Revision for Asymmetry After Buccal Fat Removal?

Question

I had buccal fat removal a year ago. Unfortunately, my cheeks are now asymmetrical. One side is thinner than the other. Will subsequent aging even it out or do you recommend I do a revision to excise out the buccal fat pads on the fatter cheek?

Vincent N. Zubowicz, MD · Answer

A revision for buccal fat removal is fairlly easy.  It can be performed under local anesthesia through the mouth.  It takes 15 to 30 minutes.  You don't need to wait for old age to even things out.

John Mesa, MD · Answer

Asymmetry post buccal fat removal could potentially be corrected with re-do / revision buccal fat removal IF and ONLY IF the cause of the asymmetry is the buccal fat pads. IF the cause of the asymmetry is other than the buccal fat pads, then other plastic surgery procedures might need to be done to correct the asymmetry.

Ali Sajjadian, MD, FACS · Answer

Hi Chickabiddy,

	 

	A period of one year post-surgery without complications should be enough to shape your end results and the asymmetry will not be corrected through the natural course (aging).

	The causes of the asymmetry are hard to determine without a photograph and a consultation.

	Nonetheless, facial revisions are of a delicate nature. Therefore, an extensively experienced surgeon is the best choice especially that the revision is to be performed conservatively and with the optimal accuracy.

	 

	Thank you for your question.

	Best of luck to you.

	Dr. Sajjadian

Brent Moelleken, MD · Answer

Removal of the buccal fat pad is an excellent procedure in the right patient.  It reduces excessive fullness on the lower face.  Its effect on patients with "chipmunk cheeks" can be profound.  It can enhance the cheeks without placing any implants in the right patient, unmasking hidden beauty.
There are many reasons for asymmetry.  It can be natural in the patient's face, or it can be a result of surgery.  Your best bet is to obtain a second consultation, complete with the operative note of your first procedure, from a surgeon with considerable experience with revisional facial surgery.

Otto Joseph Placik, MD · Answer

I am a little confused. Did you have only one buccal fat removed? If so, then, yes I would consider returning to have the other buccal fat pad removed.

Karan Chopra, MD · Answer

The best solution will require evaluation of your images. Likely you will need fat injections to the overly removed side and mild removal from the larger side. It can be fixed easily so I would not stress out if I were you. Just make sure you see an expert. Goodluck, Dr. Chopra

Raj S. Ambay, MD · Answer

Buccal fat pad reduction is a procedure that is not commonly performed but can make sense in the right patient. It is important to understand the anatomy before undergoing the surgery so that you are well informed. Normal aging reduces the buccal fat pad volume. It is true that some people have more volume in their cheeks than others. However, it is also universally true that that volume will decrease and descend over time. Removing too much buccal fat can cause premature aging. It is also important to remember that replacing fat that has been removed is extraordinarily difficult if not impossible. The main reason is the location of the buccal fat pad. It usually resides underneath a large muscle that is responsible for majority of the power motions of your chewing. Once that fat is removed that space collapses. Once collapsed it is very difficult to find the exact space and to reinsert a substance such as a filler or better yet fat. One potential solution is to use something like Sculptra. While I generally do not advocate buccal fat pad removal, I understand why somewhat would want procedures such as this. I tried to choose my patients very carefully and I also tried to be conservative in the amount of fat that is removed. Surgeons who trivialized this procedure simply don’t understand how difficult it is to correct deformities that may occur. The cost of the procedure can run anywhere from $3000-$7000, depending upon your geographic locale. Please visit with an experienced board certified plastic surgeon. My best advice is to always be conservative with any buccal fat pad reduction.

Steven Wallach, MD · Answer

Buccal fat pad excision is really limited to those patients with "chipmunk cheeks." I think it is done too frequently in patients. I can give a nice tapered facial appearance but can also lead to a premature aged look in the older patient.

Peter A. Aldea, MD · Answer

Removal of the Buccal (Bichat's) Fat pad is only a good procedure in the right person. Unfortunately, it is done too frequently. The removal of a portion of the fat pad turns can change a moon face to a more attractive tapered face. But, since we all lose fat in our faces with age, removing it in everyone soon results in thin, aged, skeletonized faces way too early.
In your case, I would suggest some of the fat pad be removed from the fatter cheek. (Although, to be honest I am not sure why it was not done at the time of the original surgery. Normally, when we remove fat from the eyelids etc, we always compare the amount taken from both sides to assure symmetry).
Good Luck.
Peter A Aldea, MD

Revision for Asymmetry After Buccal Fat Removal?

Answers (9)

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