How Dr. Harmon Minimizes Risks and Maximizes the Benefits of Buccal Fat Removal

Media coverage suggests there is a recent trend among actors presenting with newly hollowed cheeks. While pure speculation, many of these individuals may have undergone surgery to remove their buccal fat. Whether they underwent buccal fat removal surgery or not, they often appear unnatural and gaunt.

Buccal Fat Removal Side Effects: Why Some Results Look Hollow

The appearance of hollow cheeks is likely due to either:

• Too much fat being removed. This risk can be mitigated by utilizing a gentle technique that inherently limits what can be removed. This technique also limits the already very low chances of damage to nearby structures (discussed below).
• Removing fat in individuals who have narrow cheeks already. This risk can be minimized with more careful consultation with the patient and a physical exam.

Is Buccal Fat Pad Removal Safe? Understanding the Real Risks

Dr. Jeffrey Harmon performs buccal fat removal surgery to reduce fullness in the cheeks of individuals who have a more rounded, cherubic appearance to their face due to the size of their buccal fat. This procedure can be performed without general anesthesia or even IV sedation. Moreover, the procedure is minimally invasive, with small incisions hidden in the mouth. As a result, there is widespread belief that there is effectively no risk to the procedure. But while risks are low, they do exist.

Why Surgical Expertise Matters in Preventing Side Effects of Buccal Fat Removal

It is important to seek the expertise of a qualified, experienced physician who is a fellowship-trained, double board-certified facial plastic surgeon to perform buccal fat removal surgery. This is because:

• There are important anatomic structures near the buccal fat.
• Long-term aesthetic changes to the face associated with age should be considered when performing buccal fat removal surgery.

Critical Anatomy Involved in Buccal Fat Removal Surgery

The three (3) major anatomic structures located within the space that houses the buccal fat are:

1. Three (3) branches of the maxillary artery – the buccal fat has a very robust blood supply that needs to be accounted for when removing it. This is why some kind of cautery is necessary when performing buccal fat removal surgery.
2. Parotid duct – the parotid duct is a large saliva-producing gland in the cheeks. A duct exits the gland, travelling through the buccal fat for a short distance before diving deeper to open in the inner lining of the cheeks near where the teeth meet when they contact. The opening of the parotid duct into the cheek is marked and avoided during surgery.
3. Buccal branches of the facial nerve – the facial nerve branches from its origin in the face near the bottom of the ear and spreads out across the face and neck. The buccal branches cross the buccal fat close to its outside edge. This means, when the buccal fat is accessed on the deep side from the inner lining of the cheek in the mouth, that the nerve branches sit farther away from the incision.

How Dr. Harmon Minimizes Buccal Fat Pad Removal Side Effects

Ways to minimize the risk of damaging these structures include:

1. Gentle dissection using a blunt instrument rather than sharp cutting.
2. Marking the approximate path of the parotid duct and its opening into the cheek. Surgery can then be performed above or below this line.
3. Gently easing the buccal fat out of the incision with external pressure and minimal pulling. The fat usually “gives itself” rather than being forced out like a magician pulling scarves from a shirt pocket.
4. Limited bipolar electrocautery to cauterize the rich bed of small blood vessels without spraying electric energy and heat, which can bed achieved using a device that looks like tweezers to limit the focus of energy used to cauterize blood vessels.

Buccal Fat Removal Long-Term Side Effects: What Happens Over Time?

A common question patients pose is what the long-term effects of buccal fat removal surgery are. There are three (3) schools of thought:

1. The buccal fat tends to increase in size with age.
2. The buccal fat tends to decrease in size with age.
3. The buccal fat remains the same size with age.

The explanation tends to elicit laughs, understandably so. It speaks to the fact that we do not really know. It does suggest, however, a conservative approach that still provides natural-appearing results that are noticeable is the best approach. Furthermore, a conservative approach to buccal fat removal could account for any changes in the buccal fat that remains – and some does remain – over time.

How Aging and Volume Loss Affect Buccal Fat Removal Results

What we know does change is the fat in the more superficial compartments of the face. And it is the relative appearance of the cheeks when the surrounding fat falls and sometimes shrinks that can make the face appear gaunter. Solutions to falling superficial tissue include deep plane facelift surgery. Solutions for loss of superficial volume in the face include fillers and fat grafting.

Speak With Dr. Harmon About Buccal Fat Removal Side Effects

In summary, buccal fat removal surgery is a safe, effective procedure for patients who have large fat pads in this space contributing to a rounded, cherubic appearance. However, not all people are good candidates. And, for those patients who are good candidates, we do not know for certain what will happen to the remaining buccal fat over many decades. This suggests a gentle approach that does not remove all the fat is warranted, both to minimize the risks to the procedure and to maximize aesthetics. We do know that future procedures may be beneficial to restore the position and volume in more superficial compartments of the face, which could preserve and/or restore the aesthetics of buccal fat removal surgery.