid duct, which is a canal that saliva passes through. Putting these structures at risk can lead to complications for about 8.45% to 18% of surgery patients, including injury to the parotid duct, blood clots (hematoma), jaw muscle spasm (trismus), loss of muscle function (neuromotor deficits), and infection.
One example of a complication mentioned in The Journal of Craniofacial Surgery involves a patient who went to the emergency department with unevenness in their face five days after their surgery. They were initially treated for an infection, but then more swelling and pain occurred. On further investigation, doctors found that saliva was building up in the patient’s cheek because their Stenson duct had been accidentally damaged during the surgery. The patient had to stay in hospital for an additional week where they were given conservative therapy (which means the least invasive treatment possible), and had to have the built-up saliva drained from their cheek multiple times. However, their saliva flow returned to normal and they were discharged from the hospital.
Another example in the same journal report involved a patient who had severe facial pain and swelling just hours after their buccal fat pad was removed. There was also significant bruising in and around the eyes. It turned out that the sphenopalatine artery (a blood vessel in the face) was bleeding. Despite attempts to stop the bleeding and find and tie off the artery, they were unsuccessful. The patient was urgently taken back to the operating room, where doctors used a method called angiographic embolization to stop the bleeding. This severe bleeding complication is rare, and can be caused by either pulling too hard on a blood vessel or going too deep into the oral space during surgery.
Knowing the area around the buccal fat pad and how it relates to the vital structures of your face is key to minimizing complications related to buccal fat pad reduction. Clear communication with your surgeon about what can happen during and after the procedure is also absolutely critical. Remember that even with the best surgical technique, the close proximity of the buccal fat pad to these vital structures means that complications can happen.
What Else Should I Know About Buccal Fat Pad Reduction?
Buccal fat pad removal is a small cosmetic surgery often performed alongside larger procedures. This operation aims to make the face look slimmer and improve the appearance of the upper part of the cheeks. It’s particularly used to lessen the fullness under the cheekbones, giving a more defined look to the face.
