Buccal Fat Pad Suspension?

Question

I am considering a face/neck lift. I have had 2 consultations w/ board cert. facial plastic surgeons. The consultations were very different. One recommended Endoscopic Mid Face Suspension Lift with buccal fat pad suspension as I am starting to get jowls. My question is this: Will repositioning and suspending the fat pads that have gravitated to my jowls only be a temporary solution? Will this suspension then begin the aging process and over time the fat pads fall into my jowl area again?

Christopher Kolstad, MD · Answer

Hello,

Generally speaking the primary goal of a midface lift is to improve the tear trough, nasolabial fold and descent of cheek fat.  Endoscopic midface lift procedures frequently require lower blepharoplasty as well as endoscopic brow lifts to be performed at the same time.  These procedures are ideally designed to treat the upper 2/3s of the face.  This surgery may have some impact on the jowls, but it will be minimal.

If your concern is jowl descent, loss of neckline or submental skin and fat accumulation, a lower facelift if without a doubt the best treatment for this area.

Hope this helps.

Kenneth Hughes, MD · Answer

The buccal fat pad is a distinctive anatomic fat compartment located superior to the area involved in jowling. A face and neck lift is necessary to anchor the underlying SMAS and remove loose skin to improve true jowling.

William Portuese, MD · Answer

Gravity and the aging process will begin taking effect after this procedure has been performed. We suspend the buccal fat pad at the time of the facelift surgery to raise the jowls. If the patient has a flat maxilla or cheek area, then consideration for cheek implants should be made as it is a permanent which is a permanent solution to flat cheeks. This can also be performed at the time of the surgery.

Thomas Fiala, MD, FACS, FRCSC · Answer

Buccal fat doesn't cause jowling.  It causes fullness in the area of the buccal fat.

	Correction of jowling is usually done with a facelift, particularly one using the SMAS layer, not a buccal fat pad operation.

	Midface lifts are really for a totally different purpose, which is to improve the lower eyelid-cheek junction, nasolabial fold and tear trough.  Now that fat grafting to the face is here, I think this works much better, and has fewer complications than the midface lift. 

	Could you post some photos so we could see what your situation looks like?

Toby Mayer, MD · Answer

The jowl fat pad is different. Once the fat pad is elevated to fill in above it as when u were young it will stay there if done by a good surgeon. However, the aging clock starts again but you will always look younger than someone who has never had surgery.

Kevin M. Robertson, MD, FACS · Answer

I think there is some confusion about fat pads and facelifting.  The malar fat pad is normally what we discuss with facelifts, since it tends to settle from higher on the cheek during aging. So repositioning the malar fat pad is key to most effective facelifts or midface lifts, since it creates that youthful fullness high in a face.  The malar fat pad has nothing to do with the jawline however.  And more specifically, a midface lift does nothing for jowls.  Midface lifts lift the cheek, soften the transition from the lower eyelid to the cheek, and improve the groove from the nose to the corner of the mouth (nasolabial groove).

	Buccal fat provides fullness to the midportion of the cheek, about level with the corner of the mouth.  (think of the area that you can dent in by sucking in your cheeks)  Again, separate from jowls.  And truthfully an area that is rarely directly manipulated with either a facelift, or a midfacelift

	As Dr Madnani points out, addressing the jowls needs repositioning of the platysma and SMAS layers, not buccal fat.

	So either there is confusion between you and your potential surgeon, or you need more consultation time.

Dilip D. Madnani, MD, FACS · Answer

The buccal fat pad will unlikely address the jowls definitively. Elevating the SMAS layer is the primary procedure to achieve improvement in the jowls. Everything else is secondary and in addition to addressing the SMAS layer. Hope this helps.

Adam David Lowenstein, MD, FACS · Answer

Treatment of the jowl area during a face lift is a function of suspending the lower facial fat and sometimes resecting some of the lower facial fat.  This suspension is done with a SMAS lift.  The buccal fat is deep and superior to the fat that forms the jowl, and so a "buccal fat suspension" is unrelated to jowl improvement.  

	With a definitive SMAS face lift and addressing the jowl with some fat resection, you should expect significant improvement.  This will be a kind of reset of your aging process, but the aging process and gravity will continue to take their tolls- eventually things will begin to drop again, though you will certainly look much better even at that time having had the surgery compared to if you don't.

Barry L. Eppley, MD, DMD · Answer

The major procedure that you need and the one that will have the longest lasting benefit is that of teh facelift which is the best management for neck and jowl aging concerns. As a companion procedure to a facelift, which does little for cheek and midface sagging, are a variety of cheek or midface lifts. They are done different ways and an endoscopic approach is one approach to them. When it comes repositioning a fat pad it is the malar fat pad not the buccal fat pad that is lifted/repositioned in a midface lift. But that anatomic issue aside, this midface lift is not for the jowls but for the cheeks. Only a facelift affects the jowl area with a duration of 7 to 10 years for most patients.

Michael R. Menachof, MD · Answer

Huh? I had to read your question 3 times to make sure I understood what you were asking, and I still am confused. Let me try and put it in perspective. The answer you got to your question was similar to someone suggesting that you put on your coat when you tell them that you are hungry. An endoscopic midface lift with buccal fat pad suspension is not a solution for jowls (just like putting on a coat will do nothing to curb your hunger). As a general rule, jowls are treated with some kind of a facelift. Given that you said you got 2 very different opinions from the 2 surgeons you saw, I would assume that the other surgeon did recommend some kind of a facelift. My suggestion would be to consider that surgeon's opinion and seek out 1 or 2 more. It is very likely that the other consultations will talk to you about a facelift as well. The most important lesson in all of this? Seek multiple opinions before you make a decision. In doing so, you will find out whose opinion falls within the standard of care and who is the outlier. Good luck.

Buccal Fat Pad Suspension?

Answers (13)

More Facelift Questions

Can Swelling Ater a Facelift Stretch the Skin Back Out?

Swelling After Facelift and SMAS Lip Augmention? (photo)

Should I be concerned about hardness after my facelift?

Saggy Cheeks and Nose?

5 Months After Facelift I Need a Muscle Relaxer I Can Take During the Day. Any Suggestions?

Hardness on Sides of Face and Neck 10 Days After Facelift?

WE SEND PRETTY
EMAILS