Introduction:
The buccal fat pad is a structure in the face that helps with facial movement and appearance. It has been studied for use in repairing oral defects and injuries, and it can also be used to improve facial contour. Removing the buccal fat pad can enhance the shape of the cheekbones and the overall contour of the face. Still, it is important to understand this procedure's anatomy and potential complications.
What Are the Important Anatomy and Physiology Involved in Cheek Reduction and Enhancement?
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The buccal fat pad has been studied for centuries due to its complex nature and various functions. In infants, it is important for breastfeeding, and in older children and adults, it helps with chewing and protects neurovascular structures. It also contributes to facial aesthetics for all ages.
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The buccal fat pad, also known as Bichat's fat pad, is a structure in the face that anatomists have extensively studied for centuries. It was first described by Bichat in 1802 and is located in the cheek area, near the masseter and buccinator muscles. The volume of the buccal fat pad varies between individuals, with an average thickness of 6 millimeters and a volume of 7 to 11 milliliters for males and 7 to 10.8 milliliters for females. It grows significantly during adolescence and then decreases in size with age. The buccal fat pad is complex and closely related to the facial nerve, parotid duct, and chewing muscles. Understanding its anatomy is important for safely performing aesthetic and reconstructive procedures.
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Various anatomists have described the structure of the buccal fat pad since Bichat first identified it. It is generally described as having a central body with four extensions or three lobes. In 2001, Zhang studied cadavers and determined that the buccal fat pad has three separate lobes: the anterior, intermediate, and posterior. The posterior lobe is divided into the temporal, pterygoid, pterygopalatine, and buccal extensions.
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The buccal fat pad is seen in the cheek area and is surrounded by various structures, including the buccinator muscle, muscles of facial expression, and deep cervical fascia. It is also confined to the masticator space in the back. Membranes surround the three lobes of the buccal fat pad. The entire structure is anchored by ligaments that attach to the maxilla, posterior zygoma, temporalis tendon, buccinator membrane, and infraorbital fissure. These ligaments also provide a rich blood supply to the different lobes of the buccal fat pad.
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The buccal fat pad is divided into the anterior, intermediate, and posterior lobes. The anterior lobe is located in the cheek area and is surrounded by the buccinator muscle and muscles of facial expression. It is also near the infraorbital fissure and contains the infraorbital vessels, facial artery, facial nerve branches, parotid duct, and facial vein. The intermediate lobe is a thin, membranous structure that separates the anterior and posterior lobes. It is more prominent in children than adults. The posterior lobe, also known as the body, is the largest and is located in the masticatory space. It has four extensions: the buccal, pterygoid, pterygopalatine, and temporal extensions.
The buccal extension is the most superficial and is the part that is typically removed during buccal fat pad surgery. The pterygopalatine extension is located in the pterygopalatine fossa and surrounds the pterygopalatine vessels. The pterygoid extension is in the pterygoid-mandibular space and houses the mandibular neurovascular bundle, including the lingual nerve. Finally, the temporal extension is located deep in the temporalis muscle and is separate from the superficial temporal fat pad, which has its vascular supply.
What Are the Indications of Cheek Reduction and Enhancement?
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There are several reasons for accessing the buccal fat pad in a clinical setting. One use is to close oroantral communications, openings between the oral cavity and the maxillary sinus that may occur after tooth extraction, dental infections, radiation therapy, osteomyelitis (bone infection), or trauma. The buccal fat pad may also reshape the facial contours and create a more aesthetically pleasing appearance.
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A better case for buccal fat pad removal has prominent cheekbones hidden by full cheeks and a lack of facial angularity.
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Removing the buccal fat pad can reduce cheek fullness and highlight the cheekbones. It is significant to mention that buccal fat pad removal is unsuitable for patients with malar hypoplasia, as it can create a hollow appearance in the cheeks. In these cases, malar augmentation may be a better option.
What Are the Complications of Cheek Reduction and Enhancement?
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Buccal fat pad reduction is generally a safe and straightforward procedure. However, complications can occur in rare cases, with rates ranging from 8.45 to 18 percent. These complications may include injury to the parotid duct, hematoma, trismus, neuromotor deficits, and infection.
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In one case report, a patient developed an accumulation of saliva in the buccal mucosa due to damage to Stensen's duct during the surgery.
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In contrast, in another case, a patient experienced severe facial pain and edema due to bleeding from the sphenopalatine artery, which required angiographic embolization.
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To minimize the risk of complications, it is important for the surgeon to have a thorough understanding of the anatomy of the buccal fat pad and its surrounding structures and to obtain informed consent from the patient.
What Is the Clinical Significance of Cheek Reduction and Enhancement?
The buccal fat pad extraction is a surgical method involving removing excess fat from the cheek area to create a slimmer, more defined facial profile. This procedure is typically done in conjunction with other aesthetic surgery procedures and is not the main focus of the surgery. However, it is often used to reduce fullness in the upper cheeks and enhance the overall aesthetic of the face by creating a more prominent and defined appearance of the cheekbones. The procedure involves the removal of excess fat from the buccal fat pads, which are located in the cheek area, to thin the face and create a more sculpted appearance.
Conclusion:
Effective communication among the surgical team is essential when performing procedures, particularly when dealing with structures like the buccal fat pad. The team must be aware of the presence of the buccal fat pad and take care not to accidentally dislodge it with overly aggressive suctioning in the maxillary vestibule. Clear communication among team members helps to ensure a smooth and successful procedure.
