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.

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?

Richard H. Tholen, MD, FACS · Answer

With due respect to the doctor who suggested "Endoscopic Mid Face Suspension Lift with buccal fat pad suspension," either you misunderstood what is being recommended, or he misspoke. If he didn't, then this is an example of using lots of "medspeak" to sound technical, advanced, and well, AMAZING! (Actually, that should have read "misleading.")

	First of all, if you have loose wrinkled skin in need of a facelift/necklift, an endoscope is not the way to go--you need to have the facial skin cut, lifted from the underlying structures, and the support layers (SMAS--the Superficial MusculoAponeurotic System, which essentially is the facial fascia or "gristle" layer continuous with the temporal fascia and platysma muscle in the neck) tightened so that the jowls and malar fat pads are repositioned to their previous youthful position, the excess skin excised, and the remaining loose skin redraped, smoothed (neck and jawline) and tightened--not too much, but just enough to restore youthful appearance without excessive and unnatural tautness. Loose skin removal after redraping and repositioning requires skillfully-placed and hidden incisions so that the excess skin can be removed and the  jowls eliminated.

	That can't be done with an endoscope!

	And if you don't need to have the excess/loose skin removed via incisions (and well-hidden, beautifully-healed scars), then you probably don't need a facelift/necklift, especially to "suspend buccal fat pads!"

	This sounds like a limited-incision midface lift via endoscope without skin excision, but it's not the buccal fat pads that are being suspended (if this is what the doctor really meant, then he's got his anatomy descriptions wrong IMHO), it's the malar fat pads, and the SMAS near the modiolus region of the face to elevate and retighten the jowl area. Either that, or it's just marketing medical gobbledygook. And a potential waste of your time, money, and expectation!

	A properly-performed facelift will "last" for differing periods of time in different individuals, each with unique genetics, collagen, and elastic content, not to mention weight gain, smoking, or sun exposure habits. An exact amount of time is impossible to predict, but a skillfully-performed facelift/necklift should "last" in the range of 6-10 years for most individuals. What is being pitched to you might make subtle improvements (if there are no complications), but they probably won't last more than a year or two (like many Threadlifts, Lifestyle Lifts, QuickLifts, etc.) And I'll bet he's charging over $10,000 for what should be much less!

	I've often wondered if I should call my facelift operation the "Tholen Tissue-Tightening Dual-plane SMAS-securing fat sculpting facial rejuvenating Power Lift." (Darn, I left out "Laser-assisted.") Wouldn't THAT be special?

	I think you are right to feel that what is being suggested is somehow not passing muster. I'd suggest consultation with one or more American Board of Plastic Surgery-certified plastic surgeons in addition to the ENT (facial plastic) surgeons you have spoken to. You should have better information, or at least more complete and anatomically-sound, recommendations. Best wishes! Dr. Tholen

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.

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.

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.

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