Buccal Fat Removal

There is a great deal of confusion among patients between buccal fat and jowl fat and their appropriate treatment, likely due to the complex shape of facial fat compartments. This blog post seeks to reduce that confusion. It is important to seek not only a fellowship-trained but also a double board-certified facial plastic surgeon if you have aesthetic concerns about your face and/or neck. A consultation is essential to evaluate whether your concerns are related to your buccal fat, jowl fat, or both. A comprehensive, specific plan may then be developed to best address your concerns safely and effectively. There are Superficial (e.g., Jowl) and Deep (e.g., Buccal) Fat Compartments in the Face The face contains multiple compartmentalized fat pads that extend across the cheek as well as along the jawline. The fat pads along the jawline, like those in the cheek, droop with age, falling over the jawline. This results in jowling as well as the formation of marionette lines. There is little research evaluating the changes in size of the fat pads that form the jowls with age. This may be because studies of the volume of an area whose shape changes as it falls is difficult. It may also be difficult to account for other changes, such as weight gain or loss, over long periods of time when designing a study. However, plastic surgeons frequently observe that individuals experience enlargement of their jowl fat pads with age. I have found only one recent study – the only evaluating volume changes in the lower face with age – that supports what is widely seen clinically (1). This study identified thickening of the jowls with age. However, it should be cautioned that this study was limited by the fact that it simply compared a total of sixty women split into three age groups and did not follow them as they aged. However, it did account for things like body mass index (BMI) in each patient, thereby reducing the influence that overall weight has on the results. More and better-quality research is required to evaluate and characterize the changes that occur in the size and shape of jowl fat with age. In contrast, the buccal fat is located deep in the face, much deeper than the jowls. It also sits superior to the superficial jowl fat. Buccal fat winds through deep structures in the cheeks in a complex shape, surrounding important structures such as blood vessels, a salivary gland duct, and branches of the facial nerve. The research is mixed as to whether buccal fat increases in size, decreases in size, or remains the same size as we age. Many surgeons feel the buccal fat remains approximately the same size with age or even enlarges. More research is required, however. This is why only a portion of buccal fat is removed with buccal fat removal surgery. This is also why buccal fat is removed in individuals who do not anticipate significant weight loss, though long-term weight loss is difficult to predict. Treatment of Large Buccal Fat Pads Differs from the Treatment of Enlarged Jowl Fat Treatment of enlarged jowl fat differs from the treatment of enlarged buccal fat. The aesthetic goals of treating each area differ as well. Jowl fat sits closer to the skin and lower in the face compared with buccal fat. And unlike buccal fat, jowl fat falls over the jawline and forward towards the chin. The overall effect is that of making the jawline appear shorter and the face more bottom heavy. The best approach to treat the effects of falling jowl fat is through a facelift, specifically deep plane facelift surgery. Decreasing the size of jowl fat is more challenging in that the most appropriate treatment is not appropriate for most individuals. The size of jowl fat is commonly reduced using micro-liposuction, which is liposuction using a very small suction device. The jowl fat pad is small relative to fat removed using liposuction in other areas of the body, including the abdomen and thighs. As a result, the risk of "bumps" and other contour abnormalities is much greater with liposuction in this location. Therefore, only a small percentage of individuals who have very large jowl fat pads may see benefit from micro-liposuction when weighed against the risks. The more appropriate goal of treating the jowl fat is simply to bring it up closer to where it was when the patient was younger. In contrast, buccal fat pad removal targets an area between the cheeks and jawline in the center of the cheek in individuals with very round, "cherubic" cheeks. The aesthetic goal of buccal fat pad reduction is to reduce the volume of the area between the superficial cheek fat and superficial jowl fat to make this area slightly more concave. This differs greatly from the aesthetic goal of reducing the volume of the jowl fat pad. As always, a consultation is required to determine whether an individual is a good candidate for buccal fat removal. However, there is significantly less risk of contour abnormalities with buccal fat removal when compared with micro-liposuction of the superficial jowl fat pad. Trust Your Face to a Facial Plastic Surgeon It is important to seek a fellowship-trained specialist in plastic surgery of the face and neck when you have concerns about your face or neck. Why Choose Dr. Harmon The mission of Harmon Facial Plastic Surgery is to help people along their journey towards self-confidence, to feel good about feeling good. Dr. Harmon is a double board-certified facial plastic surgeon Dr. Harmon values making patients feel welcomed, listened to, and respected. Dr. Harmon graduated with honors from Cornell University with a Bachelor of Science degree in molecular biology. Dr. Harmon earned his medical degree from the University of Cincinnati. Dr. Harmon underwent five years of extensive training in head at neck surgery at the prestigious residency program at the University of Cincinnati. Dr. Harmon then underwent focused fellowship training in cosmetic facial plastic surgery through the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) with the world-renowned surgeon, Dr. Andrew Jacono, on Park Avenue in New York City. Request a Consultation Request a consultation with Dr. Harmon at Harmon Facial Plastic Surgery in Cincinnati. Visit our clinic. You will learn more about Dr. Harmon's credentials, style, and approach. Build a relationship with our dedicated team. Do not stop searching "plastic surgery near me." Get in touch with us to learn more. Contact Us References Guo Y, Wen L, Wang X, Zou H, Liang W, Wang J, Zhu X. Analysis of age-related changes in lower facial fat compartments and of the course of blood vessels using computed tomography. Plast Reconstr Surg. 2023 Apr 4.

Many patients can undergo more than one facial plastic surgery procedure in one surgical session. However, whether a patient can undergo more than one procedure in a single session depends on multiple factors. A detailed discussion with your surgeon is required to determine whether one or more procedures is indicated. A surgical and anesthesia plan is then developed that is safe and as effective as possible. This plan may involve one or more procedures. It is important to seek not only a fellowship-trained but also a double board-certified facial plastic surgeon if you have aesthetic concerns about your face and/or neck. The Level of Sedation Required to Perform the Procedure is a Factor Some procedures, such as the extended deep plane facelift, neck lift, lateral temporal brow lift, lower blepharoplasty, and nose surgery (rhinoplasty) usually require some level of sedation, whether it is oral sedation, IV sedation, or anesthesia with the use of a breathing tube (see previous blog post). Sedation allows patients to sleep during longer, more involved procedures that otherwise could be uncomfortable. Patients often prefer to add other, shorter procedures during a single surgical session involving sedation to have one recovery period. This is a major convenience, because it not only limits the total number of days patients need to recover, but it also allows patients to achieve a more complete aesthetic result earlier. The Length of Time Required to Perform Each Procedure is a Factor Other patients prefer to separate multiple procedures. This may involve undergoing the longer procedures first, followed by the shorter procedures later. This also may be reversed. For example, a patient may elect to undergo upper eyelid surgery (blepharoplasty), a lip lift, buccal fat removal, and/or neck liposuction under local anesthesia prior to or after an extended deep plane facelift and neck lift. One benefit of this is that patients are sedated for less total time, which is preferable to some patients. The Medical History is an Important Factor Many patients are very healthy and tolerate longer operative times. Other patients have medical conditions with which shorter operative times would be best. This should be discussed in consultation with your surgeon and your surgeon with their anesthesia provider. It Can be Beneficial to Perform Some Procedures Together It is common to perform a lateral temporal brow lift and/or a lip lift with the extended deep plane facelift and neck lift. There are multiple benefits to adding these procedures. First, each addresses signs of aging that the extended deep plane facelift and neck lift do not address. Second, the lateral temporal brow lift allows a shorter facelift incision. Some Procedures Cannot be Performed Together Some procedures may require a stepwise approach; that is, it may be better to allow one procedure to heal prior to proceeding with the next. For example, it may be necessary to undergo a rhinoplasty and a lip lift separately because the surgical incisions are so close. The Surgeon and Anesthesiologist Develop a Plan A final surgical plan and a final anesthesia plan that reflect the considerations above are developed in conversation between the surgeon and anesthesiologist if sedation is required. Trust Your Face to a Facial Plastic Surgeon It is important to seek a fellowship-trained specialist in plastic surgery of the face and neck when you have concerns about your face or neck. Why Choose Dr. Harmon The mission of Harmon Facial Plastic Surgery is to help people along their journey towards self-confidence, to feel good about feeling good. Dr. Harmon is a double board-certified facial plastic surgeon Dr. Harmon values making patients feel welcomed, listened to, and respected. Dr. Harmon graduated with honors from Cornell University with a Bachelor of Science degree in molecular biology. Dr. Harmon earned his medical degree from the University of Cincinnati. Dr. Harmon underwent five years of extensive training in head at neck surgery at the prestigious residency program at the University of Cincinnati. Dr. Harmon then underwent focused fellowship training in cosmetic facial plastic surgery through the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) with the world-renowned surgeon, Dr. Andrew Jacono, on Park Avenue in New York City. Request a Consultation Request a consultation with Dr. Harmon at Harmon Facial Plastic Surgery in Cincinnati. Visit our clinic. You will learn more about Dr. Harmon's credentials, style, and approach. Build a relationship with our dedicated team. Do not stop at searching "plastic surgery near me." Get in touch with us to learn more! CONTACT US

The purpose of anesthesia is to reduce the discomfort associated with surgery and to keep the patient safe while allowing the surgeon to complete the operation. The types and depth of anesthesia patients can undergo fall on a spectrum. As a facial plastic surgeon, I am not an authority on anesthesiology. However, I work closely with anesthesiologists in the operating room. I have cared for patients who have received each of the below types of anesthesia. The descriptions below are simply basic summaries to better educate patients. It is important to seek not only a fellowship-trained but also a double board-certified facial plastic surgeon if you have aesthetic concerns about your face and/or neck. Local Anesthesia Almost all procedures, regardless of the other anesthesia agents given (see below), involve the use of local anesthesia. The purpose of local anesthesia is to reduce or eliminate the local pain associated with the procedure itself. There are two families of anesthesia agents with multiple medication within these families. Some are shorter acting (e.g., one to two hours) and others are longer acting (e.g., six to eight hours). Short acting and long-acting agents are often mixed to provide the ideal time frame and depth of anesthesia. Other medications are also sometimes added to the mixture. Epinephrine is frequently added to the local anesthesia mixture. This medication can reduce the amount of bleeding during surgery by constricting the blood vessels in the area injected. Epinephrine also increases the effectiveness of the local anesthesia and can increase the safe amount of local anesthesia which is allowed to be injected. Sodium bicarbonate, which can reduce the pain associated with the initial injection, is sometimes added to local anesthesia as well. Local anesthesia can numb an area in two ways. First, the anesthesia can numb the area injected. Second, anesthesia injected around a larger nerve that supplies sensation to an entire region of the body can numb that entire region, despite no actual medication reaching the periphery of the area numbed. It is important to note that local anesthesia not only affects nerves that control sensation but also nerves that control movement. As a result, local anesthesia can cause temporary weakness in the muscle(s) in the area(s) injected. Oral Sedation Some patients prefer and could benefit from oral sedation in addition to local anesthesia. These patients may be undergoing procedures such as hair restoration surgery, upper eyelid surgery (blepharoplasty), lip lift, and/or buccal fat removal. These patients may not require being completely asleep but would prefer something to relax. The typical medication given is a benzodiazepine such as Valium. These patients have their vital signs monitored during the entirety of the procedure. It is important to note that any patient who receives oral anesthesia such as a benzodiazepine needs a caregiver for 12 – 24 hours after surgery. These patients cannot drive themselves home after surgery because of the oral medication. Intravenous (IV) Sedation The term "IV Sedation" simply refers to anesthesia in which the patient is given one or more medications to reduce their level of consciousness to make the surgical procedure comfortable for the patient and to allow the surgeon the ability to operate more comfortably. The term also refers to the fact that the patient is breathing on their own and, therefore, does not require a breathing tube (intubation). There is a wide range in the depth of sedation patients can undergo. Some patients undergo very light sedation where they are awake and able to speak comfortably. Others undergo sedation where they are sleepier. There are many different medications that can be administered intravenously to achieve this sedation. This sedation is performed by a board-certified and licensed anesthesiologist. The anesthesiologist is the expert in administering this anesthesia as well as monitoring of the patient. Intubation Some patients benefit from deeper sedation requiring a breathing tube (intubation). The breathing tube protects the airway and is used with an anesthesia machine, which breathes for the patient. There are two techniques for administering this type of anesthesia. The first technique uses medications administered only intravenously (IV). The second technique uses anesthesia gases that the patient breathes through the breathing tube in addition to medications administered IV. The Most Appropriate Technique Depends on the Patient, the Procedure, the Surgeon, and the Anesthesiologist The anesthesia plan is developed in consultation between the surgeon and the anesthesiologist. It is dependent on multiple factors, including the surgical procedure, the estimated time of anesthesia, and the medical history of the patient. We at Harmon Facial Plastic Surgery have a Quad A accredited surgery suite at our office where we perform many of our procedures. We utilize the expertise of board-certified, licensed, anesthesia physicians for our procedures requiring IV sedation at Harmon Facial Plastic Surgery. Trust Your Face to a Facial Plastic Surgeon It is important to seek a fellowship-trained specialist in plastic surgery of the face and neck when you have concerns about your face or neck. Why Choose Dr. Harmon The mission of Harmon Facial Plastic Surgery is to help people along their journey towards self-confidence, to feel good about feeling good. Dr. Harmon is a double board-certified facial plastic surgeon Dr. Harmon values making patients feel welcomed, listened to, and respected. Dr. Harmon graduated with honors from Cornell University with a Bachelor of Science degree in molecular biology. Dr. Harmon earned his medical degree from the University of Cincinnati. Dr. Harmon underwent five years of extensive training in head at neck surgery at the prestigious residency program at the University of Cincinnati. Dr. Harmon then underwent focused fellowship training in cosmetic facial plastic surgery through the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) with the world-renowned surgeon, Dr. Andrew Jacono, on Park Avenue in New York City. Request a Consultation Request a consultation with Dr. Harmon at Harmon Facial Plastic Surgery in Cincinnati. Visit our clinic. You will learn more about Dr. Harmon's credentials, style, and approach. Build a relationship with our dedicated team. Do not stop at searching "plastic surgery near me." Get in touch with us to learn more! Contact Us