Blog

This is Dr. Nakao from Nakao Plastic Surgery.

Today, I would like to talk about Buccal Fat Removal.

Some patients request removal of this fat because they are concerned about the heaviness of their cheeks. 

During facelift surgery, if the buccal fat is significantly large, we often choose to remove it.

However, in many cases, instead of removing it, we lift the buccal fat towards the zygomatic (cheekbone) area during a Deep Plane Facelift. This helps to prevent the face from appearing too wide and also avoids interference with the facelift procedure.

This approach follows the Turkish surgeon Dr. Bitik.(Bitik’s method)

Facelift surgery primarily targets the SMAS layer and since the tissues beneath it contain important facial nerves, the buccal fat—which lies below the SMAS—is an excellent tissue with mobility that works underneath the SMAS.

 

This time, we performed a simple Buccal Fat Removal via the intraoral approach.

The procedure was done to correct facial asymmetry between the cheeks.

Since Western and Japanese patients have different aesthetic preferences, we conducted thorough careful preoperative counseling.

This method is more commonly suited to Western patients, who tend to be less concerned about hollow cheeks.

 

The removal of buccal fat pad involves different approaches between a facelift surgery and a simple excision.

In a facelift surgery, the main concern is avoiding injury to the facial nerves, whereas in simple excision, care must be taken to avoid the parotid duct.

During a simple excision, the incision is made inside the mouth, for surgeons trained in Plastic Surgery, who are familiar with oral incisions from facial bone fracture surgeries, this approach is quite familiar.

When the dissection plane separates from the bone, the buccal fat pad becomes visible, making it one of the more recognizable fat pads.

 

In patients who lose weight rapidly, the buccal fat pad—originally well-developed—can suddenly become prominent.

However, since buccal fat lies deeper than subcutaneous fat, it is generally difficult to reduce with facial liposuction.

In my experience performing numerous facelift surgeries, I have seen many cases where the buccal fat was damaged after liposuction.

When buccal fat is injured from the skin side, it indicates that nearby nerves may also be at risk.

In such cases, carefully removing the buccal fat via the intraoral route is the safest and most effective approach.

 

At Nakao Plastic Surgery, we perform many facial surgeries, particularly for sagging-related concerns.

We are committed to pursuing excellence every day, striving to provide the best treatment options tailored to each patient's needs and suitability.