Is a face lift required for thick skin patients after buccal fat removal?

I see patients complaining about droopy baggy skin after buccal fat removal. What can be done for them? How can the need for face lifts, fillers, fat grafts & other issues of "bagginess"/concavity be avoided in the first place? #buccal fat removal #side effects #baggy skin #droopy skin

Doctor Answers 9

Is a face lift required for thick skin patients after buccal fat removal?

Not necessarily.  Buccal fat removal is a specific procedure to address excess fat that causes an unwanted bulge in the lower face. Often it is seen and diagnosed after a face lift where once the skin and soft tissue is lifted there remains an area of excess volume in the cheek.  If the buccal fat excess is diagnosed prior to a face lift and removal is performed and there is not a significant amount of skin excess or laxity then a face lift is not necessary.

Buccal Lipectomies

Buccal lipectomies rarely cause such a dramatic loss of facial support that skin tightening is needed. I have performed many buccal lipectomies and have never seen the need for secondary skin tightening procedures.

Buccal fat pad and facelifts

Buccal fat pad removal is often done for patients that see a bulge in their lower cheek or complain of fullness in that area.  A facelift is not always necessary.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 24 reviews

Face lift and buccal fat removal

Thank you for asking about your face lift.
  • Buccal fat removal is done to reduce excess facial fat.
  • The goal is to reduce fullness of the central cheeks and a slight concavity.
  • If too much fat is removed or if, in time, the face needs more fat, then fillers, fat grafts, facial implants and/or a face lift may be needed.
Always see a Board Certified Plastic Surgeon. Best wishes  - Elizabeth Morgan MD PHD FACS

Facial surgery

Hello and thank you for your question. In order to accurately answer your question, an in-person consultation would be very helpful.   The most important aspect is to find a surgeon you are comfortable with. I recommend that you seek consultation with a qualified board-certified plastic surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Richard G. Reish, MD
New York Plastic Surgeon
5.0 out of 5 stars 79 reviews

Is a face lift required for thick skin patients after buccal fat removal?

 Hi, I have performed facelifts for over 30 years and have performed many minimally, invasive type facelifts.  Non smiling photos of your face from the front and side would help with the evaluation. Following the beauty principles outlined in my book on face and body beauty, women look the most feminine, youthful and attractive with heart shaped faces.  Heart shaped faces have cheeks that are full and round in the front.  Cheek augmentation with a dermal filler or using cheek implants for a permanent enhancement will create full, round cheeks that will feminize the entire face.  Conversely, men look chiseled and handsome with angularity in the cheeks, chin and mandibular angles.  

If the chin is weak, this creates an imbalance making the nose appear larger, the mid face top heavy and the lower face look short that de-emphasizes the lips and allows early formation of a double chin.  Chin augmentation using a chin implant will add projection to the chin creating harmony and balance to the lower face.   I have found that placement of a silastic chin implant, through a small curved incision under the chin (also allows excess skin removal) to be very safe, quick and highly effective.

 If you have "jowls” these are sagging facial tissues and an indication for some form of a SMAS facelift.  The underlying SMAS layer, of the face, must be dissected, lifted, trimmed and re-sutured (not merely folded or suspended with threads or sutures that will not last).  The excess skin is then removed and the facelift incisions closed.

My most popular facelift is the minimally invasive, short incision facelift that has all the benefits of more invasive facelifts (traditional, mid-face, deep plane, cheek lift and subperiosteal facelifts) but with these added benefits:
  • very small incisions
  • minimal tissue dissection = less bruising and swelling = rapid recovery ( several days instead of weeks or months with the more invasive type facelifts mentioned)
  • can be performed in 90 minutes or less, with or without general anesthesia
  • no incisions within the hair = no hair loss
  • excess fat can be removed
  • excess skin removed
  • cheeks, chin and jaw line can be augmented with dermal fillers (I prefer Restylane Lyft) or facial implants
  • most patients fly back home to parts all over the world in as little as 3 days post-op
I combine facial shaping with every facelift procedure.  When jowls are present, these should be done in concert and not alone or separately in order to create a naturally, more attractive face. Prevention of facial sagging which leads to the creation of jowls is best accomplished by limited sun exposure, weight control and a reasonable skin care regimen.  In addition, creating properly shaped cheeks when the patient is in their early twenties, if the cheeks are flat or concave, will help support facial tissues against the pull of gravity as the patient ages.  Buccal fat removal, in my opinion, is detrimental as it removes fat from within the structure of the facial tissues below the cheeks leading to hollowing of the face without having "any" impact on increasing cheek volume or an improved cheek shape.

Hope this helps.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.6 out of 5 stars 24 reviews

Over Resected Buccal Fat Pad

The amount of buccal fat removal should be determined on the amount of adipose tissue present in this area in relationship to skeletal and muscular development of the individual. The simplest technique is restoration of the over resected buccal fat pad with micro-fat graft. Facelift is not the solution to over resected buccal fat pad.

Mehdi Balakhani, MD, FACS
Newark Plastic Surgeon
5.0 out of 5 stars 1 review

Buccal Fat Excision and a Facelift

Buccal fat pad should only be performed on patients with full chubby cheeks.  In these patients, removal of the buccal fat pad will result in more angulation and definition in the cheek area.  There will not be excess or hanging skin.If buccal fat is removed on thinner patients, it can create a hallow appearance.  This can contribute to the appearance of loose skin.  Likely, these patients should not of had the procedure.  Patients that are good candidates for buccal fat removal should not require a facelift. 
I hope this helps.  

Is a face lift required for thick skin patients after buccal fat removal?

Typically a facelift is not required after buccal fat pad removal.  However if there is significant skin laxity or looseness removing significant buccal fat could result in sagging of the lower face and require a facelift.

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.