Document Type
Article
Publication Title
Aesthetic Surgery Journal
Abstract
Background
Masculinization of the face is a common finding in facelift patients. It is attributed to deflation and decent of the midface-jowls coupled with skin laxity. Fullness is evident lateral to the jowl in a small percentage due to prominent buccal fat pad (BFP).
Objectives
The authors sought to examine the anatomy of the BFP, triangulate the prominent BFP with surgical landmarks, and describe an external approach to excise the BFP during facelift surgery.
Methods
Eighteen cadaveric dissections were performed. Facelift flap was elevated and the prominent buccal extension of the BFP protruding through the superficial-musculo-aponeurotic-system was identified. Measurements were taken from the BFP to surgical landmarks: zygomatic arch, tragus, and gonial angle. The locations of the facial nerve, parotid duct, and vascular pedicle relative to the BFP were calculated.
Results
BFP was 4.1 cm inferior to the zygomatic arch, 7.5 cm anterior the tragus, and 4.5 cm medial the gonial angle. The middle facial artery supplied the BFP on the inferior-lateral quadrant in 61% and inferior-medial quadrant in 39% of specimens . In all specimens, the parotid duct traversed the BFP superiorly, and the buccal branches of the facial nerve traversed the capsule superficially.
Conclusions
The buccal extension of the BFP can pseudoherniate in the aging face. Excision may improve lower facial contour. Measurements from facial landmarks may help surgeons identify the buccal extension of the BFP intraoperatively. The surgeon must be careful of the vascular pedicle, parotid duct, and the facial nerve. The external approach safely excises buccal fat during facelift dissection while avoiding intraoral incisions and unnecessary contamination.
DOI
10.1093/asj/sjaa015
Publication Date
1-22-2020
Keywords
aging, cutis laxa, tissue dissection, face, facial nerve, form perception, face lift, surgical procedures, operative, virilism, fat pad, parotid gland, zygomatic arch, facial arteries, tragus, excision, pedicle, levels of evidence, midface region
ISSN
1527-330X
Recommended Citation
Surek CC, Kochuba AL, Said SA, Cho K, Swanson M, Duraes E, McBride J, Drake RL, Zins JE. External Approach to Buccal Fat Excision in Facelift: Anatomy and Technique. Aesthetic Surgery Journal. 2020; 41(5). doi: 10.1093/asj/sjaa015.
