Crooked Smile After Bichat Pad Removal, Is It Permanent Damage? (photo)

I did a removal of the bichat pads 8 months ago. Even after all this time, my smile is crooked. Greatly reduced the fat of the face, but the right side of my smile does not raise (upper lip). After the surgery, this side of my face was incredibly more swollen than the left. I fear that the surgery has caused permanent damage. What can it be?

Doctor Answers 5

Nerve injury after buccal fat pad removal.

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Nerve injury is likely in your situation.  However, it's prominency can only be determined over time.  I recommend waiting at least 12 months to make a final determination.  Please go back and visit with your plastic surgeon.

Facial Nerve Insult post buccal fat pad excision

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Hello Lelele,


Thank you for sharing your photographs that show clearly an injury to right buccal branch of your facial nerve.


During the surgery, the buccal nervous branch is spotted and carefully protected to prohibit any facial paresis from taking place. In your case, the buccal branch has been insulted.


Recovery could happen as far as the insult is not severe and the growth of the branches is motivated and not delayed.

I encourage you to keep your surgeon in the loop and to seek a well experienced surgeon for consultation as well.


Aesthetically, relaxing the buccal muscle on the left side could help and it is achieved by Botox injections until the recovery on the right side takes place.


Best of Luck to you.

Dr. Sajjadian

Ali Sajjadian, MD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 205 reviews

Asymmetric smile

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You do have weakness of the right buccal branch of your facial nerve.  Hopefully this will continue to improve with time.  In the short term use of Botox to relax the opposite (left) side can help make your smile more symmetric

Sam Naficy, MD, FACS
Seattle Facial Plastic Surgeon
4.7 out of 5 stars 231 reviews

You have had a facial nerve injury

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The facial nerve branches are in close association with the buccal fat pad and it appears that you have had an injury there.  Fortunately, there are multiple branches of the nerve in that region and they may still recover but at 8 months it is possible they won't.  B complex vitamines and massage may help and visiting a plastic surgeon at an academic medical center who does nerve work would be useful.

Facial Nerve Paresis 8 Months After Buccal Fat Pat Removal

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Unfortunately, this pictures shows what appears to be a right buccal branch paresis (weakness) after buccal fat pad removal.  This is a rare, albeit real complication associated with the procedure.  At 8 months, there is still some chance this branch(es) of the  facial nerve will recover.  I would recommend close follow up with your Surgeon and possibly a consultation with a Facial Plastic Surgeon in a local academic center who has an interest in facial nerve recovery/ reanimation.

Stephen Prendiville, MD
Fort Myers Facial Plastic Surgeon
4.9 out of 5 stars 104 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.