What it means for a patient
- If buccal fat sags into the lower face, it can be trimmed and lifted during a deep-plane facelift, instead of through the mouth.
- The amount removed was small, 1.5-2.5 cc per side, and no patient had excess hollowing in this series.
- Nerve problems occurred in 3 of 68 patients and were temporary.
- Limits: one surgeon, retrospective, follow-up of 8 months at most, and no comparison group. Contour improvement was not measured on a stated scale.
Why this paper matters
It describes a way to treat buccal fat prolapse during a deep-plane facelift and reports its complication rates. The authors suggest it may reduce recurrence of jowls, which this short follow-up cannot confirm.
Overview
Buccal fat is commonly removed through the mouth. The authors describe treating it during a deep-plane facelift instead, where prolapsed buccal fat can be seen directly. This retrospective series covers 68 patients aged 45-64 treated by one surgeon from February 2023 to September 2024, with follow-up up to 8 months.
Findings
- 68 patients aged 45-64 years; one surgeon.
- Patients with prior hyaluronic filler, thread lift or microneedling radiofrequency were included; those with permanent filler were excluded.
- Buccal fat prolapse was seen directly during the facelift dissection.
- Partial excision of 1.5-2.5 cc per side, then suspension of the remaining fat to the SMAS when indicated.
- All patients showed improved lower face and jowl contour.
- Hematoma: 3 (4.4%).
- Transient buccal nerve paresis: 1 (1.5%).
- Transient marginal mandibular nerve injury: 2 (2.9%).
- No long-term adverse effects or excessive hollowing.
- Level of evidence: IV.
Terms
- Buccal fat pad: a deep fat pad in the cheek.
- Buccal fat prolapse: buccal fat that has slid down or bulged out of its usual place.
- Deep-plane facelift: a facelift that lifts the skin and the deeper SMAS layer together.
- SMAS: the superficial musculoaponeurotic system, a fibrous and muscle layer under the facial fat.
- Jowls: sagging tissue along the jawline beside the chin.
- Paresis: partial weakness of a muscle.
- Marginal mandibular nerve: the facial nerve branch that moves the lower lip.